ER, Ambulance & Outpatient Surgery Rider
Supplemental Insurance Carrier:
This plan is designed to cover the small gaps in your health plan like outpatient surgery, ER visits, ambulance rides or MRIs due to injury or sickness. You’ll receive a lump sum check for ER visit, ambulance ride, MRI/CT scan and outpatient surgery. Some limitations apply. It does not cover pre-existing conditions. This plan has a $20 application fee.
How does this plan work?
Hospital Indemnity plans with optional riders are a great way to cover your medical expenses even if you have a great health insurance plan. This plan gives you the opportunity to add levels of coverage and protect yourself from out-of-pocket costs associated with hospitalization. Following a hospital say, it will pay you a fixed daily benefit amount you choose. Hospital indemnity plans have no network restrictions and will pay you directly. Some plans even include guaranteed issued options so there are no medical questions to get approved. This plan can be added to your health insurance at anytime of the year. At Utah Avenue Insurance, we make getting your claim submitted and approved easy. Simply call, email or text us after you've received treatment for a covered hospitalization and we help you with the rest.
Choose your base benefit
Choose a daily benefit amount to cover your daily inpatient hospital copay and how many days of coverage you need.
Review included benefits
Hospital indemnity plans can include built-in benefits for ER visits, mental health or shorter hospital stays.
Select optional benefit riders to fit your needs
Riders can help cover your out of pocket costs including deductibles, copays and coinsurance.
Optional Benefit Riders
These optional benefits and riders are available depending on the base level plan selected. Not all riders are available on all plans. Benefits will vary depending on the plan and selections. See full plan summary for details and options.
Short Duration Hospital Stay Benefit
In the event you are hospitalized and discharged between 6 and 24 hours for either observation or confinement, you will receive the chosen daily benefit under the Short Duration Benefit.
Mental Health Benefits
Your policy will pay if you are confined to a hospital for a mental or nervous disorder.
Observation Unit Benefits
Your policy will pay you for each day you received services in an observation unit of a hospital as a result of a covered loss or sickness.
Emergency Room Benefits
This benefit will pay you if you are treated in an emergency room, emergency care or urgent care facility visit due to an accident or injury. A hospital admission is not required.
Skilled Nursing Facility Benefit Rider
This rider will pay per day if you are confined to a skilled nursing facility. This benefit applies if you are admitted to a skilled nursing facility after having been confined to a hospital for three consecutive days. The plan will pay benefits as long as confinement occurs within 30 days of hospitalization.
Ambulance Benefit Rider
This rider will pay a chosen benefit per ground or air ambulance ride to or from a hospital. It is payable once per day, up to four times per year and subject to a lifetime maximum of 12 trips. No hospital confinement is required.
Major Diagnostic Exam Rider
The Outpatient Major Diagnostic Exam Rider pays a benefit of $100 - $500 two times per year for the following exams: CT, MRI, PET, CTA, EEG and EKG. Limited to 1 exam per insured person, per day.
Outpatient Therapy Benefit Rider
This rider will pay a daily benefit for each day you receive one of the therapies, such as physical, occupational, or speech therapy on an outpatient basis. No more than one benefit will be paid per day under the rider. This benefit is limited to the maximum daily benefit and the maximum benefit of 15 or 30 days per calendar year. Chiropractic Therapy is covered up to 5 days per calendar year.
Cancer Lump Sum Benefit Rider
The Lump Sum Cancer Rider will pay you your chosen cash benefit up to $20,000 should you be diagnosed with cancer. It may include a 25% benefit for Cancer In Situ and a $500 payment for Basal cell/Squamous cell skin carcinoma. After you receive your lump sum payment, your benefits are eligible to restore with the Recurrence Benefit Rider.
Outpatient Surgical Benefit Rider
This rider will pay up to $1,000 for a surgical procedure performed in an ambulatory surgical center or outpatient hospital facility. This surgical indemnity is payable no more than two times per calendar year.
