Out-of-Pocket Protection Plan

Every benefit below is transcribed from ManhattanLife Out-of-Pocket Protection Plan brochure GAP15-BR 0320, and from the Nevada application for insurance GAP15AP-NV 0515. Benefits, amounts and riders vary by state; the policy issued to you governs.

• Read this first: it ends when Medicare starts, not on a birthday Included

  The right to renew runs to the earlier of two things — the day you become insured under Medicare, or age 69. In California it is age 65 rather than 69. If you expect to take Medicare early through disability, or at 65, this is the policy that stops then.

  It is also conditionally rather than guaranteed renewable. The brochure is clear that this does not let the company cancel you for your health or for claiming, and that is worth knowing — but it is a different word from guaranteed renewable and you should see it before you compare premiums.

• Hospital admission benefit — the point of the policy Included

  $2,500, $5,000 or $6,350 paid on being admitted to hospital as a resident inpatient, once a year. In Utah it is once per period of confinement rather than once a year.

  Choose it against the most your own major medical plan can leave you to pay in a year, rather than against a feeling — that is the number this benefit is shaped around. It is the benefit the policy is built around, and it is the reason to prefer it over a design that pays mostly by the day.

• Daily inpatient hospital confinement Included

  $100 or $200 a day while confined as a resident inpatient, to a maximum of 10 days per hospital confinement. In Maine, Texas and Utah the maximum is 31 days. In Florida it is payable for the first 20 days and then $10 or $20 a day for the next 11, depending on the level chosen.

  Not payable for treatment of mental or nervous disorders or substance abuse. A day means a 24 hour period for which room and board is charged, and being a resident inpatient means assigned to a bed for an overnight stay on a physician's advice.

• Doctor's office visit Included

  $50 a visit, twice a year for each insured person.

• Outpatient surgery Optional rider

  $1,000, $2,000 or $3,000 for surgical services in an ambulatory surgical centre or an outpatient hospital facility, twice a year.

  The brochure directs you to the policy for the limitations on this benefit rather than listing them, so ask for them.

• Emergency accident Optional rider

  $250 for each emergency treatment where an injury needs emergency care from a physician in an emergency room or urgent care facility, four times a year. Treatment must be within 72 hours of the injury.

  $250 is the maximum benefit per injury. In Florida it is limited to twice a year and is payable only if you are admitted as an inpatient within 24 hours of the emergency treatment.

• Pregnancy is covered in five states and complications everywhere Included

  The policy covers complications of pregnancy but not pregnancy itself — except in Florida, Maryland, Mississippi, New Mexico and Ohio, where it covers pregnancy and its complications both.

  Of the states this agency is licensed in, that exception reaches Florida, New Mexico and Ohio. Everywhere else, the pregnancy itself is not covered.

• How a claim is made Included

  Benefits are paid directly to you unless you assign them to your provider, and they can be paid as a lump sum. They pay in addition to all other insurance, with no deductible and no network.

  You must send a claim form with an ITEMISED STATEMENT attached. That is a step the fixed indemnity policies on this site do not all require, and it is worth knowing before you need it.

Out-of-Pocket Protection Plan on its own page, with its own enrollment link.

Issue ages

Individual, individual and children, individual and spouse or domestic partner, or family. The documents we hold state no minimum issue age; what they state is when it ends, which is the number that matters here — see the renewal terms.

Underwriting

Fully underwritten on the application. Everyone must have been performing normal activities and actively at work full time for the past 30 days. The application asks whether anyone has been declined for insurance, has surgery advised but not yet done, has been treated for elevated blood pressure in the last 12 months, is pregnant, or has been treated by a physician at all in the last 12 months — and then runs a five-year look-back over thirty-six named conditions, from cancer and heart disease to Crohn's, multiple sclerosis, uncorrected hernia and uncorrected cataracts. A telephone interview may form part of underwriting and may be used to decline the application.

Renewability

CONDITIONALLY renewable, which is not the same promise as guaranteed renewable. What the brochure says it means: the policy cannot be cancelled because your health changed or because of how many times it has paid — but the right to renew runs only until the earlier of becoming insured under Medicare or reaching age 69, and in California age 65 rather than 69. The company may change the rates on all policies of this class across the whole state.

Policy form

C-GAPJ15, C-GAPJ15-LA, C-GAPJ15-OK, C-GAPJ15-TX. Form numbers and benefits vary by state.