Aetna Hospital Indemnity Flex

Every benefit below is transcribed from the Aetna Hospital Indemnity Flex outline of coverage CLIHF03993NV (Nevada edition), for policy form CLIHIPL217 NV, and from the Aetna Hospital Indemnity Flex brochure CLIHF04053NV (Nevada edition), the Aetna Senior Supplemental Insurance company profile CGFMP08395, which states the A.M. Best rating and its date. Benefits, amounts and riders vary by state; the policy issued to you governs.

• The base benefit: a daily amount for every day you are in hospital Included

  Paid for each day of hospital confinement, in $10 units subject to minimum daily benefit amounts, up to a maximum daily benefit amount of $1,000. It is limited by the maximum number of days per period of care and the lifetime maximum number of days.

  A $1,000 daily ceiling is the highest on our hospital indemnity comparison page by a distance. What you actually buy is a number of $10 units, so the premium scales with the benefit rather than coming in fixed plan levels.

• An observation stay pays half, and only instead of the daily benefit Included

  If you receive services in an observation unit of a hospital, the policy pays 50% of the daily hospital confinement benefit, once per period of care. It is not payable if the daily hospital confinement benefit is paid.

  Read the second sentence twice. Observation and confinement do not both pay for the same stay — an observation stay that turns into an admission pays the confinement benefit, not both.

• Optional rider: skilled nursing facility Optional rider

  Pays for each day of skilled care in a skilled nursing facility, in $10 units up to a maximum daily benefit amount of $500, with a choice of covered days — days 1 to 20, days 21 to 100, or days 1 to 100. There is no lifetime maximum number of covered days for this benefit.

  Three conditions all have to be met: a physician has ordered daily skilled care that as a practical matter can only be given in a skilled nursing facility, admission immediately follows a hospital confinement of at least three consecutive days, and the care falls on a covered day. The three-day hospital stay requirement is the one that catches people.

• Optional rider: outpatient doctor's office visits Optional rider

  Pays when the insured has a physician office visit for a covered illness or injury, in $10 units up to a maximum of $100 per visit, subject to a maximum number of visits per calendar year.

  Visits for preventive care, mental and nervous disorders, substance use disorders and pregnancy are not covered under this benefit.

• Optional rider: outpatient surgery Optional rider

  Pays when an outpatient surgical procedure is performed at an ambulatory surgical centre or outpatient surgical facility for a covered illness or injury, in $250 units up to a maximum of $3,000 per surgical procedure, subject to a maximum number per calendar year.

  If more than one surgical procedure is performed at the same time, only one benefit amount is paid — even where the procedures are caused by more than one covered illness or injury.

• Optional rider: emergency room visit or ambulance Optional rider

  Pays when the insured has an emergency room visit or an ambulance service by air, ground or water, in $200 increments up to $600, subject to a maximum number per calendar year. Services must be medically necessary and provided on an emergency basis.

  Only one benefit amount per day is payable even if the insured has both an emergency room visit and an ambulance service on the same day.

• Optional rider: outpatient rehabilitation Optional rider

  Pays for each day the insured receives occupational, physical or speech therapy on an outpatient basis for a covered illness or injury, in $50 units up to a maximum benefit amount of $250 per visit, with a choice of 15 or 30 visits per calendar year.

  Without this rider those three therapies are excluded outright. That is set out in the exclusions below and it is the clearest example on our hospital indemnity comparison page of a rider buying back an exclusion.

• Optional rider: a lump sum if you are diagnosed with cancer Optional rider

  $2,500, $5,000, $10,000, $15,000 or $20,000, paid on a diagnosis of cancer made after the effective date and after a 30 day benefit waiting period. Only one cancer benefit amount is paid per insured person under the policy.

  Waiting period: 30 days. The diagnosis must be pathological. A clinical diagnosis, based on the study of symptoms, is accepted only where a pathological one cannot be made. Skin cancer other than malignant melanoma, premalignant conditions and any disease other than cancer are excluded.

• What the policy will not pay for Not covered

  Experimental or investigational procedures and clinical trials. Diagnostic lab testing, x-rays, advanced studies and venipuncture. Cosmetic surgery, routine foot care, dental services, acne and varicose veins. Allergy testing and allergy injections. Speech, occupational and physical therapy, except under the outpatient rehabilitation rider. Pre-employment, pre-marital and routine physical examinations. Learning disorders and disabilities, developmental delays, mental or nervous disorders and sleep disorders. Tobacco cessation and substance use disorders. Obesity and weight reduction, including bariatric surgery and its complications. Eye examinations, eyeglasses and contact lenses for refractive errors, surgery to remove the need for glasses, treatment for cataracts, orthoptics and visual eye training. Hospice care, custodial care and home health care. Pregnancy and reproduction, except complications of pregnancy. War, riot or international armed conflict. A crime, felony or illegal act, or time imprisoned. Suicide or intentionally self-inflicted injury, sane or insane. Skydiving, scuba diving, hang or ultra light gliding, ballooning, bungee jumping, parakiting, riding an all-terrain vehicle, racing, sports for pay or profit and rodeo contests. Medical treatment, services and supplies received outside the United States.

  Hospice care, custodial care and home health care are excluded here. The same company’s Home Care Plus policy is built around home care, so if that is what you are after these are not interchangeable.

Issue ages

The documents state no issue age range in words. The premium table runs from issue age 18 to 89.

Renewability

Guaranteed renewable for life provided premiums are paid when due, subject to the policy termination provisions.

Pre-existing conditions

Pre-existing conditions are not covered unless the loss begins more than three months after the coverage effective date. A pre-existing condition is one the insured has been medically diagnosed with, treated by, sought advice from, or consulted with a physician about during the six months before the coverage effective date.

Financial strength

Rated “A” (Excellent) by A.M. Best as of 13 March 2024 — the third highest of sixteen ratings, which is the part the letter on its own does not tell you. It is a view of the insurer’s ability to pay claims, not a comment on this policy, and it can be changed at any time.

Policy form

CLIHIPL217 NV. Form numbers and benefits vary by state.