MedSouth Life & Health

Coverage that is Extensive not Expensive!

Accident Expense Coverage for Members and their Families
• Pays 100% of Covered Medical Expenses after   satisfaction of the $100 or $250 Deductible up to the   coverage maximum
• Use any doctor or hospital
• NEW CallMD, a network of medical doctors you can   call for a consultation or medical needs anytime, any   day!
• Accidental Death & Dismemberment benefits
• Emergency Helicopter Air Ambulance benefits
• Automatic acceptance through age 64
• Benefits are paid directly to you
 
Basic Basic Plus Basic Premier Premier
ACCIDENT  MEDICAL EXPENSE COVERAGE
$2,500
(after a $100 deductible is satisfied) 		$5,000
(after a $100 deductible is satisfied)		 $7,500
(after a $250 deductible is satisfied)		 $10,000
(after a $250 deductible is satisfied)

ACCIDENTAL DEATH & DISMEMBERMENT**
$5,000 $5,000 $7,500 $10,000
EMERGENCY HELICOPTER AIR AMBULANCE WORLDWIDE COVERAGE
$4,000 $4,000 $4,000 $4,000
Monthly Cost Single or Family*
 $34.95
$44.95
$54.95
 $64.95
* Includes a $9.95 monthly administration fee.
Accident Medical Expense benefits are excess to other coverage.
**Accident Death & Dismemberment benefit are at lower amounts than shown for spouse and dependents. This site depicts only a summary of services provided. For complete details, including exceptions and limitations refer to Membership material.

BENEFITS DETAILS
 
BENEFIT DETAILS (Membership Levels $2,500, $5,000 and $7,500)
 
Accidental Death & Dismemberment Benefits:
We will pay the benefit shown below if Injury or Death occurs due to a Covered Accident, 24 hours a day, anywhere in the world, subject to the limitations listed below. If Your Injury results in any of the following losses within 365 days after the date of the Covered Accident, We will pay the amount shown below for that loss. If multiple losses occur, only one Benefit Amount, the largest, will be paid for all losses due to the same Covered Accident.
 
Covered Loss Indemnity
Life; Both Hands or Both Feet; Sight of Both Eyes Principal Sum
One Hand and One Foot; Either Hand or Foot and Sight of One Eye Principal Sum
Either Hand or Foot, or Sight of One Eye 50% of the Principal Sum
Thumb and Index Finger of the Same Hand 25% of the Principal Sum
"Loss of Hand or Foot" means complete Severance through or above the wrist or ankle joint. "Loss of Hand" includes "Loss of Four Fingers of the Same Hand." "Loss of Sight" means the total, permanent Loss of Sight of one eye that is irrecoverable by natural, surgical or artificial means. "Loss of a Thumb and Index Finger in the Same Hand" or "Loss of Four Fingers of the Same Hand" means complete Severance through or above the metacarpophalangeal joints of the same hand (the joints between the fingers and the hand). "Severance" means the complete separation and dismemberment of the part from the body.
Principal Sum: $2,500.00, $5,000.00 or $7,500.00 (Based on membership level purchased.)
 
Family Plan Coverage (if family program is elected): Your Spouse is automatically insured for 50% of your Principal Sum (the amount increases to 60% if there are no dependent children); each Dependent child is automatically insured for 20% of your Principal sum (increases to 25% if no Spouse).
G-19001-AD
 
Accident Medical/Dental Expense Benefits:
We will pay Accident Medical/Dental Benefits for Covered Expenses that result directly, and from no other cause, from a Covered Accident. These benefits are subject to a Deductible, and the Benefit Maximum (see below).
Benefit Maximum Deductible
$2,500.00 $100.00
$5,000.00 $100.00
$7,500.00 $250.00
 
The first Covered Expenses must be incurred within 90 days of the Accident.
Accident Medical/Dental Benefits are only payable:
(1) for Usual and Customary Charges incurred after the Deductible has been met;
(2) for those Medically Necessary Covered Expenses incurred by or on behalf of the Covered Person; and
(3) for charges incurred within 365 days after the date of the Covered Accident. No benefits will be paid for any expenses incurred that, in Our judgment, are in excess of Usual and Customary Charges.
 
Eligibility: Each person under the age of 65 who are members of Value Benefits of America, Inc. and his or her Eligible Dependents (if family program is elected).
 
