Health Insurance for Small Business
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SAGICOR FIT - HEALTH INSURANCE
What is Sagicor Fit? Sagicor Life Jamaica Limited is pleased to offer a selection of HEALTH INSURANCE PLANS designed just for the small business owner. You are eligible for this programme if you have between 5 & 30 employees. We have realized the need to design a plan allowing us to view small businesses as a community. This will provide:
Improved budget management Low impact of unpredictable claim costs Manageable renewal increases
The selection of Benefit Schedules has been designed to allow you the flexibility to balance affordability and coverage. You get to choose what you can afford today without giving up room for improvements tomorrow. Now Health Insurance for your Employees, their Spouses and their Children is more accessible than ever. Our selection includes six attractive Health Insurance packages from which to choose based on benefits and affordability.
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WHO CAN BUY?
Eligible dependents are your employee’s spouse and/or unmarried children. Children can be covered up to their 26th birthday, without proof of school attendance.
a) ELIGIBLE EMPLOYER - You can purchase one of our plans if you have between five (5) to thirty (30) employees who will enroll. b) ELIGIBLE EMPLOYEES/DEPENDENT DEFINITION - Eligible employees are those actively at work, working at least thirty (30) hours or more per week for you. DO ALL EMPLOYEES HAVE TO BUY? 100% (hundred percent) participation is required for all eligible employees and dependents. Coverage will become effective on the 1st of the month following receipt of the Application for Contract, enrollment forms and the first month’s premium. HEALTH CARDS JUST FOR YOU! Personalized health cards are provided for enrolled employees and dependents. These cards allow you to access your benefits and ensure prompt and efficient processing of claims. Note the following: Lost cards are to be reported immediately. Please collect health cards from employees who are terminating.
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PRE-EXISTING CONDITIONS & LIMITATIONS
A pre-existing condition is an illness or injury that occurred six (6) months before getting coverage, for which the person received medical treatment, prescribed drugs, or any other medical services. These expenses are not covered during the waiting period unless immediately moving from another carrier. If you have been advised that you have a pre-existing condition that attracts a waiting period, there will be no coverage during that period for the following benefits: Surgery Hospitalization Major tests, such as MRI’s and CT Scans EXCEPTION This condition is waived for all persons who were members of a formal plan either carried by a previous carrier or internally administered which ceased immediately before the beginning of this policy.
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MEDICAL CHARGES NOT COVERED Charges for which benefits are payable in accordance with:
Workmen’s Compensation Law to the extent of such coverage. Intentional self-inflicted injury. Charges incurred because of alcoholism or drug addiction. Injuries sustained while committing a felony.
TERMINATION Coverage for an employee terminates when:
Non-payment of premiums. Termination of your insurance contract with Sagicor. Termination of employment with the employer.
BENEFICIARY Beneficiaries are to be appointed for Group Life coverage. Beneficiaries under the age of 18 years are required to have a Trustee appointed.
CONVERSION Terminating employees have an option to convert to an individual health and/or life insurance policy within 31 days, without medical assesment. BENEFITS
SCHEDULES.
There are 6 benefit plans to choose from:
DOCTOR’S VISITS Benefits Schedules
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SURGERY + MATERNITY BENEFITS Benefits Schedules
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PREVENTATIVE CARE + OTHER MEDICAL SERVICES Benefits Schedules
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MAJOR MEDICAL + DENTAL & OPTICAL + LIFE BENEFITS Benefits Schedules
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+
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EXPLANATION OF BENEFITS
IN-HOSPITAL SERVICES Surgical benefit is subject to a surgical schedule and R&C charges, Major Medical then pays 80% of R&C. Private Duty Nursing should be requested by the physician and is subject to preauthorization; it is paid per eight hour shift. All fees are considered on a per disability basis. OVERSEAS EMERGENCY (EMBEDDED BENEFIT) The overseas emergency benefit covers the insured for emergency illness and accidental injury while travelling overseas. Coverage is not extended to dependents who reside overseas. NB. This benefit is not applicable if the ‘Overseas Emergency Rider’ is a part of the plan. OVERSEAS NON-EMERGENCY (EMBEDDED BENEFIT) If an insured member is referred for treatment overseas, the member must be pre-authorized by Sagicor before proceeding. Coverage will only be approved where there is no treatment available in Jamaica for the specific condition.
22 MATERNITY
New born babies are eligible for coverage fourteen (14) days after birth. All costs related to maternity are accessed from the maternity benefits. No payments are made from major medical. Complications of pregnancy due to the following conditions are treated as non-maternity medical expenses and will NOT be paid from the maternity limits:
Hyperemesis Gravidarum Toxemia with convulsions Ectopic pregnancy
Benefit covers a maximum of three (3) pregnancies.
23 DENTAL & OPTICAL
SAGICOR pays 80% of cost up to the negotiated maximum, the insured pays 20%. One pair of frames is covered in a 24-month period. One pair of lenses every 12-month period. The eye examination is paid from the medical plan as a consultation visit. Dental Examination and cleaning once every 6 months
MAJOR MEDICAL Cash Deductible: This is the initial amount which you must pay after benefits have been exhausted under the basic plan, thereby making you eligible for benefits under Major Medical. This may be a one time payment or an accumulation of payments over the policy year.
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RESTORATION PERIOD: Members may apply to have the Major Medical coverage restored, provided satisfactory medical evidence required by Sagicor is submitted. NB: Reasonable & Customary Charges “R&C� means charges which do not exceed the general level of fees usually charged for similar services or materials by other professionals or institutions within the community where the fee is charged.
Special Life Insurance
PACKAGE JUST FOR YOU
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LIFE INSURANCE The coverage amount will be paid to the named beneficiaries and can be used to cover family obligations, final expenses.
COVERAGE Coverage Amount: $500,000
TERMINAL ILLNESS In the event that you have been diagnosed as terminally ill, where the prognosis is no more than six (6) months to live, after twelve (12) months of the commencement of coverage – Sagicor will immediately pay fifty percent (50%) of the sum insured (subject to an upper limit, as determined by Sagicor from time to time).
WAIVER OF PREMIUM If a member, while insured and under the age of sixty (60) years, becomes totally disabled and if such total disability continues after the discontinuance of premium payments for the member’s insurance, the insurance will be extended, without payment of the premium during the continuance of the total disability for a period of one (1) year. The member is required to submit proof of disability within three (3) months immediately preceding the end of each subsequent year.
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HOW DO I SIGN UP?
SIGNING UP YOUR COMPANY IS SIMPLE: Complete the included Application for Group Contract Form on page 28 of this booklet. PROVIDE US WITH:
Cheque for 1st month’s premium Copy of Registration of Business Name Certificate or Certificate of Incorporation Copy of Company’s Tax Registration Number (TRN) Certificate, General Consumption Tax (GCT) certificate or Tax Compliance Certificate (TCC)
Enroll your employees and eligible dependents using the required form. Pay the first month’s premium. WHAT TO EXPECT ONCE YOU HAVE SIGNED UP Here is what you can expect within 5 working days:
CONFIRMATION that your employees and dependents are covered. Provision of Your Draft CONTRACT. Provision of HEALTH CARDS for your Employees and their Dependents.