·        Plan Highlights

·        Plan Descriptions

·        Eligibility

·        Plan Limitations & Exclusions

·        Association Benefits (AUIC)

 

Plan Highlights

 

·         No Medical Questions or Physical Examinations

·         Freedom to Choose any Health Service Provider

·         Assignable Benefits - You give your Insurance Card to the Doctor/Hospital and they may bill insurance company.

·         Pays in Addition to Other Private Insurance

 

Plan Descriptions1

 

Hospital2:

 

First Day Admission2: You will have coverage up to the amount shown in the benefit schedule of the plan You select. 

Hospital (Standard)2: You will have coverage up to the amount shown in the benefit schedule of the plan You select, for standard, board, miscellaneous medical Hospital charges, and general nursing services for each day You are Confined to a hospital due to a covered Injury or Sickness.  This benefit is paid in lieu of a benefit payable for Intensive Care/Cardiac Care Confinement.

 

Intensive Care/Cardiac Care Unit2: You will have coverage up to the amount shown in the benefit schedule of the plan You select, for each day You are Confined to a Hospital in an Intensive Care or Cardiac Care Unit due to a covered Injury or Sickness.  This benefit is paid in lieu of a benefit payable for a standard Hospital room.

 

Maximum Benefit for ALL First Day Admission, Hospital and Intensive Care/Cardiac Care Unit Confinements is 31 days per person per Policy Year.

 

Surgery2:  You will have coverage up to the amount shown in the benefit schedule of the plan You select, for surgery performed while Confined to a Hospital or in an Outpatient Surgery Facility resulting from a covered Injury or Sickness.  Limited to 1 surgery (Inpatient or Outpatient) per person per Policy Year.

 

Anesthesia2: When a covered surgical procedure is performed, You will have coverage up to the amount shown in the benefit schedule of the Plan You select, for anesthesia and its administration during the surgery.  Limited to 1 (Inpatient or Outpatient) per person per Policy Year.

 

Doctor’s Office Visits: You will have coverage up to the amount shown in the benefit schedule of the plan You select, for a Medically Necessary Doctor Visit due to a covered Injury or Sickness, visits will also be for newborn well-care and routine health examinations and immunizations for children aged 5 and under.  Limited to 5 visits per person per Policy Year.

 

Wellness Visits: You will have coverage up to the amount shown in the benefit schedule of the plan You select, for a routine health examination.  Limited to 1 visit per person per Policy Year.

 

Diagnostic Testing:

Basic: You will have coverage up to the amount shown in the benefit schedule of the plan You select, for x-rays, laboratory and other diagnostic tests, ordered or performed by a Doctor that are Medically Necessary due to a covered Injury or Sickness.  Limited to 5 sittings per person per Policy Year.

 

Advanced Studies:  You will have coverage up to the amount shown in the benefit schedule of the plan You select, for Medically Necessary EEG’s, EKG’s, CT Scan’s and MRI’s.

 

Emergency Room: You will have coverage up to the amount shown in the benefit schedule of the plan You select, for Medical treatment received by a Doctor in a Hospital Emergency Room for a Medical Emergency due to a covered Injury or Sickness.  Limited to 1 visit per person per Policy Year.

 

Accident Medical Expense Benefit:  You will have coverage up to the amount shown in the benefit schedule of the plan You select, for an accidental Injury that requires Medically Necessary care. Initial treatment for the Injury must be received within 30-days of the date of the Injury.  Limited to 1 treatment per person per Policy Year and subject to a $100 deductible.

   

Accidental Death & Dismemberment:  You or Your beneficiary will be paid, up to the amount shown in the benefit schedule of the plan You select, for a covered Injury that results in death or dismemberment.  Dismemberment is paid as a percentage of the amount shown in the benefit schedule, please see dismemberment table for specific benefits and limits.

 

New York State Mandated Benefits:  Residents of New York will be provide with extra state mandated benefits.  Click here for a description.

