
For employees who do not participate in a District medical plan, the District provides a Hospital
Indemnity Benefit. The purpose of the Hospital Indemnity Plan is two-fold.....
- To provide a daily hospital benefit in the event you have an illness or
injury that requires
hospital confinement, AND - To provide a $15,000 term life insurance benefit.
The
primary purpose of the Hospital Indemnity Plan is to provide a benefit for eligible
employees
who for whatever reason have no health insurance, or for eligible employees
who have their
health insurance provided by another source.
The Hospital Indemnity Benefit will pay a $250 daily benefit fo an inpatient
hospital confinement
where charges are made by the hospital for room and board. The Hospital
Indemnity Benefit is
supplemental plan and benefit is paid directly to the employee.
The benefit can be used to pay expenses associated with the hospital confinement
or other
medical treatment, cover deductibles and coinsurance, or as an income replacement
for lost
wages while recuperating.
The maximum benefit period is thirty (30) days. A new benefit period
will not begin unless it is
separated by fourteen (14) continuous days of non-confinement.
Additionally,
the Hospital Indemnity Benefit will pay a $10, 000 term life insurance benefit
through Met Life Insurance Company to your designated beneficiary in the
event of your death.
Eligibilty
You
are eligible and automatically covered as a District employee if you meet the
following
conditions:
- You are a fulltime regular employee of North East ISD and scheduled to
work at least
32 hours per week on a continuous basis, or
- You are a part-time regular employee of the District and scheduled to work
a minimum
of 20 hours per week, on a continuous basis, and
- You
are not
currently enrolled as a participating member of any health plan offered
by
North East Independent School District.
There
is no monthly contribution due from the employee for this coverage. The District
will
contribute the monthly premium for the coverage to the NEISD Health Trust
Fund.
How
to file a claim
Upon
release from a hospital confinement, you can request a Hospital
Indemnity Plan Request
for Benefits form from the Employee Benefits Office.
Benefits are payable from the first day you are billed for room and board by
the hospital.
Admissions through a hospital emergency room begin when you are admitted as
an inpatient.
Eligible charges for room and board include charges for a private or semiprivate
room, ward,
or an intensive care unit. When you are discharged from the hospital,
request an itemized
statement documenting the room and board charges from the date of admission
to the date
of discharge.
IMPORTANT
INFORMATION: A Request for Benefits form must be completed
and submitted along with the
hospital's
itemized statement to the Employee
Benefits Office within ninety (90) days of the hospital discharge.
All
Request for Benefits forms will have the dates of hospital confinement
verified with the
hospital's business office. The number of days to be paid must be approved
by the Medical
Auditor and Risk Management Director. Once the approval process is completed,
you will
receive your Hospital Indemnity Benefit payment in your paycheck as supplemental
salary.
All Hospital Indemnity Benefit payments are subject to federal income tax and
will be reported
on your W2 as income. Hospital Indemnity Benefits do not qualify for Teacher
Retirement
System (TRS) deposit.
Enrollment
If
you fully meet the eligibility requirements for the Hospital Indemnity Benefit
as outlined
above, your enrollment is automatic.
New employees will receive information about the Hospital Indemnity Benefit
during their
new employee orientation meeting. If you choose not to enroll in one of
the health plans
offered by the District within the first 31 days of employment, the Employee
Benefits office will
file the beneficiary for the $15,000 term life insurance.
As for current employees who were previously enrolled in a NEISD health plan
and later
canceled coverage, your enrollment in the Hospital Indemnity Benefit will become
effective on
the first day of the month following cancellation of the other plan.
Please
refer to your Hospital Indemnity Benefit Handbook for more information about
the plan.