Sickness & Accident, Hospital & Medical Insurance
THIS POLICY PROVIDES LIMITED BENEFITS
• Benefits are Paid Directly to You* • No Deductible or Co-pays • Pays Benefits in Addition to any Other Insurance • Issue Ages 18 through 64 • Dependent Child Coverage Available to Age 19 or 25 if   a Full Time Student**** • Use any Doctor, Hospital or Licensed Provider • Preexisting Conditions Incurred within the 12 Month   Period Preceding the Effective Date are Covered after   12 Months** • Your Rates Cannot Increase Due to Your Advanced   Age or Declining Health*** • Guaranteed Renewable to age 65
VALUE MED PLAN BENEFIT SCHEDULE PAYS Doctors Office Visits Pays up to 10 Doctor Office visits per calendar year for each insured adult and up to 5 per calendar year for all insured children combined. Doctor Office visits are limited to one per week, except in Maryland. $75 per visit Hospital Outpatient Visits Pays for Doctors treatment, medical supplies, x-ray and lab tests. Outpatient Benefit maximum per calendar year is $1,000 per insured and $1000 for each covered child. Up to $250 per visit Ambulance Services Pays ambulance expense per sickness or accident $200 maximum per sickness or accident Hospital Confinement Pays $100 per day, beginning on the 1st day of hospital confinement, up to 365 days. Option for $500 per day is available.***** $100 or $500
* The benefits may be paid directly to the hospital or other health care facility if an assignment of benefits is made by the policyholder. ** Pre-existing conditions are those medical conditions disclosed or not disclosed on the application which were diagnosed or for which medical advice or treatment was recommended or received from a Doctor within a 12-month period immediately preceding the Effective Date of Your coverage. Any loss due to a pre-existing condition is not covered unless the loss begins more than 12 months* after the Effective Date of coverage. *The pre-existing condition waiting period is 6 months in Idaho and Oregon. Wyoming Applicants Only – Your Pre-existing Conditions Limitation reads: The policy will not cover loss resulting from pre-existing conditions during the first year that your policy is in force. A "pre-existing condition" is any sickness or injury diagnosed for which You received medical advice and /or treatment was received from or recommended by a Physician within the 90 day period immediately before the effective date of Your coverage, or the effective date of an increase in coverage, whichever is applicable *** The insurer has the right to increase premium rates of all like policies in your state. **** Instead of age 19 the following states have higher limits: Indiana age 24, New Mexico age 25, North Dakota age 22 and Utah age 26. ***** Hospital confinement must be medically necessary because of injury or sickness. Our definition of hospital excludes (a) a convalescent home, convalescent, rest or nursing facility; or, (b) a facility or portion thereof used primarily for the care of the aged, the terminally ill, drug or alcoholic rehabilitation, or primarily affording custodial, long-term nursing, convalescent or educational care.
Please Note this Policy contains a 10-Day Right to Examine Coverage: You may cancel coverage under this Policy or Certificate within 10 days of receiving it by returning the Policy or Certificate to Us. If it is returned for cancellation, we will refund any premium paid for your coverage. The Policy or Certificate will then be void as of the Effective Date and there will be no coverage. The states of New Hampshire and Oklahoma have a 30-Day Right to Examine Coverage.
Underwritten by: Guarantee Trust Life Insurance Company in All Other States Except NY. Group Policy #GP2005 LA Policy Form G0551-LA, ME Policy Form G0551-ME, MT Policy Form G0551-MT, OR Policy Form G0551-OR, SC Policy Form G0551-SC, MD Policy Form G0551-MD
Underwritten by: United National Life Insurance Company of America in AR, ID, IL,KS, MN, MO, NE, NV, NM, ND, OK, SD, TX. Group Policy #UP2005, UT Policy Form U0552-UT, AR Policy Form U0552-AR, OK Policy Form U0552-OK SD Policy Form U0552-SD, WV Policy Form U0552