Period of Coverage: Coverage begins on the later of:
(1) the Policy Effective Date; or 2) the date that the Insured becomes eligible. Coverage will end on the earlier of the date:
(2) the policy terminates; 2) the Insured is no longer eligible;
(3) the period ends for which the premium is paid; or
(4) the Insured attains age 70.
 
For insurance to take effect, each person must be in Active Service. If an Eligible Person or Dependent is not in Active Service on the date insurance would otherwise be effective, it will be effective on the date he or she returns to Active Service. A Dependent’s insurance will not be in effect prior to the date an Eligible Person is insured.
 
Active Service means a Covered Person is either: 1) actively at work performing all regular duties on a full-time basis either at his or her primary employer’s place of business or someplace the employer requires him or her to be; 2) employed, but on a scheduled holiday, vacation day or period of approved paid leave of absence; or 3) if not employed, able to engage in substantially all of the usual activities of a person in good health of like age and sex and not confined in a Hospital or rehabilitation or rest facility.
G-19001-E
 
Covered Expenses:
1. Hospital Room and Board Expenses: the daily room rate when a Covered Person is Hospital Confined and general nursing care is provided and charged for by the Hospital.
2. Ancillary Hospital Expenses: services and supplies including operating room, laboratory tests, anesthesia and medicines (excluding take home drugs) when Hospital Confined.
3. Registered Nurse Services Expenses for private duty nursing while a Covered Person is Hospital Confined; these services must be ordered by a Doctor.
4. X-ray Expenses (including reading charges) but not for dental X-rays.
5. Dental Expenses including dental X-rays for the repair or treatment of each injured tooth that is whole, sound and a natural tooth at the time of the Accident.
6. Ambulance Expense for transportation from the emergency site to the Hospital.
7. Prescription Drug Expenses (for injuries only) prescribed by a Doctor and administered on an outpatient basis.
8. Medical Emergency Care (room and supplies) Expenses; incurred within 72 hours of a Covered Accident and including the attending Doctor’s charges, X-rays, laboratory procedures, use of the emergency room and supplies.
G-19001-SA
 
BENEFIT DETAILS (Membership Level $10,000)
 
ACCIDENTAL DEATH, DISMEMBERMENT SCHEDULE
AND LOSS OF SIGHT, SPEECH AND HEARING BENEFIT
Description of Loss Benefit Maximum
Life; Both Hands or Both Feet; Sight of Both Eyes; Speech and Hearing.............. Principal Sum
Either Hand, Foot, Sight of One Eye, Speech or Hearing.................................... One-Half the Principal Sum
Thumb and Index Finger of the Same Hand or Four Fingers of the Same Hand..... One-Quarter the Principal Sum
See certificate of coverage for dependent benefit maximum
 
ACCIDENT MEDICAL EXPENSE BENEFITS
The Carrier will pay Accident Medical Expense Benefits for Covered Expenses that result directly, and from no other cause, from a Covered Accident. These benefits are subject to the Deductible, Maximum Benefit Period, Benefit Maximum and other terms or limits shown below.
 
• Benefit Maximum: $10,000
• Maximum Benefit Period: 365 days after the date of the Covered Accident
• Deductible: $250
• Accident Medical Expense Benefits are only payable:
1) For Usual and Customary Charges incurred after the Deductible has been met;
2) For those Medically Necessary Covered Expenses that You receive; and
3) If the first incurred expenses are within 365 days from the date of the Covered Accident. No benefits will be paid for any expenses incurred that, in Our judgment, are in excess of Usual and Customary Charges.
 