 

THIS IS LIMITED INDEMNITY COVERAGE.  IT IS NOT MAJOR MEDICAL COVERAGE and is not intended to replace other medical coverage.

 

1 There is a 30-day waiting period for Sickness

2 A 12-month Pre-existing Condition Limitation applies to the following benefits:  Hospital, including First Day Admission, Hospital Standard room, Intensive Care/Cardiac Care Unit, Surgery and Anesthesia.

 

·         Please see Exclusions and Limitations

·         Underwritten by United States Fire Insurance Company

 

Table of Contents:

 

·        Eligibility

·        Enrollment Process

·        Rate Increases / Policy Cancellation

·        Effective date of Coverage

·        Survivor Benefit

·        Premium Billings

·        Payment of Claims

·        Evidence of Coverage

·        Pre-Existing Limitation of Coverage

 


Eligibility.  To be eligible for any Core Health Insurance plans you must be a member of The Association of United Internet Consumers (AUIC) and be: 

  • over the age of 18, unless an eligible dependant child;
  • under the age of 65;
  • reside in the United States;

 

Eligible Dependent means:

(1)   Your lawful spouse; and

(2)   Your unmarried child or children who:

(a)   Reside in Your home for more than 6-months a year;

(b)   Chiefly relies on You for support and maintenance; and

(c)   Who is under 19 years of age (the Limiting Age).

 

The Limiting Age will be extended from the child’s 19th  birthday through the child’s 24th  birthday provided they are enrolled in a school as a full time student and attend classes regularly at an accredited college or university.  “Child” includes stepchild, foster child, legally adopted child, a child of adoptive parents pending adoption proceedings, natural child and child you are required to provide coverage for by court order.

 

Individuals may enroll in The Association of United Internet Consumers and Core Health, from this website.  For details of the AUIC you can go to the website at www.auic.org.

 

Enrollment Process.  You may enroll online or via paper application.  The first months payment must be provided in order for coverage to becomes effective.


Rate Increases / Policy Cancellation. No individuals can be singled out for cancellation or rate increase under the policy. The Policyholder (AUIC) has the right to cancel the policy as it pertains to all insured's on any premium due date by providing 31 days written notice. The insurance company has the right to cancel the policy by providing at least 31 days notice to the Policyholder.


Effective Date of Coverage. Coverage becomes effective "next day" (12:01 am) following the date of the completed enrollment form is received or a specified date in the future (can not be more than 60 days in advance), provided that full premium for the coverage has been received. 


Termination for Members/Dependents. A covered member automatically ceases to be insured on the occurrence of any of the following events:

·         he or she requests cancellation via written notice

·         the end of the last period for which all required premium has been paid;

·         the date membership ends;

·         the date he or she reaches age 65;

·         the date the association ceases to offer the plan;

·         the date the policy terminates.

 

Spouse and children’s coverage terminates concurrently with that of the primary member, or earlier if they no longer qualify as a dependent, or if the primary member requests termination of coverage.

 

Premium Billings.  Online payment is the most popular choice; payments are automatically withdrawn from your credit card or checking/savings account.  You can check the status of your payments online.  You may also set up email alerts to let you know when payments will be withdrawn.

 

Another option is to have a bill sent to your resident address.  A modal billing fee will be reflected on each bill.  Please be advised that a one-time administration fee of $10 will be required at time of enrollment for this payment option.

 

Payment of Claims.  Your provider may bill the insurance company for the eligible insured benefits outlined in your membership plan; you will receive an Explanation of Benefits (EOB) from the administrator explaining what was paid and what you owe the provider.  A welcome kit will be issued, which includes ID cards and instructions for filing claims.  Members will be given access to the online Customer Care Center where he/she may have access to billing, claim forms, Identification cards, customer surveys, customer services, and more, available 24 hours a day 7 days a week.


Evidence Of Coverage. All members will receive a fulfillment kit that will include information about your AUIC member benefits, as well as a certificate of insurance and an identification card.