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BENEFITS DETAILS

A. Daily Hospital Confinement Indemnity Benefit We will pay the Daily Hospital Benefit Amount for each day when a Covered Person is Confined in a Hospital when such confinement is Medically Necessary because of an Injury or Sickness. Benefits will begin on the first day. We won't pay more than a total of 365 days for Hospital Confinement during the Covered Person’s lifetime. Choose either the $100 or $500 daily benefit.   B. Doctor's Office Visit Benefit We will pay $75 as the Doctor’s Office Visit Benefit when a Covered Person receives the medical services of a Doctor, limited to one visit to the Doctor's office per Week, except in Maryland. We won't pay more than a total of 10 visits to the Doctor's office per Calendar Year per Covered adult and 5 per calendar year for all Covered children combined.   C. Outpatient Benefit We will pay the Out-of-Pocket Costs incurred for care and services received in an outpatient department of a hospital. Care and services include, but are not limited to: (1) Doctor's treatment; (2) medical supplies; or (3) x-rays or laboratory tests. We won't pay more than $250 per Outpatient visit up to $1,000 for any one Sickness or Injury or the Maximum Calendar Year Outpatient Benefit shown in the Policy Schedule in any one Calendar Year.   D. Ambulance Transportation Benefit If a Covered Person requires the use of an ambulance for transportation to a Hospital for Medically Necessary care of a Sickness or Injury, We will pay the Ambulance Benefit shown in the Policy Schedule. This Benefit is limited to a single benefit payment for any one Sickness or Injury. For purposes of this Benefit, “use of an ambulance service" means the physical transportation of the Covered Person in an ambulance or other appropriate vehicle registered to a licensed medical transportation service for which a charge is normally made.   Discount Benefits Are Not Insurance

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VBA TERMS

VBA TERMS AND CONDITIONS

1. Member understands that VBA is not an insurance company or program. Accident Benefit Payments are made by the administrator for the insurance company issuing the blanket coverage to Members. 2. VBA provides savings to its members on services through a number of sources. The current list of benefits may be modified through additions or deletions. A quarterly newsletter, posted on our website or sent via e-mail, will keep Members up to date on benefits and other pertinent information. 3. Payments for the VBA Program are due in advance. Payments will be drafted on or about 15 days before the due date. If you choose to cancel your program, it is your responsibility to make sure that your membership card and a written request for cancellation are sent to VBA at least 15 days prior to the anniversary of your effective date in order for your account not to be charged for additional fees. 4. Member hereby appoints, Value Benefits of America Association (VBA) President, or failing this person, a VBA Director, as proxy holder for and on behalf of the member with the power of substitution to attend, act and vote for and on behalf of the member in respect of all matters that may properly come before the meeting of the members of VBA and at every adjournment thereof, to the same extent and with the same powers as if the undersigned member were present at the said meeting, or any adjournment thereof. Annual meetings are to be held in Arizona the second Tuesday of August. 5. VBA reserves the right to terminate any enrollment or deny eligibility in the program for lack of payment to VBA. Returned checks, insufficient notices on bank drafts or denial by the member’s credit card company for payment of the membership fee is deemed to be evidence of non-payment by a member. There will be a $10.00 charge to be reinstated in the program after such denial. If reinstatement for non-payment happens more than once, a $20.00 reinstatement will apply. 6. In the event of any dispute, member agrees to resolve said dispute solely by binding arbitration that shall be governed by the laws of the state of Arizona and enforceable at Scottsdale, Maricopa County. 7. Membership cancelled within the first 30 days of the enrollment date may be eligible for refund if the membership card and written cancellation request are sent to VBA. The administrative fee is not refundable. Approved refunds will be processed approximately 30 days after cancellation. 8. Membership is effective on the 1st of the month following enrollment acceptance by VBA. Member Agreement: By signing your enrollment form, Member expresses desire to become a member of Value Benefits of America. Member acknowledges that the discount plans ARE NOT INSURANCE, but membership includes certain limited supplemental insured coverage's. Membership benefits are not a replacement for health insurance coverage nor are they intended as a substitute for health insurance coverage. Membership fees may change for all members, but not individually, with notification.

Discounts and Dividends are not insurance

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DEFINITIONS

DEFINITIONS:

Any one Sickness or Injury means either Sickness or Injury from the same cause at various times or Sickness or Injury from various causes at the same time. Calendar Year means the period beginning on the Certificate Effective Date and ending December 31 of that year. Thereafter it is the period from January 1 through December 31 of each following year. Complications of pregnancy means any condition that requires medical treatment or Hospital confinement prior to or subsequent to the termination of the pregnancy whose diagnosis is distinct from, but is adversely affected by the pregnancy. Such conditions include, but are not limited to: (1) acute nephritis; (2) nephrosis; (3) cardiac decompensation; (4) missed abortion; and, (5) similar conditions of comparable severity. A complication of pregnancy will also include nonelective cesarean section or termination of pregnancy that occurs during a period of gestation when a viable birth is possible. "Complications of Pregnancy" will not include: (1) false labor; (2) occasional spotting; (3) prescribed bed rest; (4) morning Sickness; or, (5) similar conditions that are common to the care of a difficult pregnancy. Covered Person means You and Your spouse, if any, that have been accepted for coverage. Daily Hospital Benefit Amount means the amount we will pay each day when hospital confined. The Daily Hospital Benefit Amount is shown in the Certificate Schedule. Doctor means any licensed practitioner of the healing arts operating within the scope of his or her license in treating any Injury or Sickness. It doesn’t include a member of the Immediate Family. Hospital means an institution which operates pursuant to law that has organized facilities for the care and treatment of sick and injured persons on a resident or inpatient basis, including facilities for diagnosis and surgery under the supervision of a staff of one (1) or more Doctors and which provides twenty-four (24)-hour nursing service by registered nurses on duty or call. Hospital does not mean convalescent, nursing, rest or extended care facilities or facilities operated exclusively for treatment of the aged, drug addict or alcoholic, even though such facilities are operated as a separate institution by a Hospital. Hospital Confinement/Confined means confinement in a Hospital as a resident bed patient for a period of 23 consecutive hours or longer. Hospital Elimination Period is the number of consecutive days when a loss is first incurred for which the Hospital Benefit is are payable under this Policy, but during which no benefits will be paid. For each day of Hospital Confinement to be applied towards the satisfaction of the Elimination Period, the loss must be otherwise covered by this Policy and eligible for benefits. When benefits do begin, they will not be retroactive to the beginning of the Elimination Period. The Elimination Period must be satisfied at the beginning of each period of Hospital Confinement. Immediate Family means You or Your spouse, You or Your spouse’s parents, grandparents, children, grandchildren, or siblings by blood or marriage. Injury means an accidental bodily injury sustained by a You that is the direct cause of loss, independent of disease or bodily infirmity. The loss must begin while Your insurance under this Certificate is in force. Insured means the person named as the Insured in the Certificate Schedule. Intoxicated means that state that is determined by the laws and/or decisions of the jurisdiction in which loss because of being intoxicated occurs. Maximum Outpatient Benefit Amount means the maximum amount we'll pay each calendar year for outpatient services. The Maximum Outpatient Benefit Amount is shown in the Certificate Schedule. Medically Necessary means a service, supply, or hospital confinement that: is prescribed by a Doctor; is required for the treatment or management of a medical symptom or condition; is the most efficient and economical service which can safely be provided; and is commonly accepted as proper for the treatment or management of a condition by an established United States medical society. All four of the above conditions must be met in order to establish Medical Necessity. The fact that a Doctor may prescribe, order, recommend or approve a service, supply or a confinement does not, of itself, make it Medically Necessary or a covered loss under this Certificate even though it is not specifically listed as an exception. Mental Illness means a neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder of any kind classified in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders on the date care or medical treatment is rendered. It doesn’t mean a demonstrable organic brain disease, such as Parkinson’s disease, Alzheimer’s disease or senile dementia. Out-of-Pocket Costs means that portion of the expenses incurred that You are obligated to pay. Sickness means an illness or a disease that results in loss covered by the Group Policy. The loss must begin while the Covered Person’s insurance under this Certificate is in force. Week means a period of 7 days beginning on a Sunday and ending on the following Saturday.

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Exclusions and Limitations

Pre-Existing Condition Limitation

Pre-existing conditions are those medical conditions disclosed or not disclosed on the application which were diagnosed or for which medical advice or treatment was recommended or received from a Doctor within a 12-month period immediately preceding the Effective Date of Your coverage. Any loss due to a pre-existing condition is not covered unless the loss begins more than 12 months* after the Effective Date of coverage. *The pre-existing condition waiting period is 6 months in Idaho and Oregon.

Wyoming Applicants Only – Your Pre-existing Conditions Limitation reads:

The policy will not cover loss resulting from pre-existing conditions during the first year that your policy is in force. A "pre-existing condition" is any sickness or injury diagnosed for which You received medical advice and /or treatment was received from or recommended by a Physician within the 90 day period immediately before the effective date of Your coverage, or the effective date of an increase in coverage, whichever is applicable.

Exceptions and Limitations

We won’t pay for charges incurred: 1. war or act of war, whether declared or not (does not apply to Oklahoma applicants); 2. intentionally self-inflicted injury; 3. mental illness or nervous disorders without demonstrable organic disease (loss due to Parkinson’s Disease, Alzheimer’s Disease or senile dementia is covered) (or for DC applicants except as state mandated; and this exception does not apply to Vermont applicants); 4. normal pregnancy and childbirth; complications of pregnancy, however, will be covered as a sickness (this exception does not apply to Montana applicants); 5. treatment of an injury that results from your commission of, or attempt to commit a felony, or from you being engaged in an illegal activity (or for Nebraska applicants, an illegal occupation; or for Vermont applicants, treatment of an injury that results from Your participation in a felony); 6. cosmetic surgery; cosmetic surgery does not include reconstructive surgery which is incidental because of previous surgery due to trauma, infection, or other disease of the involved part (or for New Hampshire applicants, reconstructive surgery because of a congenital disease or anomaly of a covered dependent child that has resulted in a functional defect); 7. confinement in a Hospital located or care received outside of the territorial limits of the United States of America, its commonwealth partners, or the countries of Canada and Mexico; or 8. you being intoxicated or under the influence of alcohol or a narcotic, unless administered on the advice of a Physician (or for DC applicants, or as state mandated; and for Nevada applicants, substance abuse, including alcoholism, drug addiction, narcotics, or hallucinogens unless administered on the advice of a Physician).

