The UPMA Supplemental Health Insurance Plan (SHIP)
Underwritten by: New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010
Coverage is Guaranteed
Eligible UPMA members are guaranteed to be accepted when enrolling the SHIP plan no matter what the condition of their health is. You will NOT be required to take a physical exam or answer a health questionnaire.
Who Can Apply?
As a UPMA member, under age 70 and enrolled in a Federal Employee Health Benefit Plan (FEHB) you are eligible and qualify to enroll for the UPMA SHIP benefits. You can cover your spouse and all of your dependent, unmarried children under age 26. It is an outstanding opportunity to help protect the whole family at competitive rates.
This coverage is only available to residents of the United States (except ME, MN, NH, OR, VT and WA), Puerto Rico and the District of Columbia. Individuals who are on active duty in the armed forces are not eligible.
Hospital Indemnity Benefits*:
Daily benefits payable for: Employee, Spouse or Child(ren)
- $75 (Red Plan)
- $150 (White Plan)
- $225 (Blue Plan)
Benefits are paid directly to you – in addition to any other medical benefits you may have.
Hospital Confinement Benefit*:
Daily Benefit of $75 (Red Plan), $150 (White Plan), or $225 (Blue Plan) .
Maximum Benefit Period: 365 days
Intensive Care Benefit*:
Pays an additional Daily Benefit of $75 (Red Plan), $150 (White Plan), or $225 (Blue Plan) .
Maximum Benefit Period: 90 days (excludes confinement of less than 24 hours in a recovery room after an operation).
At Home Recuperation (Home Convalescent Care Benefit)*
Daily Benefit $50 (Red Plan), $100 (White Plan), or $150 (Blue Plan). Must follow a Covered Stay and the Maximum Benefit Period is equal to the number of covered days of Hospital Confinement.
$150 (Red Plan), $300 (White Plan), or $450 (Blue Plan) per related surgery.
$150 (Red Plan), $300 (White Plan), or $450 (Blue Plan) benefit per session.
Accident Treatment Benefit*:
$75 (Red Plan), $150 (White Plan), or $225 (Blue Plan) – one benefit payment per accident if treatment begins within 90 days after the accident (provided the accident occurs while insured). However, this benefit does not apply to a loss caused by, or resulting from: (a) sickness or its medical or surgical treatment, including diagnosis; and (b) bacterial infection, except through a wound sustained in an accident.
*No Waiting (Elimination) Period except for Pre-Existing Conditions (see “Definition: Pre-Existing Condition” below). The blue plan is not available to residents of New York.
All premiums are based on the member’s age at issue and at renewal is determined by the member’s attained age the immediately preceding December 31, except that if a person’s birthday is December 31, then age is determined as of that day. Rates increase as the member attains a new age bracket. Premium rates shown are current and may be changed by New York Life on any premium due date and on any date on which benefits are changed. Benefits are subject to change by agreement between New York Life and the policyholder. Bi-Weekly, Monthly, Quarterly, Semi-Annual and Annual payment cycles available. Click here for complete premium chart.
When Coverage Becomes Effective
Insurance on you and your eligible dependents will take effect after the first of the month following the date your enrollment form is received and approved by New York Life, provided the initial premium is paid for monthly Check Service or Quarterly Direct Bill, or the first day of the pay period following the date the first deduction is received for Bi-Weekly Direct Deposit. You and any person to be insured must be performing the normal activities of a person in good health of like age on the later of the date of approval and the premium is paid. Otherwise, insurance will take effect on the day the proposed covered person is performing such normal activities if such day is within three months of the date insurance would otherwise have taken effect. The member must be insurance for dependent coverage to take effect.
Additional Dependents May be Automatically Covered:
Generally you must apply for coverage for new dependents. But there is an important exception: If you have any dependent hospital indemnity insurance in force, newborn children are automatically covered from birth for 31 days. This coverage will be continued if there is medical insurance in force on other dependent children. You must inform the SHIP Administrator in writing of the child’s name and date of birth. If there is no dependent coverage in force, you must notify the SHIP Administrator within 31 days and remit the extra premium needed.
When Coverage Ends
You may continue your coverage as long as you: remain a member; pay your premiums when due; don’t enter in the armed forces for more than 30 days of active duty; are under age 70; or, the Master Policy is not terminated or modified to end your coverage. Dependent coverage ends when they are no longer eligible, enter in the armed forces for more than 30 days of active duty, or when your coverage ends.
Definition: Pre-Existing Condition
Conditions for which an individual consulted a doctor or received any medical services or supplies, or took any medication, during the 12* months prior to their effective date of coverage won’t be covered until after: 12** consecutive months have elapsed while insured and during which no treatment, care or advice was received for that condition; or, after 24*** consecutive months of coverage under the plan. (* 6 Months in Florida, Indiana and New York; ** 6 months Mississippi; ***12 months in Montana, New York and North Carolina.)
A “hospital” is a licensed institution primarily engaged in providing in-patient medical services. It must have permanent facilities for diagnosis and surgery, 24-hour nursing by registered nurses and continuous supervision by one or more doctors. It does not include a convalescent home, nursing home, rest home, an extended care facility or a place for the aged.
Benefits provided only for confinements, which begin while insured for which a room and board charge is made, and which are recommended by a doctor as medically necessary to treat a sickness or accident. Benefits are not provided for confinements caused by, resulting from or contributed to by: intentionally self- inflicted injury, while sane or insane (Missouri while sane); treatment of nervous or mental condition, alcoholism or drug addiction; injuries resulting from active military service; dental care, except as a result of injury to sound natural teeth; well-baby care of a newborn dependent child; treatment or service rendered in any Hospital or Convalescent Facility owned or operated by the Government where, in the absence of insurance, there is no legal obligation to pay (Exclusions may differ in your state. See your Certificate of Insurance for details); declared or undeclared war or any act of war; pregnancy (except Complication of Pregnancy, as defined in your certificate of insurance); expenses incurred or care received outside of the United States; participating in a crime, illegal activity; or a pre- existing condition as defined above.
30-Day “Free Look”
You will be sent a certificate of insurance summarizing your benefits under the Group Hospital Indemnity Insurance plan. If you are not completely satisfied, you may return you certificate of insurance, without claim, within 30 days. Your coverage will be invalidated and you will receive a full refund of any premium paid – no questions asked.
Brokered and Administered by:
Mass Benefits Consultants, Inc.
P.O. Box 828
Annandale, VA 22003-0828
Call Toll-Free – 1-800-221-3083
New York Life Insurance Company
51 Madison Avenue
New York, New York 10010
on policy form GMR
New York Life is licensed/authorized to transact business in all of the 50 United States, the District of Columbia, Puerto Rico, and Canada. However, not all group plans it underwrites are available in all jurisdictions.
New York Life’s state of domicile is New York, and NAIC ID # is 66915.
This information is a brief description of important features of the UPMA Supplemental Hospital Indemnity Plan. It is not a contract. Terms and conditions of coverage are set forth in the group policy GMR-FACE/G-29162-0 issued to the Government Employees Voluntary Benefit Trust.