 

Pre-Existing Conditions Limitation (applicable to Hospital, ICU/CCU, Surgery and Anesthesia benefits only). Pre-existing Condition means a medical condition, Injury or Sickness, not excluded by name or specific description, for which:

(1)   Medical advice, Consultation, care or treatment was recommended by, or received from, a Doctor within 12-months immediately prior to the Effective Date of coverage for a Covered Person; or

(2)   Symptoms existed within 12-months immediately prior to the Effective Date of coverage for a Covered Person that would cause a reasonable person to seek Consultation, care, or treatment from a Doctor.

 “Consultation” means evaluation, diagnosis, or medical advice given without the necessity of a personal examination or visit.

 

Plan Limitations and Exclusions Applicable To All Benefits

 

Benefits will not be paid for charges or loss caused by, or resulting from, any of the following:

 

(1)  Suicide or any intentionally self‑inflicted Injury; 

(2)  Any drug, narcotic, gas or fumes, or chemical substance voluntarily taken, administered, absorbed or inhaled unless prescribed by, and taken according to the directions of, a Doctor (accidental ingestion of a poisonous substance is not excluded.); 

(3)  Commission, or attempt to commit, a felony; 

(4)  Participation in a riot or insurrection; 

(5)  Driving under the influence of a controlled substance, unless administered on the advice of a Doctor;  

(6)  Driving while Intoxicated.  "Intoxicated" will have the meaning determined by the laws in the jurisdiction of the geographical area where the loss occurs. 

(7)  Declared or undeclared war or act of war; 

(8)  Nuclear reaction or the release of nuclear energy.  However, this exclusion will not apply if the loss is sustained within 180-days of the initial incident and:

(1)  The loss was caused by fire, heat, explosion or other physical trauma which was a result of the release of nuclear energy; and

(2)  The Covered Person was within a 25-mile radius of the site of the release either:

(a)  At the time of the release; or

(b)  Within 24-hours of the start of the release; or

(c)  Occurs while he is in the issue state of this Certificate;

(9)  Routine health checkups or immunizations for Covered Person aged 6 and older except as specifically provided; allergy testing; 

(10) Surgery to correct vision or hearing; eyeglasses, contact lenses and hearing aids, braces, appliances, or examinations or prescriptions therefore; 

(11) Dental care, x-rays, or treatment other than Injury to natural teeth and gums resulting from an accidental Injury and rendered within 6-months of the Injury; 

(12) Spinal manipulations and manual manipulative treatment or therapy or phisotherapy; 

(13) Weight loss or modification and complications arising therefrom, including surgery and any other form of treatment for the purpose of weight loss or modification; 

(14) Rest cures or custodial care, or treatment of sleep disorders; 

(15) Treatment, services or supplies received outside of the U.S. except for acute Sickness or Injury sustained during the first 30-days of travel outside the U.S.;  

(16) Normal pregnancy or childbirth, except for Complications of Pregnancy;  

(17) Any drug, treatment, or procedure that either promotes or prevents conception or childbirth regardless of what the drug, treatment, or procedure was originally prescribed or intended for; 

(18)  (19) Treatment of temporomandibular joint (TMJ) disorders involving the installation of crowns, pontics, bridges or abutments, or the installation, maintenance or removal of orthodontic or occlusal appliances or equilibration therapy; 

(20) Cosmetic surgery.  This Exclusion does not apply to reconstructive surgery:

(a)   On an injured part of the body following trauma, infection or other disease of the involved part;

(b)   Of a congenital disease or anomaly of a covered dependent newborn or adopted infant; or

(c)   On a non-diseased breast to restore and achieve symmetry between two breasts following a covered Mastectomy;

(21) The repair or replacement of existing artificial limbs, orthopedic braces, or orthotic devices; dentures, partial dentures, braces or fixed or removable bridges; 

(22) Treatment or removal of warts, moles, boils, skin blemishes or birthmarks, bunions, acne, corns, calluses, the cutting and trimming of toenails, care for flat feet, fallen arches or chronic foot strain;  