Oklahoma applicants only: We will also not be liable for any loss sustained or contracted in consequence of Your being under the influence of any narcotic, unless administered on the advice of a Doctor.

Benefit Limitations

1. Outpatient Benefit maximum is $1,000.00 per calendar year per covered adult and for each covered child. 2. Doctor’s office visits are limited to 10 per calendar year for adults, 5 per calendar year for all children combined. 3. Doctor’s office calls are limited to one call per week, except in Maryland.

Stable Premiums

Your premiums cannot be changed due to declining health. Your premiums can only be changed if we change the premiums of all like policies in your state. You will be notified before any changes are made. This benefit description is a brief summary of benefits only and is subject to the terms, conditions, exclusions and limitations of your Certificate of Insurance or Insurance Policy. Coverage may not be available in all states. Please call VBA at 1-800-366-2467 if your state is not listed.

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Security and Privacy Statement

When you become a GACquote.com customer, you entrust us with your personal data. We consider your data to be private and confidential, and we hold ourselves to the highest standards of trust and fiduciary duty in their safekeeping and use. General Agent Center (GAC) and our partners will not release information about you or your application, policy or claims information, unless one or more of the following conditions are met: We receive your prior written consent. We believe the prospective recipient to be you or your authorized representative. We are required by law to release information to the recipient. Questions about your medical history and physical condition are required by our insurance carrier partners and will be released to the insurer so that they may underwrite your insurance application. GAC will not give or sell information about you to any other company, individual, or group without your prior authorization. GAC will only use information about you to help us better serve your insurance needs or to suggest GAC services or insurance materials that may be of interest to you. To further protect your privacy, our web site uses the highest levels of Internet security, including data encryption, user names and passwords, and other security tools. Occasionally, GAC may conduct marketing surveys or research to help us evaluate products, services, and the changing needs of our customers. It is GAC's policy to keep this information confidential. We will not share individual marketing data gathered from our web site with individuals or business entities not affiliated with GAC. We know that the privacy of your personal information is important to you. In order to provide you with insurance products of the highest quality and with the service you deserve, it may be necessary for us from time to time to collect nonpublic personal and financial information about you (the "Information") and, in certain situations, to share that Information with others. The following notice describes our policies and practices with regard to your Information.

HOW WE PROTECT YOUR INFORMATION

We maintain physical, electronic and procedural safeguards to protect the Information against unauthorized access and use. We restrict access to the Information to those employees who need access to provide products and services to you and your dependents. The personnel who have access are trained in the proper handling of the Information. Employees who violate this strict level of confidentiality are subject to our disciplinary process.

CATEGORIES OF INFORMATION THAT WE COLLECT

In the normal course of business we may collect the following types of Information: Information you provide on applications and other forms (including name and address) Data about your transactions with us (such as types of products you have purchased and your account status) Information gathered on our Web sites through online forms, site visit data and online information-collecting devices known as "cookies"

HOW WE USE YOUR INFORMATION

We may share your information among the Insurance Companies as permitted by law, including for routine business administration. We may share information with non-affiliated companies as allowed by law, such as firms that perform services on our behalf, including the administration and marketing of our products. We require these companies to meet strict privacy standards. We may disclose information to non-affiliated entities when required by law, such as to respond to a subpoena, to prevent fraud or to comply with an inquiry by a government agency.

ACCURACY OF YOUR INFORMATION

We strive to maintain the accuracy of Information that is in our possession about you. In order to help us maintain accuracy, you have the right to reasonably access your information. If you believe any information in our possession is inaccurate, a request can be made to amend or delete the information that you believe to be erroneous. If we concur with the request, we will amend or delete the information in question. You may write our Privacy Office at the address below to receive our complete policy on accessing and amending the Information.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice. We reserve the right to make the revised Notice effective for the Information we already have about you as well as any Information we receive in the future. If we make any material changes to our policies or practices, we will provide you with a copy of a revised Notice. We will post a copy of the current Notice on our websites. The Notice will contain in the top right-hand corner, the effective date.

You may contact our Privacy Office at:

General Agent Center 15575 North 79th Place, Suite 100 Scottsdale, AZ 85260