Supplemental Medical Overview

You may have the option to enroll in supplemental medical coverage to provide additional financial protection in the event of accident, serious illness or hospitalization. You’ll see the specific benefits for which you’re eligible when you access the Mercer Marketplace 365+ website.

Supplemental medical insurance can help protect you from significant expenses not covered by your primary medical plan. These plans are intended to supplement your primary medical plan. On their own, they don’t provide the minimum level of medical coverage needed to meet health care reform requirements.

Chenega offers three different types of supplemental medical insurance through Aetna; choose any combination of the following:

  • Accident insurance
  • Critical illness insurance
  • Hospital indemnity insurance

Be sure to consider your anticipated medical needs for the coming year — for example, a major surgery — when deciding if supplemental coverage is right for you.

 

Accident Insurance

You may have the option to enroll in accident insurance to supplement your medical plan by providing cash benefits in case of accidental injuries that occur off the job. You’ll see the specific benefits for which you’re eligible when you access the Mercer Marketplace 365+ website.

You can’t always avoid accidents — but you can help protect yourself from accident-related costs that can strain your budget.

Accident insurance provides cash benefits that you can use to help pay for expenses your medical plan does not cover, such as your deductible or coinsurance, or for ongoing living expenses such as your mortgage or rent.

Benefits are paid:

  • Directly to you, unless assigned to someone else
  • In addition to any other coverage, like medical or an accidental death & dismemberment (AD&D) plan

The policy pays you a benefit up to a specific amount for:

  • Dislocation or fracture
  • Initial hospital confinement
  • Intensive care
  • Ambulance
  • Medical expenses
  • Outpatient physician’s treatment

The actual benefit amounts depend on the type of injuries you have and the medical services you need.

How accident coverage works

Let’s suppose you are involved in a mountain biking accident or take a nasty fall down some stairs. You suffer a fractured leg and a dislocated wrist, and you also need stitches. You take an ambulance to the emergency room, receive X-rays and spend two days in the hospital. Although your medical plan pays most of the medical expenses, you are still responsible for a remainder of the cost. That’s where accident insurance can help, as shown in the example below.

Aetna would pay you:
Service Covered Amount
ER services, X-rays and physician fees $150 + $50 X-ray
Fractured leg $1,125
Laceration requiring stitches $25-$600
Dislocated wrist $600
Ambulance $300 ground/ $1,500 air
Follow-up treatment ($50 a visit; three visits) $150
Hospital admission $1,500
Hospital care (plan pays $300 a day up to 90 days) $600 (2 days)
Total benefit paid directly to you $4,500–$6,275
 

Critical Illness Insurance

You may have the option to enroll in critical illness coverage that provides a lump-sum benefit to help protect against the financial impact of certain illnesses. You’ll see the specific benefits for which you’re eligible when you access the Mercer Marketplace 365+ website.

When a serious illness strikes, critical illness insurance can provide financial support to help you through a difficult time. If you are diagnosed with certain illnesses such as a heart attack or cancer, you receive a benefit payment to cover out-of-pocket expenses for your treatment that are not covered by your medical plan. You can also use the money to take care of your everyday living expenses like housekeeping services, special transportation services and day care.

Choose from two benefit coverage options:

  • $10,000
  • $20,000

Benefits are paid:

Directly to you, unless assigned to someone else.

How critical illness coverage works

Let’s suppose you choose the $20,000 coverage option. Then three months after enrolling, you have a heart attack. Three years later you suffer a stroke. In both cases, critical illness insurance would provide you with a lump-sum payment to use however you see fit. Your full benefit can be paid twice a year if your illness is separated by six months.

Aetna would pay you:
Heart attack benefit (100%) – year 1 $20,000
Stroke (100%) – year 3 $20,000
Total benefit paid directly to you $40,000
Key things to know
  • You can enroll during open enrollment without having to provide Evidence of Insurability (EOI).
  • If you choose to cover your dependents, the covered spouse/domestic partner and covered children benefit amount is 50% of your benefit amount.
  • Benefits are not paid for any critical illness diagnosed before your coverage effective date.
  • You can take your coverage with you if you leave Chenega.
 

Hospital Indemnity Insurance

You may have the option to enroll in hospital indemnity coverage that provides a lump-sum benefit to pay for certain expenses your medical plan doesn’t cover. You’ll see the specific benefits for which you’re eligible when you access the Mercer Marketplace 365+ website.

A trip to the hospital can be stressful, and so can the bills. Even with a major medical plan, you may still be responsible for copays, deductibles and other costs. A hospital indemnity plan provides supplemental payments you can use to cover out-of-pocket expenses for hospital stays, surgery and certain inpatient or outpatient treatments.

Benefits are paid:

  • Directly to you, unless assigned to someone else
  • As a lump sum or on a benefit schedule

Choose from two benefit coverage options:

  • Basic
  • Enhanced

How hospital indemnity coverage works

Let’s say your appendix ruptures, and your recovery keeps you in the hospital for five days.

Aetna would pay you: Basic Enhanced
Hospital admission benefit $1,000 $2,000
Daily hospital confinement benefit $100
($100 x 5 days)
$200
($200 x 5 days)
Total benefit paid directly to you $1,500 $3,000
Talk the talk

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Questions

If you have questions, call a Mercer Marketplace 365+ benefit counselor at 888-281-3534.