Hospital Insurance

The plans advertised herein offer supplemental insurance coverage and are not major medical insurance plans.

1 HOSPITAL – B40000 SERIES

In Arkansas, Policies B40100AR & B401HAR. In Delaware, Policies B40100DE & B4010HDE. In Idaho, Policies B40100ID & B4010HID. In New York, Policies NYB40100 & NYB4010H. In Oklahoma, Policies B40100OK & B4010HOK. In Oregon, Policies B40100OR & B4010HOR. In Pennsylvania, Policies B40100PA & B4010HPA. In Texas, Policies B40100TX& B4010HTX. This is a brief product overview only. Coverage may not be available in all states including but not limited to New Jersey. Benefits/premium rates may vary based on plan selected. Optional riders are available at an additional cost. The policy has limitations and exclusions that may affect benefits payable. Refer to the policy for complete details, limitations, and exclusions. For costs and complete details of the coverage, please contact your local Elise Insurance Group agent.

Limitations & Exclusions for the residents of Arizona:

Elise Insurance Group will not pay benefits for care or treatment that is: (1) caused by a Pre-existing Condition, unless it begins more than 12 months after the Effective Date of coverage, or (2) received prior to the Effective Date of coverage.

Elise Insurance Group will not pay benefits whenever coverage provided by the policy is in violation of any U.S. economic or trade sanctions. If the coverage violates U.S. economic or trade sanctions, such coverage shall be null and void.

Elise Insurance Group will not pay benefits whenever fraud is committed in making a claim under the coverage. If you have received benefits that were not contractually due under the coverage, then Elise Insurance Group reserves the right to offset any benefits payable under the coverage up to the amount of benefits you received that were not contractually due.

The policy does not cover losses caused by or resulting from:

Giving birth within the first ten months of the Effective Date of coverage; or pregnancy in existence prior to the Effective Date of coverage. Complications of Pregnancy, including nonelective cesarean, are covered to the same extent as a Sickness;
Receiving routine nursing or routine well-baby care for a newborn child;
Using any drug, narcotic, hallucinogen, or chemical substance (unless administered by a Physician and taken according to the Physician’s instructions), or voluntarily taking any type of poison or inhaling any type of gas or fumes;
Participating in, or attempting to participate in, an illegal activity that is defined as a felony (“felony” is as defined by the law of the jurisdiction in which the activity takes place); or being detained in any detention facility or penal institution;
Being intoxicated or under the influence of alcohol, drugs, or any narcotic, unless administered on the advice of a Physician and taken according to the Physician’s instructions (the term “intoxicated” refers to that condition as defined by the law of the jurisdiction in which the cause of the loss occurred);
Intentionally self-inflicting a bodily injury, or committing or attempting suicide, while sane or insane;
Having dental treatment, except as a result of Injury;
Having cosmetic surgery that is not Medically Necessary;
Having elective surgery that is not Medically Necessary within the first 12 months of the Effective Date of coverage;
Being exposed to war or any act of war, declared or undeclared, or actively serving in any of the armed forces, or units auxiliary thereto, including the National Guard or Reserve;
Actively participating in a riot, insurrection, or terrorist activity;
Donating an organ within the first 12 months of the Effective Date of coverage; or
Having mental or emotional disorders, including but not limited to the following: bipolar affective disorder (manicdepressive syndrome), delusional (paranoid) disorders, psychotic disorders, somatoform disorders (psychosomatic illness), eating disorders, schizophrenia, anxiety disorders, bereavement, situational depression, depression, stress, or post-partum depression. The policy will pay, however, for covered losses resulting from Alzheimer’s disease, or similar forms of senility or senile dementia, first manifested while coverage is in force.

A “Pre-existing Condition” is an illness, disease, infection, disorder, condition, or injury for which, within the 12-month period before the Effective Date of coverage, prescription medication was taken or medical testing, advice, consultation, or treatment was recommended or received, or for which symptoms existed that would ordinarily cause a prudent person to seek diagnosis, care, or treatment. Care or treatment caused by a Pre-existing Condition, including deliveries for children conceived prior to the Effective Date of coverage, will not be covered unless it begins more than 12 months after the Effective Date of coverage.

Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York.

Elise Insurance Group WWHQ | Tier One Insurance Company | 1932 Wynnton Road | Columbus, GA 31999.

Elise Insurance Group New York | 22 Corporate Woods Boulevard, Suite 2 | Albany, NY 12211

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