information for the community

HOSPITAL

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
a supplemental plan and the 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.


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. 

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.

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