Guardian Life Health Plan
University life can be quite a challenge. Coping with the responsibilities of growing up and an extensive workload has its rewards and problems. Guardian Life of the Caribbean recognizes that in this special period of your life, you must take care of yourself so we have designed a comprehensive health package to cater to the dynamics of campus life.
The Health Plan offers extensive coverage for medical consultations and treatment with a maximum benefit of $ 100,000.00. Now you can afford to take care of your health with this special plan that provides hospitalization, surgical and prescription benefits as well as considerable coverage on doctor’s visits, specialist consultations, diagnostic x-rays and laboratory reports.
Effective August 1st, 2015 the plan now includes an increased Emergency Accident and Sickness benefit of $ 10,000.00 and a new Emergency Dental Benefit of $ 5, 000.00- not subject to the deductible and co-insurance.
EXPENSES NOT COVERED
- PRE-EXISTING CONDITIONS
Pre-existing conditions are defined as conditions that were in existence before the cover was effective whether the insured was aware of it or not, and for which he/she may not have received advice or treatment.
- Expenses incurred before the effective date of coverage.
- Routine Vision and Dental care, unless necessitated by an accidental injury incurred while covered under this plan.
- Cosmetic or plastic surgery unless necessitated by an accidental injury incurred while covered under this plan.
- All expenses related to Pregnancy (including childbirth, miscarriage or abortion) and complications arising therefrom.
- Preventative medicine, homoeopathy, alternative medicine, check-ups, expenses not medically necessary.
- Expenses incurred for sexually transmitted diseases and /or its related complications.
- Students must be financially cleared i.e. all fee due to the University must be paid for the Academic Year, before cover can take effect.
- Call-out fee.
FREQUENTLY ASKED QUESTIONS
What is Deductible?
This is the dollar amount of covered expenses for which the insured is responsible before benefits are payable under the supplementary major medical plan.
What is Co-Insurance?
Under your Supplementary Major Medical Plan, the co-insurance is: 90%- 10% on 1st $ 20,000.00
100%- above $20,000.00
This means that the plan will pay you back at 90% of eligible expenses up to the first $20,000.00 after you have satisfied the Deductible. The plan will then pay you 100% of eligible expenses after that up to the maximum benefit stated in the schedule of benefits. You will be responsible for the other 10% of expenses up to $ 20,000.00 out of your own pocket.
What are Reasonable & Customary Charges?
These are charges or fees determined by the Insurer to be the general rates charged by Providers who render of furnish treatments, services or supplies to persons who reside in the same area; and whose injury or illness is comparable in nature and severity.
For example, if a doctor charges $3,000.00 for a surgical procedure and the normal level of fees for the procedure is $ 2,000.00, then the plan will reimburse you based on the charge of $2,000.00.