(23)  (24) Treatment of Mental or Nervous Disorders, or alcohol or substance abuse, unless specifically provided for under this Certificate; 

(25) Prescription medicines; 

(26) Any Injury that is caused by flight or travel in, or upon:

(a)   An aircraft or other, craft designed for navigation above or beyond the earth's atmosphere except as a fare‑paying passenger;

(b)   An ultra light, hang‑gliding, parachuting or bungi‑cord jumping;

(c)   A snowmobile;

(d)   Any two or three wheeled motor vehicle;

(e)   Any off‑road motorized vehicle not requiring licensing as a motor vehicle;

(f)     Any watercraft or other craft designed for water use above or beneath the water, except as a fare-paying passenger;

(27)  Any accidental Injury where the Covered Person is the operator of a motor vehicle and does not possess a current and valid motor vehicle operator's license; 

(28)  Services, treatment or loss:

(a)   Rendered in any Veterans Administration or Federal Hospital, except if there is a legal obligation to pay;

(b)   Payable by any automobile insurance policy without regard to fault. (Does not apply in any state where prohibited);

(c)   Which a Covered Person would not have to pay if he did not have insurance;

(d)   Provided by a Doctor, Nurse or any other person who is employed or retained by a Covered Person or who is a member of a Covered Person’s Immediate Family;

(e)   Covered by state or federal worker's compensation, employers liability, occupational disease law, or similar laws;

(f)     Injury or Sickness sustained while on active duty in the armed forces of any country. Upon receipt of proof of service, we will refund, any unearned premium paid on a pro rata basis;

(29)  Hemorrhoids, tonsils, adenoids, middle ear disorders, any disease or disorder of the reproductive organs unless the loss is incurred at least 6-months after the Covered Person becomes insured under this Certificate; 

(30)  Elective treatment or surgery and treatment, procedures, products or services that are experimental or investigative.  “Experimental or Investigative” means a drug, device or medical treatment or procedure that:

(a)   Cannot lawfully be marketed without approval of the United States Food and Drug Administration and approval for marketing has not been given at the time of being furnished;

(b)   Has Reliable Evidence indicating it is the subject of ongoing clinical trials or is under study to determine its maximum tolerated dose, toxicity, safety, efficacy, or its efficacy as compared with the standard means of treatments or diagnosis; or

(c)   Has Reliable Evidence indicating that the consensus of opinion among experts is that further studies or clinical trials are necessary to determine its maximum tolerated dose, toxicity, efficacy, or its efficacy as compared with the standard means of treatment or diagnosis.

“Reliable Evidence” means (i) published reports and articles in authoritative medical and scientific literature; (ii) the written protocol(s) of the treating facility or the protocols of another facility studying substantially the same drug, device, medical treatment or procedure; or (iii) the written informed consent used by the treating facility or by another facility studying substantially the same drug, device, or medical treatment or procedure.

THIS IS LIMITED INDEMNITY COVERAGE. IT IS NOT MAJOR MEDICAL COVERAGE and is not intended to replace other medical coverage.

Terms and conditions may vary by state, please review your certificate.

Association Non-Insured Benefits (AUIC)

 

AUIC Association is an organization comprised of families, individuals, employers, and employees. This nationwide association empowers the individual member with the clout and protection of a large organization.

The below benefits are only a summary description of benefits available.  Actual Benefit descriptions and how to access benefits will be delivered to members of the AUIC.  Please contact us at 1-800-279-2290 or on the web at www,auic.org, if you have any specific questions.

 

Internet Shopping:

Includes more than 150 stores. Find quality items at low prices for the best deals in America. Each vendor in the mall has been scrutinized carefully. HopTheShops.com offers the best value on quality items coupled with excellent customer service. Here’s a list of categories:

 

Health & Beauty Products

Learning Tools/Education

Home & Garden 

Art & Books

Computers & Electronics

Music & Entertainment

Automobiles 

Food

Cards & Gifts

Pet Supplies  

Fashion  

Savings & Coupons

Wine, Liquor & Cigars

Toys

Sporting Goods

 

 

Moving Services:

Our association has a special agreement with Cord NorthAmerican, an agent for North American Van Lines, that applies to relocation services for all members. This agreement provides a substantial discount for our members. Cord NorthAmerican was selected to provide this relocation benefit to members because of their ability to offer reduced costs while still providing the highest level of service and customer satisfaction.