Covered Medical Expenses:
1) Hospital Room and Board Expenses: the daily room rate when You are Hospital Confined and general nursing care is provided and charged for by the Hospital. In computing the number of day’s payable under this benefit, the date of admission will be counted but not the date of discharge
2) Ancillary Hospital Expenses: services and supplies including operating room, laboratory tests, anesthesia and medicines (excluding take home drugs) when Hospital Confined.
3) Medical Emergency Care (room and supplies) for Expenses incurred within 72 hours of an Accident and including the attending Doctor’s charges, X-rays, laboratory procedures, use of the emergency room and supplies.
4) Outpatient Surgical Room and Supply Expenses for use of the surgical facility. 5) Outpatient diagnostic X-rays, laboratory procedures and tests.
5) Doctor Non-Surgical Treatment/Examination Expenses (excluding medicines) including the Doctor’s initial visit, each necessary follow-up visit and consultation visits when referred by the attending Doctor.
6) Doctor’s Surgical Expenses if an Injury requires multiple surgical procedures through the same incision, the Carrier will pay only one benefit, the largest of the procedures performed. If multiple surgical procedures are performed during the same operative session but through different incisions, the Carrier will pay for the most expensive procedure and 50% of covered expenses for the additional surgeries.
7) Assistant Surgeon Expenses when Medically Necessary.
8) Anesthesiologist Expenses for pre-operative screening and administration of anesthesia during a surgical procedure whether on an inpatient or outpatient basis.
9) Outpatient Laboratory Test Expenses.
10) Physiotherapy Expenses on an inpatient or outpatient basis limited to one visit per day; Expenses include treatment and office visits connected with such treatment when prescribed by a Doctor, including diathermy, ultrasonic, whirlpool, or heat treatments, adjustments, manipulation, massage or any form of physical therapy.
11) X-ray Expenses (including reading charges) but not for dental X-rays.
12) Diagnostic Imaging Expenses: including Magnetic Resonance Imaging (MRI) and CAT Scan.
13) Dental Expenses including dental x-rays for the repair or treatment of each injured tooth that is whole, sound and a natural tooth at the time of the Accident.
14) Ambulance Expenses for transportation from the emergency site to the Hospital.
15) Rehabilitative braces or appliances prescribed by a Doctor. It must be durable medical equipment that a) is primarily and customarily used to serve a medical purpose; b) can withstand repeated use; and c) generally is not useful to a person in the absence of Injury. No benefits will be paid for rental charges in excess of the purchase price.
16) Prescription Drug Expenses (for injuries only) prescribed by a Doctor and administered on an outpatient basis.
17) Medical Equipment Rental Expenses for a wheelchair or other medical equipment that has therapeutic value for You. The Carrier will not cover computers, motor vehicles or modifications to a motor vehicle, ramps and installation costs, eyeglasses and hearing aids.
18) Medical Services and Supplies: expenses for blood and blood transfusions; oxygen and its administration.
 
Note: Covered Medical Expense is the Usual and Customary Charge based on the average amount charged by most providers for treatment, service or supplies in the geographic area where the service is provided.
 
Exposure and Disappearance: Coverage includes exposure to the elements after the forced landing, stranding, sinking, or wrecking of a vehicle in which the Covered Person was traveling.
A Covered Person is presumed dead if:
1) he or she is in a vehicle that disappears, sinks, or is stranded or wrecked on a trip covered by the Policy; and
2) the body is not found within one year of the Covered Accident.
 
Accidental Death & Dismemberment Benefits: If the Covered Person’s Injury results in any of the following losses within 365 days after the date of the Covered Accident, the Carrier will pay the amount shown below for that loss. If multiple losses occur, only one Benefit Amount, the largest, will be paid for all losses due to the same Covered Accident.
 
Principal Sum (amount is based on the coverage level purchased)
 
Description of Loss Benefit Maximum
 
1) Life; Both Hands or Both Feet; Sight of Both Eyes; Speech and Hearing: Principal Sum
2) Either Hand, Foot, Sight of One Eye, Speech or Hearing: One-Half the Principal Sum
3) Thumb and Index Finger of the Same Hand or Four Fingers of the Same Hand: One-Quarter the Principal Sum
 
“Member” means Loss of Hand or Foot, Loss of Sight, Loss of Speech, and Loss of Hearing. “Loss of Hand or Foot” means complete Severance through or above the wrist or ankle joint. “Loss of Sight” means the total, permanent Loss of Sight of one eye. “Loss of Speech” means total and permanent loss of audible communication that is irrecoverable by natural, surgical or artificial means. “Loss of Hearing” means total and permanent Loss of Hearing in both ears that is irrecoverable and cannot be corrected by any means. “Loss of a Thumb and Index Finger of the Same Hand” or “Loss of Four Fingers of the Same Hand” means complete Severance through or above the metacarpophalangeal joints of the same hand (the joints between the fingers and the hand). “Severance” means the complete and permanent separation and dismemberment of the part from the body.
 
Age Reduction Schedule:
The amount payable for a loss will be reduced to the following based on the covered person’s age on the date of the Covered Accident causing the loss:
65% of the Principal Sum if the Covered Person is aged 70-74
45% if the Covered Person is aged 75-79
30% if the Covered Person is aged 80-84
15% if the Covered Person is aged 85 and older.
If the Covered Person is age 70 or older, his or her premium is based on 100% of the coverage that would be in effect if he or she were under age 70. “Age” as used above refers to the Covered Person’s age on his or her most recent birthday.