What is Essential Health?

Essential Health features insurance benefits that can help you pay expenses for covered events due to accident or illness*. You also have full access to a non-insurance Essential Health Discount Plan, which allows you to save up to 5-60% on physician care, vision, prescriptions and more*

All benefits are paid directly to you or whomever you choose. This means you can use the cash benefits you receive from this plan any way you wish. There are no deductibles or co-pays, and no restrictions on hospital providers to receive the insurance benefits.

Unlike many plans, Essential Health provides benefits on the first day of hospitalization due to covered accidents ($400/day up to 365 days) and from the first day of hospitalization lasting 3 days or more due to covered illness ($200/day up to 365 days). And, you can’t be turned down if you’re aged 18-65.

You can also receive benefits out of the hospital, too: starting at $50 per each doctor visit (3 visits per year) and $300 per each Emergency Room accident visit (up to 4 visits per year).

Best of all, your coverage amounts automatically increase every 3 months – with no increase in premium – for ten years, regardless of whether or not you’ve used your coverage.

You can be covered for a long-term hospital stay, too. The plan provides a single lump sum benefit in addition to your daily cash benefits: $5,000 after a 30 consecutive day inpatient hospital stay; or $10,000 after 60 consecutive day inpatient hospital stay or $25,000 if you’re still in the hospital after 90 consecutive days.

If you do not have traditional medical insurance, Essential Health can be an affordable way to help provide some insurance benefits against the high cost of medical care. For example, if you are hospitalized due to a covered illness you will receive $200 a day up to /$6,000 a month to help cover expenses, PLUS a lump sum benefit of $5,000 to $25,000 based on the length of your hospitalization after 30 days.

If you already have traditional health insurance — or feel like you don't have enough coverage under your current plan — Essential Health can be a good way to supplement your current coverage plan. Essential Health's benefits are paid to you regardless of any other coverage you might have. So even if you are covered for an event by your current insurance, you would be eligible to receive a cash benefit with Essential Health. Many people find their current coverage does not offer the level of benefits and coverage they need. Essential Health can help to add that extra level of insurance benefits.

Please note that benefits are reduced by 50% for covered accidents or illnesses occurring at age 70 and older.

Is Essential Health health insurance?

Essential Health is not traditional or comprehensive health insurance or major medical insurance, and should not be considered a substitute for traditional comprehensive health insurance or major medical insurance. It is a limited benefit insurance program that pays indemnity based benefits for covered events.

What types of coverage are available?
How much does it cost?

With Essential Health, you can elect individual or family coverage. With our family plan, you can receive valuable insurance coverage if your spouse or child is hospitalized. Our family plan covers your Spouse with 50% of your plan benefits and your dependent children with 20% of your plan benefits. Individual coverage is available for $29.95/month; family coverage is available for $45.95/month.

What are the benefits of Essential Health?

1. Save on prescriptions, doctor visits and eye care. Your plan includes full access to the non insurance Health Network Discounts* which can save you on prescriptions, physician care and eye care at tens of thousands of participating providers nationwide. These savings are in addition to any insurance benefits you are eligible to receive through the Essential Health. While you are free to visit any provider of choice to receive the insurance benefits, you need to use the Health Benefit Network Discount Plan’s participating providers in order to receive these discounts.

2. You can worry less about hospital bills. Your available daily insurance benefit amount starts at $400 a day for hospital stays due to a covered accident and $200/day beginning with the first day for hospitalizations lasting 3 or more days due to a covered illness. Emergency room visits due to covered accidents are $300 per accident visit.

3. Benefits include doctor visits, too. The plan pays benefits out of the hospital too: Starting at $50/doctor visit (3 visits per year) individual, 5 visits per year family.

4. Your coverage amounts automatically increase every 3 months (with no increase in premium!) for ten years – regardless of whether or not you’ve used your coverage.

How your coverage amounts G R O W…

5. Since this is not traditional health care insurance, there are no deductibles, co-payments, referrals or pre-approvals.

