hospital indemnity insurance
Effective January 1, 2017, Chevron will offer a new Group Hospital Indemnity* Insurance underwritten by Continental American Insurance
Company (CAIC), a wholly-owned subsidiary of Aflac Incorporated (Aflac), and administered by Mercer Voluntary Benefits.
Even if you have health insurance, you could face unanticipated out-of-pocket expenses your medical plan doesn’t cover with an inpatient
hospital stay. Group Hospital Indemnity Insurance with Aflac can help with the out-of-pocket costs associated with a covered hospital
stay, including benefits for hospital admission, confinement, and intensive care. It provides financial assistance to enhance your current
medical and disability coverage if you are hospitalized due to a covered injury or illness.
who can enroll
If you or a covered dependent are admitted as an inpatient for
a covered injury or illness, submit a claim for benefits directly to
Aflac. Most claims are processed in about four days. Because you
receive cash benefits directly, unless otherwise assigned, you have
the flexibility to use the money any way that’s best for you, even
for day-to-day expenses such as mortgage or rent.
Group Hospital Indemnity Insurance is available to all U.S.-payroll
employees eligible for Chevron health benefits. You must enroll
to be covered. If you enroll, you can also cover your eligible
dependents:
• Eligible spouse.
• Benefits are paid to you unless you choose otherwise.
• Eligible domestic partner.
• There is no coordination with other insurance.
• Eligible child (under age 26)*.
benefit amount
*If you do not have dependent child coverage, a newborn or newly
adopted child will be automatically covered for 60 days from the
date of birth or placement for adoption. To continue coverage
beyond 60 days, you must apply for coverage for the child and pay
any required premium.
There are two different levels of coverage you can purchase,
Hospital Indemnity High and Hospital Indemnity Low. For
complete eligibility rules and details, see the Certificate of
Insurance available on hr2.chevron.com or by contacting Mercer.
When you enroll, you’ll be required to indicate which dependent is
receiving coverage. In addition, to be eligible for coverage, when
you enroll you’ll be required to attest to meeting certain additional
eligibility requirements, including but not limited to:
2017 Hospital Indemnity Low
• Hospital Admission: $1,500 per confinement, once per covered
injury or illness per calendar year for each insured.
• That you’re actively at work.
• Hospital Confinement: $150 per day, maximum of 31 days per
confinement for each covered injury or illness for each insured.
• The person to be insured has comprehensive health benefits
from an insurance policy, an HMO plan, or an employer’s health
benefits. You do not have to be enrolled in Chevron health
coverage. This means you can have comprehensive health
coverage from another source.
• Hospital Intensive Care Unit: $150 per day, maximum of 10
days per confinement for each covered injury or illness for each
insured.
• Intermediate Intensive Care Step-Down Unit: $75 per day,
maximum of 10 days per confinement for each covered injury or
illness for each insured.
how it works
The Group Hospital Indemnity Insurance plan pays you, unless
otherwise assigned, a cash benefit (Hospital Admission) when you
or a covered dependent are admitted as an inpatient for a covered
injury or illness, including pregnancy. It then pays additional
benefits each day you are confined, as well as for time spent in an
intensive care unit (Hospital Confinement, Hospital Intensive Care
Unit, and Intermediate Intensive Care Step-Down Unit). To review a
complete list of covered injuries or illnesses and the corresponding
schedule of benefit payments, see the Certificate of Insurance
available on hr2.chevron.com or by contacting Mercer.
U.S. Pay and Benefit News
52
2017 Hospital Indemnity High
If an insured’s coverage terminates, Aflac will provide benefits
for valid claims that were incurred while coverage was active.
For further details, see the Certificate of Insurance available on
hr2.chevron.com or by contacting Mercer.
• Hospital Admission: $2,000 per confinement, once per covered
injury or illness per calendar year for each insured.
• Hospital Confinement: $300 per day, maximum of 31 days per
confinement for each covered injury or illness for each insured.
when you can change coverage
• Hospital Intensive Care Unit: $300 per day, maximum of 10 days
per confinement for each covered injury or illness for each insured.
You can enroll, discontinue, or change coverage:
• Within 31 days of a qualifying life event.
• Intermediate Intensive Care Step-Down Unit: $150 per day,
maximum of 10 days per confinement for each covered injury or
illness for each insured.
• During Chevron’s open enrollment period.
when you leave chevron
when coverage begins
• If you enroll within 31 days of qualifying life event, coverage will
begin on the first of the month following enrollment.
Group Hospital Indemnity Insurance is not eligible for continuation
through COBRA if you leave Chevron. Coverage is portable
(with certain stipulations). That means you can take it with you,
if you change jobs or retire. It’s your responsibility to contact
Aflac within 31 days of leaving Chevron to move to direct bill.
Your premiums may change, and you’ll pay Aflac directly for
coverage. Aflac will provide written notice at least 31 days before
any change is to take effect.
• The Group Hospital Indemnity Insurance plan doesn’t have a
waiting period for benefits.
how to enroll or ask questions
• If you enroll during open enrollment, coverage will begin on
January 1 of the following year.
• If you enroll within 31 days of hire or rehire, coverage will begin
on the first of the month following enrollment.
This benefit is insured by Aflac and administered by Mercer
Voluntary Benefits. Contact Mercer for information about plan
coverage, how the plan works or for payroll deduction inquiries.
proof of good health
You and covered dependents will not have to answer medical
questions or otherwise prove you are in good health if you enroll
during Chevron open enrollment, October 17 through October
28, 2016 or within 31 days of hire or rehire or within 31 days of a
qualifying life event. The Group Hospital Indemnity Insurance plan
doesn’t have any pre-existing condition limitations.
