The Family Indemnity Plan (F.I.P) covers funeral expenses for the member and the other individuals insured under the plan.

Any member under the age of 76 can purchase an F.I.P of his/her choice.

The following are the eligible family members:

• Member’s spouse or significant other (significant other: a person who lives with the member and is considered to be the insured’s common-law spouse)
• Unmarried dependents between the ages 1 – 25 (biological or non-biological)
• Members’ parents or spouses’ parents

Yes, the monthly premium payment covers everyone insured under the plan.

This is the annual dollar amount of covered expenses for which the Insured is responsible before benefits can be payable under the Policy.

This is the agreed percentage split of the covered expenses, between the Insurer and the Insured. This plan has an 80% / 20% coinsurance factor.

A pre-existing condition is a condition resulting from illness or injury for which a Covered Insured has received a diagnosis , consultation , medical treatment , or drug prescription prior to the effective date of the policy or date cover was effective; OR for which a symptom and/or sign of illness, if presented to a physician prior to the effective date of the policy would have resulted in the diagnosis of an illness or medical condition whether of not the patient was aware of the condition.

Medicals are done at the request of the insurer.

Certainly, you will get access to a Guardian’s “easi” claim card.

Coverage is only applicable to your spouse (common-law included) and children (step, legally adopted + incapacitated over the age of 25 years included). Children are covered without exception up to age 19. Between the ages of 19 and 25 children can continue coverage; however, they must be in school full-time as evidenced by a letter from the respective institution at the start of each academic year.

When an individual is covered under more than one health plan and is able to claim for the expenses incurred from both plans, the benefits under this policy will be reduced to an amount which when added to the benefit of the other plan will equal 100% of medical expenses incurred.

The following will determine which plan will pay first:

• The plan covering the insured as an employee;
• The plan covering the insured as a Dependent of a Male employee; and
• If the above do not establish an order of priority, the plan which has covered the insured for the longer period of time pays the benefits first.

Pre-certification is a notification of anticipated or schedule medical services that is required in advance of the actual medical treatment. Before you actually receive treatment or incur the medical expenses, BEACON upon request by the Provider, issues a pre-approval letter stating whether the anticipated service is eligible for coverage and the level of charges that would be reimbursed from the health plan.

A letter from the treating Physician or Medical facility with an itemization of the charges and the type of treatment/procedure recommended or scheduled must be sent to your PSCU plan administrator, who in turn will send to GENESIS.

Exclusions and Limitations refer to services, equipment, procedures and types of treatment that are not covered under the plan. These are listed in the policy contract.

UCR means the charge or fee determined by the Company to be the general rate charged by others who render or furnish such treatments, services or supplies to persons whose injuries or illnesses are comparable in nature and severity.

The Company will consider such factors as; complexity; degree of skill needed, type of specialist required, and the range of services or supplies provided by the facility. For example, if a doctor charges $3,000 for a surgical procedure and the usual fee for the procedure is $2000 then the plan will reimburse you based on the charge of $2000 and applicable co-insurance will apply.

You must be a member and under the age of 60 years in order to be eligible to apply for medical coverage.

The plan covers medical, dental, vision and there is also a term life insurance benefit.