 

The association has in place through North American Van Lines the certified Home-To-Home Handling program and a single source of contact. The Home-To-Home Process includes professional packing, loading, and transportation by North American' s top drivers, as well as unloading, and unpacking. Each relocation can be itemized to help with your needs, wants and/or budget. Cord NorthAmerican is proud to present relocation discounts, features and benefits designed for our members. Estimates/Quotes are always free of charge!

 

Amusement Park Discounts:

The Amusement Park Discounts benefit will allow members to receive discounted rates to well-known theme parks throughout the U.S.

·    Members are entitled to a variety of special savings at well-known theme parks throughout the United States. You will enjoy savings up to a 15% discount on every ticket.

·    Discount tickets, delivered to your door. Never wait at the gate again! We ship your valid, unrestricted tickets right to your door. With amusementpark.com, there’s nothing else to buy, EVER. We sell only real tickets (not vouchers or coupons for tickets), so you’ll breeze on through the gate.      

 

Quest Travel Plan:

Quest Hotel Savings:  Quest is America’s Premier Hotel Savings Company because of the exceptional service, the quality of participating hotels and the elegant simplicity the program has to offer.  Save up to 50% off the standard, non-discounted rack rate at more than 3,100 hotels, motels, inns and resorts (based on availability).  The plan includes the U.S., Canada, Mexico and over 15 different countries ranging from the Caribbean to the Netherlands.

 

Quest Metro & Chainwide Hotel Savings:  You will receive special negotiated rates of up to 50% off at more than 1,500 hotels in 30 major cities specializing in room reservations for sold-out dates.  You can also save up to 30% at more than 3,000 participating “Choice Hotels” including Clarion, Comfort Inns, Econo Lodges, MainStay Suites, Quality Inns, Rodeway Inns and Sleep Inns.

 

Quest Cruise Line Savings:  Choose from thousands of cruise dates and itineraries on cruise lines such as Carnival, Holland America, Princess and Royal Caribbean.  You can save up to 70% off published cruise line brochure rates. 

 
Quest Car Rental Savings:  Save up to 30% off rental rates from Hertz, National and Alamo.

 

Travel Assistance Plan:

As a member, you receive the following benefits through the Travel Assistance Program when traveling more than one hundred (100) miles from your permanent residence.

·        Emergency Evacuation/Repatriation. If a member suffers an illness or injury  while traveling over 100 miles away from home, and cannot be treated by a local medical facility, the member is transported by the most appropriate means to the nearest hospital capable of providing necessary treatment.

·      Transportation of Mortal Remains. If a member loses his/her life while traveling over 100 miles from home, the  member’s remains will be returned to the member’s place of residence.

·      Transportation of Escort. If the member needs emergency evacuation by air ambulance or repatriation by covered  commercial airline, the member’s spouse, other family member, or companion is free to accompany the member in flight, subject to space availability with priority given to medical equipment and personnel.

·      Family Visitation. If a member is traveling alone and is expected to be hospitalized for more than 7 days, the spouse or another family member will be flown in to be with the member.  Also, expenses for accommodations and transportation during their stay, up to $100.00 per day for 10 days, are provided.

·      Minor Children Return/Escort. If a member requires emergency evacuation, hospitalization for over 24 hours, or in the event of death, and the minor children are left unattended, transportation home is furnished for them.

·      Vehicle Return. The Travel Assist Provider will return the member’s vehicle home and bear the cost up to $1,000.00 when illness, injury, or death requires emergency evacuation or repatriation and the member is unable to drive the vehicle.

