Page 3 - Metal-Gap2_Brochure
P. 3
Metal Gap 2 Plans MG675 MG35S MG70S MG25
Insurance Benefits MG35
Accident Medical Expense $3,500 $6,750 $3,500 $7,000 $2,500
Accidental Death and $3,500 $6,750 $3,500 $7,000 $10,000
Dismemberment
Critical Illness $7,500 $10,000 $7,500 $10,000 $10,000
Inpatient Surgery $1,000 $1,500
Outpatient Surgery $750 $1,250 $1,000
Hospital Admission Benefit $500
Hospital Confinement Benefit $1,000
The amount of benefits provided depends on the plan selected and the premium will vary with the amount of benefits selected.
Accident Medical Expense: Benefits are payable for covered charges incurred by a covered person due to injury up to the select maximum benefit
amount, or the actual expense you incur, whichever is less. Charges are payable only for an injury for which the first treatment or service is incurred within
the initial treatment period and for which expense for all treatment or service is incurred within the benefit period. No benefits are available beyond the
benefit period.
Accidental Death and Dismemberment: The benefit is paid when an accident results in death or a covered loss or dismemberment. The amount paid will
vary based on the nature of the loss. This benefit is available once during the coverage period.
Critical Illness: Covered critical illnesses include life-threatening cancer; heart attack; kidney (renal) failure which is independent of disease or bodily
infirmity or any other cause; stroke; coma; coronary artery bypass graft; loss of sight, speech or hearing; major organ transplant; paralysis and severe
burn. (Covered illnesses may vary by state.) The percentage of the benefit paid varies based on the illness diagnosed. In addition to the standard plan
benefit, a critical illness benefit of $2,500 is available for each covered dependent child.
Refer to the Critical Illness Indemnity Benefit Rider for complete details on each covered critical illness. In the event that a Covered Person is first
Diagnosed with one of the conditions listed below during the first 30 days after the Covered Person’s Effective Date of Coverage, the benefit will be limited
to the lesser of $500 or 10 percent of the total amount that would have been paid had the condition been diagnosed after 30 days of the effective date of
coverage. Only those conditions listed in the Benefit Rider will be covered.
Inpatient and Outpatient Surgical: The benefit is paid for a covered inpatient or outpatient surgical procedure to repair damage, control a disease or
certify a diagnosis. One inpatient and one outpatient benefit are available per calendar year.
Hospital Admission Benefit and Hospital Confinement Benefit: The first-day hospital admission benefit is available when admitted as an inpatient
due to a covered accident or sickness. The daily hospital confinement benefit is paid for up to 10 days of a covered inpatient hospital stay. The first-day
confinement benefit is available once per calendar year, and the daily confinement benefit is available for up to 10 days per calendar year.
Eligibility
Metal Gap 2 is available to the primary applicant up to age 64, his or her spouse age 18 to 64 and dependent children under the age of 26. Child-only plans
are not available. All benefits terminate when the covered person has attained age 70.
Exclusions and Limitations
The following services are NOT covered by the Metal Gap 2 plans. This is only a brief list of exclusions. For a complete list of all policy provisions, including
limitations and exclusions refer to the policy.
• Expenses incurred outside the United States, unless such expenses are incurred while traveling less than 90 days.
• Treatment which is: not medically necessary; not prescribed by a physician; received without charge; received from any family member; not rendered in
accordance with generally accepted standards of medical practice; or not specifically listed in the Policy as a covered charge or covered loss.
• Injury received as a result of: suicide or attempted suicide; declared or undeclared war; voluntary participation in a riot or insurrection; engaging
in an illegal act; traveling or flying by air, except as a fare-paying passenger; participating in a rodeo; participating in or practicing for any collegiate or
professional sports; flying in an ultra-light aircraft, hang gliding, parachuting or bungee-cord jumping, or by flight in a spacecraft; as well as work-related
injury covered under Workers’ Compensation or incurred while on active duty in the armed forces; or injury incurred while intoxicated or under the
influence of alcohol.
• Inpatient and Outpatient Surgical Procedures: Benefits will not be payable for: a weekend confinement unless medically necessary; cosmetic or plastic
surgery; treatment, services or supplies for breast augmentation or removal of breast implants; surgery to correct refractive errors; fertility or sterility;
impregnation techniques; abortion; sexual reassignments or sexual dysfunctions; obesity or weight reduction; temporomandibular joint (TMJ) dysfunction;
pregnancy; outpatient minor surgical procedures performed in a physician’s office or clinic; or a pre-existing condition.
A pre-existing condition is defined as a sickness, disease or injury for which medical advice, diagnosis, care or treatment was recommended or received
from a physician, or symptoms that would have caused an ordinarily prudent person to seek care, during the 12 months immediately preceding the covered
person’s effective date.