6. You’re covered for extended hospital stays, too.
To help ease the financial impact of an extended hospital confinement, the plan provides a single lump-sum benefit in addition to your daily cash benefits: $5,000 after a 30 consecutive-day inpatient hospital stay; or $10,000 after 60 consecutive-day stay or $25,000 if you’re still in the hospital after 90 consecutive days.

Unlike many plans, Essential Health provides benefits on the first day of coverage for covered accidents. Coverage for hospital stays due to covered illness begin after you have been covered for 6 months at 50% of your daily benefit amount for accident. Equal benefit amounts are paid for a covered accident and illness after one year.

7. You can cover yourself or your whole family. You can get coverage for just yourself or include your spouse and eligible dependent children. Benefit amounts for dependents are lower than the primary insured's benefit amounts. Either way, you pay one monthly rate that does not increase due to changes in your health or how many claims you submit: INDIVIDUAL PLAN $29.95/month FAMILY PLAN $45.95/month

8. You get more of the features you want. We listened when our customers told us they want: * Cash benefits paid direct to you or whomever you choose * Benefits paid in addition to any other insurance you have * No restrictions on hospitals or doctors

9. You can change your mind. If you’re not 100% satisfied with your coverage, you can cancel at any time. No additional premiums will be charged.

* Please note: the Health Benefit Network Discount Plan is not a health insurance policy. Savings are based upon a comparison of national average negotiated network provider discounts. Actual savings will vary based upon procedure, geographic location, and the provider’s discount. Discount Services may not be available in all states. Please call to verify availability in your home state.

What types of discounts are available?

You can save on doctor visits, dental, vision, prescriptions and more! You’ll have full access to the Health Benefit Network Discount Plan, with automatic savings of up to 55%* when you use in-network providers for:
* Physician Care
* Dental Treatment
* Vision
* Prescriptions

These savings are in addition to any cash benefits you are eligible to receive through Essential Health. You need to use the Health Benefit Network Discount Plan’s participating providers in order to receive these discounts.

* Please note: the Health Benefit Network Discount Plan is not a health insurance policy. Savings are based upon a comparison of national average negotiated network provider discounts. Actual savings will vary based upon procedure, geographic location, and the provider’s discount. Discount Services may not be available in all states. Please call to verify availability in your home state.

Health Benefit Network Discount Plan:

This plan provides discounts at certain health care providers for medical services. This plan does not make payments directly to the providers of medical services. The plan member is obligated to pay for all health care service but will receive a discount from those health care providers who have contracted with this discount plan organization. It is the member’s responsibility to confirm with Member Services that a provider is an active participant of the program prior to seeing that provider. Discount Medical Provider Organization: MedNet Benefits Inc., 428 E. Thunderbird Road, #645, Phoenix, AZ 85022
Discount Services may not be available in all states. Please call to verify availability in your home state. This package of benefits is NOT a substitute for Comprehensive Health Insurance.

Can I sign up for Essential health if I already have health insurance?

If you already have traditional health insurance – or feel like you don’t have enough coverage under your current plan - Essential Health can be a good way to supplement your current coverage. Essential Health’s benefits are paid to you regardless of any other coverage you might have. So even if you are covered for an event by your current insurance plan, you would still be eligible to receive cash benefit as a member of Essential Health. Many people find their current coverage does not offer the level of benefits and coverage they need. Essential Health can help to add that extra level of insurance and benefits.

What are the exclusions and limitations?

This disclosure explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this disclosure and the Policy, the terms of the Policy apply. Complete details are in the Insurance Documents issued to each insured person.

Insurance underwritten by National Union Fire Insurance Company of Pittsburgh, Pa., a Pennsylvania insurance company, with its principal place of business at 70 Pine Street, New York, New York 10270. It is currently authorized to transact business in all states and the District of Columbia. NAIC No. 19445. This is a brief description of the coverage(s) available under policy series BSR# C11695DBG and GAP# A30293NUFIC (in CO, FL & OR). The Policy contains reductions, limitations, exclusions and termination provisions. Full details of coverage are contained in the Insurance Documents and the Policy. If there are any conflicts between this document and the policy, the policy shall govern. Coverage may not be available in all states.

