Hospital stay reimbursement

Overview

If you need to be hospitalized for any reason, this will reimburse up to $250 per overnight stay in a hospital for up to 5 days.

• Reimburses member up to $250 for each required overnight stay in a hospital up to a max of 5 days per hospital stay.
• Limit of 2 claims per member per year

Description

In the event You, the member, is involved in an accident that requires You to stay overnight
in the hospital, this coverage will reimburse You for an amount equal to a maximum of  $250 for
each required overnight stay up to a maximum of five (5) days per hospital stay.  Coverage is
limited to two claims per member per year.  Failure to give notice within 30 days from the date of
the incident or as soon as reasonably possible will result in a denial of the claim.

Hospital stays resulting from the following are not covered:

• Related to pregnancy or childbirth
• Intentionally self-inflicted injury, suicide or attempted suicide, whether the Eligible Person is sane or insane.
• Claims for or arising from the influence of alcohol or intoxicants or the use of drugs, except as prescribed by a Physician.
• For the purpose of plastic or cosmetic surgery, except as the result of an injury.

“Hospital” is defined as a facility that:
• Is primarily engaged in providing medical care by or under the supervision of, doctors of medicine or osteopathy, Inpatient services for the diagnosis, treatment, and care, or rehabilitation of persons who are sick, injured, or disabled;
• Is not primarily engaged in providing skilled nursing care and related services for persons who require medical or nursing care i.e.; long term care homes or nursing homes;
• Provides 24 hours nursing service;
• Is licensed or approved as meeting the standards for licensing by the state in which it is located or by the applicable local licensing authority; and
• Is not, other than incidentally, a place for treatment of drug addiction.

How To File a Claim

How to file a claim:

(1) Call 1-800-711-4280 to report your claim within 30 days of the date(s) of your hospital stay and a Claim form will be mailed to you.

(2) Complete the Claim Form and return it along with any other requested information and a copy of:
a) hospital and/or insurance forms showing injury and diagnosis of treatment,
b) all medical bills relating to injury/treatment including room charges, and
  a letter from physician treating injury.

(3) Completed Claim form and supporting documentation should be mailed to the Claim
Administrator:
cynoSure Financial, Inc.
P.O. Box 7690
St. Clair Shores, MI 48080

Call administrator at 1-800-711-4280