Brochure Metal Gap 2 IAIC 1118 3
Insurance Benefits MG35
Accident Medical Expense $3,500 $6,750 $3,500 $7,000 $2,500
Accidental Death and $3,500 $6,750 $3,500 $7,000 $10,000
Dismemberment
Critical Illness $7,500 $10,000 $7,500 $10,000 $10,000
Inpatient Surgery $1,000 $1,500
Outpatient Surgery $750 $1,250 $1,000
Hospital Admission Benefit $500
Hospital Confinement Benefit $1,000
The amount of benefits provided depends on the plan selected and the premium will vary with the amount of benefits selected.
Accident Medical Expense: Benefits are payable for covered charges incurred by a covered person due to injury up to the select maximum benefit
amount, or the actual expense you incur, whichever is less. Charges are payable only for an injury for which the first treatment or service is incurred within
the initial treatment period and for which expense for all treatment or service is incurred within the benefit period. No benefits are available beyond the
benefit period.
Accidental Death and Dismemberment: The benefit is paid when an accident results in death or a covered loss or dismemberment. The amount paid will
vary based on the nature of the loss. This benefit is available once during the coverage period.
Critical Illness: Covered critical illnesses include life-threatening cancer; heart attack; kidney (renal) failure which is independent of disease or bodily
infirmity or any other cause; stroke; coma; coronary artery bypass graft; loss of sight, speech or hearing; major organ transplant; paralysis and severe
burn. (Covered illnesses may vary by state.) The percentage of the benefit paid varies based on the illness diagnosed. In addition to the standard plan
benefit, a critical illness benefit of $2,500 is available for each covered dependent child.
Refer to the Critical Illness Indemnity Benefit Rider for complete details on each covered critical illness. In the event that a Covered Person is first
Diagnosed with one of the conditions listed below during the first 30 days after the Covered Person’s Effective Date of Coverage, the benefit will be limited
to the lesser of $500 or 10 percent of the total amount that would have been paid had the condition been diagnosed after 30 days of the effective date of
coverage. Only those conditions listed in the Benefit Rider will be covered.
Inpatient and Outpatient Surgical: The benefit is paid for a covered inpatient or outpatient surgical procedure to repair damage, control a disease or
certify a diagnosis. One inpatient and one outpatient benefit are available per calendar year.
Hospital Admission Benefit and Hospital Confinement Benefit: The first-day hospital admission benefit is available when admitted as an inpatient
due to a covered accident or sickness. The daily hospital confinement benefit is paid for up to 10 days of a covered inpatient hospital stay. The first-day
confinement benefit is available once per calendar year, and the daily confinement benefit is available for up to 10 days per calendar year.
Eligibility
Metal Gap 2 is available to the primary applicant up to age 64, his or her spouse age 18 to 64 and dependent children under the age of 26. Child-only plans
are not available. All benefits terminate when the covered person has attained age 70.
Exclusions and Limitations
The following services are NOT covered by the Metal Gap 2 plans. This is only a brief list of exclusions. For a complete list of all policy provisions, including
limitations and exclusions refer to the policy.
• Expenses incurred outside the United States, unless such expenses are incurred while traveling less than 90 days.
• Treatment which is: not medically necessary; not prescribed by a physician; received without charge; received from any family member; not rendered in
accordance with generally accepted standards of medical practice; or not specifically listed in the Policy as a covered charge or covered loss.
• Injury received as a result of: suicide or attempted suicide; declared or undeclared war; voluntary participation in a riot or insurrection; engaging
in an illegal act; traveling or flying by air, except as a fare-paying passenger; participating in a rodeo; participating in or practicing for any collegiate or
professional sports; flying in an ultra-light aircraft, hang gliding, parachuting or bungee-cord jumping, or by flight in a spacecraft; as well as work-related
injury covered under Workers’ Compensation or incurred while on active duty in the armed forces; or injury incurred while intoxicated or under the
influence of alcohol.
• Inpatient and Outpatient Surgical Procedures: Benefits will not be payable for: a weekend confinement unless medically necessary; cosmetic or plastic
surgery; treatment, services or supplies for breast augmentation or removal of breast implants; surgery to correct refractive errors; fertility or sterility;
impregnation techniques; abortion; sexual reassignments or sexual dysfunctions; obesity or weight reduction; temporomandibular joint (TMJ) dysfunction;
pregnancy; outpatient minor surgical procedures performed in a physician’s office or clinic; or a pre-existing condition.
A pre-existing condition is defined as a sickness, disease or injury for which medical advice, diagnosis, care or treatment was recommended or received
from a physician, or symptoms that would have caused an ordinarily prudent person to seek care, during the 12 months immediately preceding the covered
person’s effective date.
Brochure Metal Gap 2 IAIC 1118 3