Exclusions:

No coverage shall be provided under the Policy and no payment shall be made for any loss resulting in whole or in part from, or contributed to by, or as a natural and probable consequence of any of the following excluded risks even if the proximate or precipitating cause of the loss is an accidental bodily Injury.

1. suicide or any attempt at suicide or intentionally self-inflicted Injury or any attempt at intentionally self-inflicted Injury or autoeroticism.
2. sickness, disease, mental incapacity or bodily infirmity whether the loss results directly or indirectly from any of these
3. the Insured Person's commission of or attempt to commit a felony.
4. infections of any kind regardless of how contracted, except bacterial infections that are directly caused by botulism, ptomaine poisoning or an accidental cut or wound independent and in the absence of any underlying sickness, disease or condition including but not limited to diabetes.
5. declared or undeclared war, or any act of declared or undeclared war, except if specifically provided by the Policy.
6. participation in any team sport or any other athletic activity, except participation in a Covered Activity.
7. full-time active duty in the armed forces, National Guard or organized reserve corps of any country or international authority. (Unearned premium for any period for which the Insured Person is not covered due to his or her active duty status will be refunded) (Loss caused while on short-tem National Guard or reserve duty for regularly scheduled training purposes is not excluded).
8. travel or flight in or on (including getting in or out of, or on or off of) any vehicle used for aerial navigation, if the Insured Person is:
A. riding as a passenger in any aircraft not intended or licensed for the transportation of passengers; or
B. performing, learning to perform or instructing others to perform as a pilot or crew member of any aircraft; or
C. riding as a passenger in an aircraft owned, leased or operated by the Policyholder or the Insured’s employer;
9. the Insured Person being under the influence of intoxicants.
10. the Insured Person being under the influence of drugs unless taken under the advice of and as specified by a Physician.
11. the medical or surgical treatment of sickness, disease, mental incapacity or bodily infirmity whether the loss results directly or indirectly from the treatment.
12. stroke or cerebrovascular accident or event; cardiovascular accident or event; myocardial infarction or heart attack; coronary thrombosis; aneurysm.
13. any condition for which the Insured Person is entitled to benefits under any Worker’s Compensation Act or similar law.
14. the Insured Person riding in or driving any type of motor vehicle as part of a speed contest or scheduled race, including testing such vehicle on a track, speedway or proving ground.
15. any loss incurred while outside the United States, its Territories or Canada.

Reduction Schedule.

The Maximum Amount used to determine the amount payable for a loss will be reduced if an Insured Person is age 70 or older on the date of the accident (or sickness) causing the loss with respect to any of the following Benefits provided by the Policy: Emergency Treatment Benefit, In-Hospital Indemnity Daily Benefit, In-Hospital Indemnity Single Payment Benefit, In-Hospital Indemnity Sickness Daily Benefit, In-Hospital Indemnity Sickness Single Payment Benefit. The Maximum Amount is reduced to a percentage of the Maximum Amount that would be used if the Insured Person were under age 70 on the date of the accident (or sickness), according to the following schedule:

AGE ON DATE OF ACCIDENT OR SICKNESS AGE - 70

PERCENTAGE OF UNDERAGE-70

MAXIMUM AMOUNT - 50%

Premium for an Insured Person age 70 or older is based on 100% of the coverage that would be in effect if the Insured Person were under age 70.

Who is Eligible

All customers ages 18 – 65 are eligible for this offer. In order to initiate your coverage YOU MUST CALL US OR ENROLL ONLINE. If you select Family Coverage, the person who signs the benefit form or calls to enroll will be the Primary Insured Person. You are eligible for coverage as a customer of the Policyholder identified on the Schedule of Benefits. Benefits are reduced by 50% by age 70. The sickness coverage terminates at age 75. No Insurance Underwriting Restrictions

All eligible customers who complete the Enrollment Form will be accepted. There are no medical questions or physical examinations for enrollment.

Effective Date of Coverage

Your coverage begins on the date for which the first premium for Your coverage is paid when due.

