Hospital Indemnity Coverage (HIC)
Hospital Indemnity Coverage (HIC) provides benefits for you and your eligible dependents if you are admitted into a hospital as an inpatient due to a covered sickness or injury. The levels of daily coverage are $50 or $150.
Hospital Indemnity Coverage
Unexpected hospital stays can mean lost time and lost income, which can make it hard to keep up with bills and things at home. Hospital Indemnity Coverage (HIC) pays you a set amount for every day you are in the hospital, for a covered sickness or injury, so you can rest easier.
The Employee must be enrolled for coverage in order to enroll your dependent(s).
If a child is born to anyone under this policy while family coverage is in force, the child shall automatically become a covered dependent from the moment of birth. However, you must still contact the FBMC Service Center at 1.855.MDC.PS4U (1.855.632.7748) and request a Change in Status form. This includes coverage for sickness or injury, and the necessary care and treatment of medically diagnosed congenital defects, birth abnormalities and premature birth. Routine care for the child is not covered under this policy.
"Doctor" means a duly licensed practitioner of the healing arts acting within the scope of his/her license. Doctor does not include: the Insured or the Insured's spouse; or the Insured or the Insured spouse's child, parent, brother, sister; or a person living with the Insured. "Hospital" means an institution which:
- is licensed as a hospital pursuant to applicable law
- is primarily and continuously engaged in providing medical care and treatment to sick and injured persons on an inpatient basis;
- is under the supervision of a staff of doctors
- provides 24-hour nursing service by or under the supervision of a graduate registered nurse (R.N.)
- has medical, diagnostic and treatment facilities, with major surgical facilities:
- on its premises, or
- available to it on a prearranged basis, and
- charges for its services.
Hospital does not include:
- a clinic or facility or unit of a hospital for 1) convalescent, custodial (primarily for the purpose of meeting personal needs and could be provided by person other than doctors and nurses), educational or nursing care; 2) the aged, drug addicts or alcoholics; 3) rehabilitation; or
- a military or veterans hospital contracted for, or operating by a national government or its agency unless: 1) the services are rendered on an emergency basis; and 2) in the absence of insurance, a legal liability exists to pay the charges for the services given.
Effective Date Provision
An insured’s coverage begins on the effective date shown in the issued Certificate of Insurance, subject to receipt of the correct initial premium and provided the person is considered to be actively at work.
An insured’s coverage will end on the earliest of: if no longer an eligible employee/retiree of the policy holder; if required premium is not paid by the end of the grace period; the date the group policy is terminated; the date coverage is terminated for the class of eligible persons to which the insured belongs.
- All Full-Time employees and Part-time employees are eligible to enroll in the Hospital Indemnity Coverage offered by the School Board.
- COBRA participants are ineligible to enroll in Hospital Indemnity Coverage.
Tools and Resources
Exclusions and limitations in any policy and certificate issued will be based on the policyholder’s situs state, plan design and states where employees reside. If the policyholder has employees residing in the following states, that state’s Exclusions and Limitations will apply: Alaska, Arkansas, Connecticut, Louisiana, Minnesota, Mississippi, Montana, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, South Carolina, Texas, Utah, Vermont, Washington, West Virginia, and Wisconsin.
How to read this section:
Exclusions appear in bold font. Applicable state variations are noted in italics.
We will not pay benefits for any loss due to an Accident or Sickness for a covered person caused or contributed to by any of the following:
- the covered person’s voluntary use, by any means, of:
- any drug, medication or sedative, unless it is:
- taken or used as prescribed by a physician; or
- an “over the counter” drug, medication or sedative taken as directed
- alcohol in combination with any drug, medication, or sedative
- poison, gas, or fumes
- the covered person’s suicide or attempted suicide (while sane or insane)
- the covered person’s intentionally self-inflicted injury
- war, whether declared or undeclared; or act of war
- the covered person’s active participation in an insurrection, rebellion, riot, or terrorist act
- the covered person’s engagement in any activity that constitutes a felony under the laws of the jurisdiction in which the activity occurred
- dental procedures or surgery except as the result of an Accident causing Injury to a sound natural tooth
- cosmetic surgery, except when such surgery is performed to:
- treat an Injury or Sickness;
- correct a disorder of normal bodily function or structure that was caused by an Injury or Sickness for which coverage is not otherwise excluded under the certificate; or
- reconstruct a part of the body which was disfigured or removed as a result of an Injury or Sickness for which coverage is not otherwise excluded under the certificate
- the covered person’s mental illness, or the diagnosis or treatment of such mental illness, except for the covered person’s use of:
- any drug, medication or sedative that is taken or used as prescribed by a Physician; or
- an “over the counter” drug, medication or sedative taken as directed
- activities required by the covered person to carry out the duties and responsibilities of their service in the armed forces or any auxiliary unit of the armed forces of any country or international authority
In addition, We will not pay benefits for:
- a covered person while incarcerated in any type of penal or detention facility
- any of the following outside of the United States, Canada or Mexico:
- any medical or healthcare treatment, services or transportation; or
- any inpatient admission or stay in any medical or health care facility
The following additional exclusions apply to payment of benefits for any loss due to an Accident:
We will not pay benefits for any loss due to an Accident for a covered person caused or contributed to by any of the following:
- the covered person’s operation, while intoxicated, of a motor vehicle involved in the incident. For purposes of this exclusion:
- intoxicated means that the covered person’s blood alcohol level met or exceeded .08%; and
- motor vehicle means any vehicle that is powered by a motor, including, but not limited to: an automobile; a boat; a motorcycle; a truck; an all-terrain vehicle; or a snow mobile
- the covered person’s travel or flight in any aircraft except as a fare-paying passenger on a regularly scheduled charter or commercial flight
- the covered person parachuting or otherwise exiting from a motorized or non-motorized aircraft while such aircraft is in flight, except for self-preservation
- the covered person riding in or driving any motor-driven vehicle in a race, stunt show or speed test
- the covered person participating in any semi-professional or professional competitive athletic activity for which any type of compensation or remuneration is received
- the covered person bungee jumping, base jumping, hang gliding, para-kiting, sail-gliding, scuba diving deeper than 130 feet; spelunking; or mountaineering including rock climbing using ropes and any other climbing equipment for the purposes of this exclusion the term mountaineering does not include backpacking, mountain biking, hiking or trail running
The following additional exclusions apply to payment of benefits for any loss due to a Sickness:
We will not pay benefits under the certificate for:
- a dependent child’s routine pregnancy or routine childbirth and any well baby or nursing care provided to the dependent child’s newborn child
- the covered person’s alcoholism, drug addiction, chemical dependency or complications thereof
Mon - Fri, 8 a.m. to 8 p.m. ET
Sat. 9a.m. to 1 p.m. ET
FBMC Service Center
Mon - Fri, 7 a.m. to 7 p.m. ET