• 1-800-274-4833, 8 a.m. to 7 p.m. Central time, Monday through
Friday beginning October 17, 2016.
• You can also read the Certificate of Insurance for this plan on
hr2.chevron.com or request a copy from Aflac.
To enroll or change coverage, contact the Chevron HR Service
Center. Please note, the HR Service Center is unable to answer
questions about this coverage; please contact Mercer at the
number above for that information.
how you pay for coverage
This voluntary coverage is paid entirely by you through after-tax
payroll deductions; Chevron does not contribute. You can view
premiums online, when you enroll, or you can call the Chevron
HR Service Center. If you enroll, your Group Hospital Indemnity
Insurance premium is automatically taken through after-tax payroll
deductions in 24 equal payments, regardless of your pay frequency.
• Benefits Connection website available from hr2.chevron.com
• 1-888-825-5247 (610-669-8595 outside the U.S.)
**The Aflac coverage described here is subject to plan limitations, exclusions,
definitions, and provisions. For detailed information, please see the plan brochures,
as this material is intended to provide general summaries of the coverage.
when coverage ends
Continental American Insurance Company (CAIC), a proud member of the
Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and
underwrites group coverage. CAIC is not licensed to solicit business in New York,
Guam, Puerto Rico, or the Virgin Islands. For groups sitused in California, group
coverage is underwritten by Continental American Life Insurance Company.
You are not required to re-enroll to continue coverage each year.
Participation will end when any of the following occurs:
• On the date the Group Hospital Indemnity Insurance plan
offering is terminated.
• On the date an insured cancels plan coverage or stops making
required plan contributions.
• On the date an insured no longer meets the plan eligibility
requirements and is therefore no longer eligible for coverage
under the plan.
September 2016
53
Human Energy. Yours.TM
Update to the Summary Plan Description
Effective January 1, 2017
All changes described in this SMM are effective January 1, 2017 unless otherwise indicated.
This enclosed newsletter serves as an official summary of material modification (SMM) for the plans
referenced herein. Please keep this information with your other plan documents for future reference.
This communication provides only certain highlights about changes of benefit provisions. It is not
intended to be a complete explanation. If there are any discrepancies between this communication and
the legal plan documents, the legal plan documents will prevail to the extent permitted by law. There
are no vested rights with respect to Chevron health care plans or any company contributions towards
the cost of such health care plans. Rather, Chevron Corporation reserves all rights, for any reason and
at any time, to amend, change or terminate these plans or to change or eliminate the company
contribution toward the cost of such plans. Such amendments, changes, terminations or eliminations
may be applicable without regard to whether someone previously terminated employment with Chevron
or previously was subject to a grandfathering provision. Some benefit plans and policies described in
this document may be subject to collective bargaining and, therefore, may not apply to unionrepresented employees.
You can access the summary plan descriptions for your benefits on the Internet at hr2.chevron.com or
by calling the HR Service Center at 1-888-825-5247 (610-669-8595 if you’re outside the U.S.), option 2.
This SMM applies to the following summary plan description:
•
January 1, 2017 Group Hospital Indemnity Insurance
January 1, 2017
Official Summary of Material Modification (SMM)
Updates to this Plan
Since the printing of the September 2016 U.S. Pay and Benefits newsletter, Prepare to Make Choices –
2017 Benefit Changes, several updates regarding this plan have surfaced. Information about the
changes are included here, but were also previously provided directly to Group Hospital Indemnity
Insurance participants.
When Payroll Deductions Begin
If you enroll during open enrollment.
Your Group Hospital Indemnity Insurance coverage begins on January 1 of the new year. However, due
to administrative processes surrounding enrollment and payroll deduction setup, payroll deductions for
Group Hospital Indemnity Insurance coverage will occur on your first paycheck in February. The first
payroll deduction will be your normal coverage cost; no retroactive deductions for the month of January
will be taken.
If you enroll mid-year.
If you enroll mid-year within 31-days of a qualifying life event or your hire date, your Group Hospital
Indemnity Insurance coverage begins on the first of month following the date your enrollment election is
made. Your first payroll deduction for Group Hospital Indemnity Insurance coverage will occur on in the
month following the date your coverage begins. The first payroll deduction will be your normal coverage
cost; no retroactive deductions to your coverage start date will be taken. For example:
•
•
•
Enrollment election is made on February 10.
Date coverage begins is March 1.
First payroll deduction will occur in April.
“Other Dependents” are not Eligible for Coverage
The Group Hospital Indemnity Insurance as currently underwritten does not include “other dependents”
in the definition of an eligible dependent. Please note that this eligibility restriction does not apply to
Chevron’s other health and welfare benefit plans which currently continue to provide access to
coverage for “other dependents.”
An “other dependent” is defined as a dependent who meets all of the following:
•
Not married.
•
Younger than age 26.
•
Is a member of your household.
•
Someone for whom you act as a guardian.
•
Dependent on you (or on your spouse/domestic partner) for more than
50 percent of his or her financial support.
Updated Eligibility Attestation
To be eligible for coverage, when you enroll you’ll be required to attest to meeting certain additional
eligibility requirements, including but not limited to:
•
You are actively at work for Chevron at the time of enrollment.
•
The person(s) to be insured has comprehensive health benefits from an insurance policy,
an HMO plan, or an employer’s health benefits. You do not have to be enrolled in
Chevron health coverage. This means you can have comprehensive health coverage
from another source.
•
California law prohibits an HIV test from being required or used by health insurance
companies as a condition for obtaining health insurance coverage.
January 1, 2017
Official Summary of Material Modification (SMM)
January 1, 2017
Official Summary of Material Modification (SMM)