Termination of Coverage

Your coverage ends on the earliest of: (1) the date the Policy is terminated; (2) the premium due date if premiums are not paid when due; (3) the date You cease to be a member of any eligible class(es) of persons, as described in the classification of eligible persons section of the Policy; or (4) the date You request, in writing, that Your coverage be terminated.

How to File a Claim

Filing a claim is easy.Call our Claims Customer Service Department toll-free 1-800-551-0824. We will send you a claims form and can answer any questions you have. Simply complete the claim form and return it to the Claims Department (the address is indicated on the form). Please allow 10-15 days to receive payment. If additional information is needed to process the claim, the Claims Department will notify you by mail and will detail what information is required.

Definitions:

1. Eligible Dependent Child means Your unmarried child(ren), including natural, step, foster or adopted children from the moment of placement in Your home, under age 19 ( 23 if attending an accredited institution of higher learning on a full time basis) and primarily dependent on You for support and maintenance.

2. Sickness as used in this benefit means an illness or disease which is diagnosed or treated by a Physician after the effective date of coverage. Any exclusion in the above Exclusions section regarding sickness or disease; stroke or cerebrovascular accident or event; cardiovascular accident or event; myocardial infarction or heart attack; coronary thrombosis or aneurysm is hereby waived for this benefit.

3. Injury means bodily injury: (1) which is sustained as a direct result of an unintended, unanticipated accident that is external to the body and that occurs while the injured person’s coverage under the Policy is in force; (2) which directly (independent of sickness, disease, mental incapacity, bodily infirmity or any other cause) causes a covered loss; and (3) which occurs while such person is participating in a Covered Activity.

4. Emergency Treatment Benefit If an Insured Person suffers an Injury that, within 72 hours of the date of the accident that caused the Injury, requires him or her to receive Medically Necessary Emergency Treatment in a Hospital emergency room or a Satellite Emergency Center, the Company will pay 100% Emergency Treatment Benefit Maximum Amount shown in the Benefit Schedule. Only one Emergency Treatment Benefit is payable for any one accident per Insured Person.

5. Hospital as used in this Benefit, means a facility which: (1) is operated according to law for the care and treatment of injured and sick people; (2) has organized facilities for diagnosis and surgery on its premises or in facilities available to it on a prearranged basis; (3) has 24 hour nursing service by registered nurses (R.N.’s); and (4) is supervised by one or more Physicians. A Hospital does not include: (1) a nursing, convalescent or geriatric unit of a hospital when a patient is confined mainly to receive nursing care; or (2) a facility which is, other than incidentally, a rest home, nursing home, convalescent home or home for the aged; nor does it include any ward room, wing, or other section of the hospital that is used for such purposes.

6. Inpatient as used in this Benefit, means a person: (1) who is confined in a Hospital as a registered bed patient; and (2) for whom at least one day’s room and board is charged by the Hospital unless the Insured Person is confined as an Inpatient in any military, veterans or other government supported or sponsored Hospital for which a charge for room and board is not made.

Important Notice to Persons On Medicare

This insurance duplicates some Medicare Benefits. This is not Medicare Supplement Insurance. This insurance pays a fixed dollar amount, regardless of your expenses, for each day you meet the policies conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplemental insurance. This insurance duplicates Medicare benefits when any expenses or services covered by the policy are also covered by Medicare. Medicare generally pays for most or all of these expenses.

Medicare Pays extensive benefits for medically necessary services regardless of the reason you need them. These include hospitalization; physicians services, outpatient prescription drugs if you are enrolled in Medicare Part D; hospice, and other approved items and services. Before you buy this insurance check the coverage in all health insurance policies you already have. For more information about Medicare and Medicare Supplement Insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company. For help in understanding your health insurance, contact your state insurance department or state health assistance program (SHIP)

Note: If you are 70 years of age or older on the date of a covered accident (or sickness) for which benefits are payable, the benefits listed below will be reduced by fifty percent (50%), except for the Physician's Office Visits Indemnity Benefit.

When will my coverage begin?

Your coverage begins immediately upon payment of your first month’s premium.

How can I cancel my coverage? Are there any penalities?