·      24-hour Information Service. Helpful information before and during travel is available to the  member. The multilingual staff is prepared to assist and coordinate the management of a wide variety of travel related situations.  Services include information on required documents, immunization requirements, State Department Travel Advisory warnings, weather and hazard information about foreign locations and more.

·      Medical Monitoring. If a member needs to be medically monitored, the Travel Assist Provider’s duty physician will monitor the case, while acting as a liaison between the member, the local treating physician, and the family physician as needed. 

·      Medical Referral. The Travel Assist Provider will arrange referrals to a local doctor or hospital, when a member needs help in locating a doctor or hospital while traveling.

·      Guarantee of Medical Expenses. If a member needs help for overseas claims, the Travel Assist Provider will arrange for a payment or guarantee of payment to providers.

·      Insurance Coordination. If a member needs help for overseas claims, the Travel Assist Provider will assist in coordinating the claims procedure with the appropriate insurance program.

·      Lost Documentation Service. If a member needs help to replace lost or stolen travel documents (i.e., passport, baggage, tickets, credit cards, etc.), the Travel Assist Provider will advise and assist where possible in their replacement.

·      Legal Assistance. If a member needs help finding a local attorney or embassy, arranging bail, cash advances, or coordination of payment for legal services from available resources of the traveler, the Travel Assist Provider will arrange referrals.

·      Emergency Delivery of Prescription Items. If a member needs prescription medication or lenses not available locally, the Travel Assist Provider will organize the delivery of the prescribed item when possible and legally permissible, to the member upon written authorization of the prescribing physician.

·      Emergency Cash Transfer and Advances. The Travel Assist Provider will arrange for emergency cash advances and transfers through additional sources including hotels, banks, Western Union, etc. if a member needs cash as a result of loss or theft.  Limit of $500 per transaction. 

24 Hour Emergency Roadside Assistance

Members can gain peace of mind on the road by registering for Emergency Roadside assistance.  Once registered, members will receive emergency roadside assistance membership materials including membership cards that will enable the member and their family to get assistance from a participating service provider whenever car troubles arise (may vary by state).  Members will be covered for the first $50 per occurrence for each covered emergency expense, including towing, flat tire assistance, battery service and lock-out service.

 

Car Rental Discounts

The car rental discount will allow members to receive discounts on selected car rental companies. The participating rental companies are featured below on the page.

Use the following toll free numbers and codes when arranging a car rental: Alamo, Avis, National, Hertz

 

Magazine Discounts

You can save up to 85% off regular subscription rates on popular titles through your Association discount magazine subscription magazine service. In addition to this great discount, some of our programs offer rebates of up to 35% off the purchase price if purchases are made online through eGroupManager.com.

 

Floral Discount

Welcome to “My Online Florist” Member benefits. Your Association membership lets you send flowers anywhere in North America from the website or by phone. As an association member, you will receive a 40-60 % discount from most retail flower shop prices. Try it and see!

You may also take advantage of these important benefits:

·    Convenience – call the toll-free number, 1-888-321-ROSE (7673), and mention Association Member Number 38801 to receive your association discount.   You can call 24 hours a day, seven days a week, and request delivery anywhere in North America!

            (Please note that phone orders are priced slightly higher to reflect the additional service required.)

·    Quality Guarantee – They guarantee every floral product and provide a customer satisfaction department available to track an order from placement through delivery.   All Arrangements are guaranteed to last at least seven days.

·    Service – enjoy personalized attention from My Online Florist’s experienced, friendly Floral Coordinators who can assist you in selecting the perfect gift and assure you that your order will be delivered promptly.   They ship UPS and FedEx next day delivery on most orders.

·    Diversity – choose from a wide variety of products including fresh flowers, plants, specialty baskets, gifts, and candies.

 

Video Discounts

The Video Discount benefit allows members to receive discounts on Video Gift Cards from Hollywood Video.

Members can purchase $5 Gift Cards from Hollywood Video for $4.25 each. You can receive up to 5 gift cards per order. These gift cards can be used for any purchases made in the store. Best of all, the card never expires! So, they make excellent gifts to have on hand.

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