Critical Accident Benefit Rider
After an emergency room visit, this rider will pay a lump sum benefit up to $10,000 for the following types of accident injuries: Accidental Death, Hip or Skull Fracture, Hip Dislocation, Knee Dislocation, Knee Ligament Tear, or Fractures.
Lump Sum Hospital Benefit Rider
Some primary health plans leave you with a lump sum hospital co-pay. In addition to the daily benefit, a lump sum benefit can be used to help cover that cost. The benefit is payable once during any period of hospital confinement and restores after 60 days of no hospital confinement.
Wellness Benefit Rider
The Wellness Benefit Rider offers an incentive to stay healthy and help keep health care costs under control because individuals who have annual preventive care exams could detect diseases and conditions early. The Wellness Rider pays the benefit per year for covered wellness exams, including physicals, blood tests, colonoscopies, mammograms, vision exams, and more.
Dental, Vision and Hearing Benefit Rider
The Dental, Vision and/or Hearing Rider will pay you an annual benefit for services performed by a licensed doctor, dentist, ophthalmologist or optometrist. It may include up to $200 for prescription eye glasses or contact lenses.
1. Get the Care you need
See your doctor, urgent care facility or emergency room for a covered accidental injury or sickness. Have your doctor or the hospital bill your regular medical health insurance plan.
2. Let us do the paperwork
Call, text or email us that you have a claim. Our office staff will help you fill out and send in all the right forms and track your claim.
3. Get paid
Get paid! You'll get a check made out to you. Use these funds to cover your medical expenses, lost wages, or something fun.
Frequently Asked Questions
How do I get my ID card?
Hospital plans do not come with ID cards. So you will not receive a card in the mail. You can access your plan benefits, update payment options, and more in your member portal. Log in with the link below.
Are there medical questions or blood work to get approved for this plan?
Sometimes these plans require simple medical questions to be approved. If you are concerned about or want to know the medical questions required, please ask your local agent. We are happy to send you the questions before you apply for coverage. Two plans options are available with no medical questions. One offered is for those between the ages of 64 and a half and 65 and a half. You will have no medical questions required to get approved. The other is based on benefit level of the hospital confinement and optional riders. This plan can be purchased at any age. Contact your local agent to get approved today.
Is your doctor and hospital in network?
Hospital plans do not have networks. Which means that you can see any doctor or hospital in nation and still file a claim. It is recommended that if you have a health insurance plan that you see an in-network doctor or hospital if possible as only emergency are covered out of network on most health insurance plans.
Currently Enrolled with this plan? Log into your portal.
Below is the link to log into your client portal. Most companies have an app you can also download onto your phone. The best place to view information about this plan is through the member portal. The member portal gives you easy access to your plan details, claims information, and more. You can update your payment information in the member portal, too. Simply set up an account and login by clicking the member portal link below. If you have any issues logging in, just give us a call and we can help.
Premium payments is the monthly amount you pay for your insurance plan. The initial premium, or binder payment, needs to be made before your plan starts. Be sure to watch your account to make sure the premium has been debited. Most carriers accept bank accounts, debit cards and credit cards as payment. If you need to update your account, you can log into your portal or call our office for help.
Deductible? Copays? Coinsurance? What does it mean?
Learn the basic terms about insurance plans to better understand your plan. Don't worry, most people don't know what these terms mean and how they apply to your plan. That's why we're here. Please contact us if we missed any terms or if you'd rather talk to us to go over any benefits.
Learn more about this plan and talk to a local agent
Want to add extra coverage to you plan? Contact a local agent today. We can get you a quote right away and start these plans as soon as tomorrow. These plans can be added to your high deductible employer plan as well.
Schedule a consultation with a local Utah health insurance agent
We're happy to meet with your in-person or over the phone to help you with your health insurance needs. We can help you with health insurance on or off the marketplace, Medicare Advantage & supplements, dental insurance, vision insurance, life insurance or accident plans. Thank you for letting us be your advocate. Best part, is our help is always free!