You can cancel your coverage at any time with no additional cancellation penalties.

How do I file a claim under this plan?

Filing a claim is easy. Call our Claims Customer Service Department toll-free 1-877-341-0244. We will send you a claims form and can answer any questions you have. Simply complete the claim form and return it to the Claims Department (the address is indicated on the form). Please allow 10-15 days to receive payment. If additional information is needed to process the claim, the Claims Department will notify you by mail and will detail what information is required.

How are benefits paid?

Benefits for covered claims are paid directly to you , or whomever you choose, in the form of a check. There are no deductibles, no co-pays, no coordination with third party service providers. Since benefits are paid directly to you, YOU decide how best to spend the money you receive. You can pay doctor bills, or even household expenses. It’s up to you!

How do I know if Essential Health is right for me?

Essential Health is an affordable way to provide some insurance coverage against the high cost of medical care. For example, if you are hospitalized due to a covered accident, you will receive up to $400 a day to a maximum of 365 days to help cover expenses, PLUS a lump sum benefit of $5,000, $10,000, or $25,000 for covered inpatient hospitalizations lasting 30 or more, 60 or more or 90 or more days.

Unlike some other plans, Essential Health provides benefits on the first day of coverage for covered accidents. Coverage for hospital stays due to covered illness begins on the first day for any hospitalization lasting 3 days or more.

If you already have traditional health insurance — or feel like you don't have enough coverage under your current plan — Essential Health can be a good way to supplement your current coverage. Essential Health's benefits are paid to you regardless of any other coverage you might have. So even if you are covered for an event by your current insurance, you would still collect a cash benefit as a member of Essential Health. Many people find their current coverage does not offer the level of benefits and coverage they need. Essential Health can help to add that extra level of insurance benefits.

How do I enroll?

You can enroll online through our secure server. Or, feel free to call us toll-free at 1-877-341-0244. We have representatives available weekdays from 9 a.m. to 10 p.m. (EST) to enroll you right over the phone.

How can I get more information?

We would be happy to answer any questions you have about Essential Health. Please call us toll-free at 1-877-341-0244. We have representatives available Monday - Friday from 9 a.m. to 10 p.m. (EST) and Saturday 10am - 6pm EST to provide you with more details on benefits, pricing, signing up, billing, claims and much more. We understand that buying a health insurance plan can be confusing and we want you to make an informed decision by giving you as much information as you need. We look forward to hearing from you!

Who is National Union Fire Insurance Company?

Essential Health is underwritten by National Union Fire Insurance Company of Pittsburgh, PA. National Union began conducting business in 1901 and has been a leader in the management and professional liability markets for nearly three decades. National Union’s proven record, coupled with top rankings for financial strength and top credit ratings has made National Union the preferred management liability source for America’s largest companies.

Disclaimer

Insurance underwritten by National Union Fire Insurance Company of Pittsburgh, Pa., a Pennsylvania insurance company, with its principal place of business at 70 Pine Street, New York, NY 10270. Is currently authorized to transact business in all states and the District of Columbia. NAIC No. 19445. This is only a brief description of the coverage(s) available under policy series A30293NUFIC (in CO, FL & OR) A30329NUFIC and C11695DBG. The Policy will contain reductions, limitations, exclusions and termination provisions. Full details of coverage are contained in the Policy. If there is any conflict between the contents of this document and the Policy, the Policy will govern in all cases. Coverage may not be available in all states.
Essential Health Discount Plan provides discounts at certain health care providers for medical services. This plan does not make payments directly to the providers of medical services. The plan member is obligated to pay for all health care service but will receive a discount from those health care providers who have contracted with this discount plan organization. It is the member's responsibility to confirm with Member Services that a provider is an active participant of the program prior to seeing that provider. Discount Medical Provider Organization: MedNet Benefits Inc., 428 E. Thunderbird Road, #645, Phoenix, AZ 85022. Discount Services may not be available in all states. Please call to verify availability in your home state. This is a non-insurance discount service provided by Lifeguard Benefit Services. National Union assumes no responsibility or liability for the services provided by Third Parties.