TransChoice® Plus
A Group Limited Benefit Hospital Indemnity Insurance

Coverage to Include
First Class
Priority
Express
Outpatient Benefits
Doctor Office Visit
This benefit pays the amount shown per physician’s office visit as a result of a sickness or accident. Benefits are payable for a maximum of six visits per calendar year per person.
$80
$80
$80
Wellness Visit
This benefit pays the selected amount for each covered person who undergoes the following (after the selected waiting period):
  • physical examinations
  • mammograms
  • pap smears
  • immunizations
  • flexible sigmoidoscopy
  • blood screenings
  • prostate-specific antigen tests

This benefit is payable once each calendar year for each covered person. Services must be under the supervision or recommended by a physician and a charge must be incurred.
$0
$100
$100
Diagnostic Tests
This benefit pays the amount shown per testing day for tests performed for the purpose of diagnosis of a covered sickness or accident as indicated by symptoms that would suggest an injury or sickness had occurred. The benefit is limited to the number of days noted of testing per calendar year per covered person and is not payable while the insured is confined in a hospital (i.e., it applies to outpatient services only).
$100/3
$150/4
$250/4
In-Hospital Indemnity Benefits
Daily In-Hospital Indemnity Benefit
When a covered person is confined in a hospital as a result of an accident or sickness, this policy pays the benefit amount for each day the insured is confined in a hospital up to a maximum of 30 days per confinement.
$400
$750
$750
Accident Injury Benefit
Off-the-Job Accidental Injury Benefit
This benefit pays based on the actual charges incurred up to a maximum of $100 to $1,500 in $100 increments (employer elected) for each covered accident (maximum of 5 covered accidents) for x-rays used to diagnose an accidental injury and for treatment of a covered accident by a physician in the physician’s office, clinic, urgent care facility, or hospital emergency room per covered person per calendar year. Treatment must be received within 72 hours of the accident for benefits to be payable.
$300
$300
$500
Surgical & Anesthesia Indemnity Benefit
Surgical Benefit (see Surgical Schedule)
When a covered person undergoes a surgical procedure listed in the Schedule of Surgical Indemnity Benefits in the certificate as a result of an accident or sickness, the policy pays the benefit amount shown in the schedule based on the plan level selected by the group.

If two or more procedures are performed through the same incision or operative field, the benefit paid will be for only the procedure that has the larger benefit. If more than one procedure is performed, but each through a separate incision or in a separate operative field, the amount payable will be the specified amount for the primary procedure plus 50% of the amount payable for all other surgical procedures performed.
$2,000
$3,000
$4,000
Anesthesiology
The anesthesia benefit is the percentage noted of the surgical benefit amount.
20%
$400
20%
$600
30%
$1,200
Emergency Room
2 visits per year per covered person
$0
$50
$200
Group Term Life Insurance
Group Term Life
Term life available for member, spouse, and children. Term life with full benefit amounts for member.
  • Member Life - $10,000
  • Spouse Life - $5,000
  • Children Life - $2,500
Included
Included
Included
Member Discount Card
Discount Card
Included
Included
Included
Nationwide PPO Network
PPO Network
Included
Included
Included
Critical Illness
Critical Illness
When a covered person is diagnosed with a covered critical illness, the selected amount will be paid.* This amount is payable up to two times for each covered person, first under the Critical Illness Indemnity Benefit and then under the Subsequent Critical Illness Indemnity Benefit, and is paid in addition to any other benefits paid by the TransChoice policy.

The Subsequent Critical Illness Indemnity Benefit is paid if the covered person is diagnosed as having a subsequent and separate covered critical illness more than sixty (60) days after the first one.

After the waiting period has expired, benefits are payable for the following critical illnesses:

  • Cancer (including leukemia and Hodgkin’s Disease, except Stage 1 Hodgkin’s Disease)
  • Heart attack (diagnosis must be based on EKG changes consistent with injury, elevation of cardiac enzymes,and confirmatory imaging studies)
  • Stroke (diagnosis must be based on documented neurological deficits and confirmatory neuroimaging studies)
  • End stage renal failure (chronic, irreversible failure of the function of both kidneys, such that a covered person must undergo regular hemodialysis or peritoneal dialysis at least weekly)
  • Major organ transplant (undergoing surgery as a recipient of a transplant of a human heart, lung, liver, kidney, or pancreas)
  • Skin cancer (including basal cell epitheloma or squamous cell carcinoma); does not include malignant melanoma or mycosis fungoides
  • Carcinoma in situ (cancer that is confined to the site of origin without having invaded neighboring tissue)

Dependant coverage equal to 50% of this benefit.
$10,000
$10,000
$10,000
Prescription Benefit
Prescription Drug Discount Card
By presenting a Caremark prescription drug discount card, provided by KBA, to one of Caremark’s 59,000 participating providers, an insured can receive savings of at least 14% on retail pharmacy prices for brand-name drugs and up to 60% for generic drugs. The insured will continue to receive savings even after his or her TransChoice Plus benefit has been used for the year.
Included
Included
N/A
Prescription Drug Indemnity Benefit
The amount shown is per prescription; maximum of prescriptions per calendar year
N/A
N/A
$15
Additional Benefits
Ambulance
Benefit amount shown is for the number of trips noted.
$0
$100/3
$150/2
Intensive Care
Up to the number of days noted per calendar year. If you are confined in a hospital intensive care unit due to an injury received in a covered accident or because of a covered sickness.
$0
$200/30
$500/10

Premium Rates
Member
Member + Spouse
Member + Child(ren)
Family
First Class – Monthly
$97.11
$163.45
$141.89
$208.87
Priority – Monthly
$141.53
$246.63
$222.29
$328.43
Express – Monthly
$177.41
$317.89
$292.26
$433.95

Underwritten by Transamerica Life Insurance Company, Home Office, Cedar Rapids, IA. Policy Form Series CPCH0200 and CCCH0200. Administration provided by Key Benefits Administrators (KBA) Fort Mills, SC

Limitations & Exclusions

TransChoice® Plus Group Limited Benefit Hospital Indemnity Insurance Policy
Form Series CPCH0200 and CCCH0200

No benefits will be payable as the result of:

  • suicide or any attempt thereof, while sane or insane. In the event of suicide, the company's liability may be limited to only the return of premiums paid. In Missouri, suicide is no defense to payment of benefits unless the company can show the insured intended suicide when he/she applied/enrolled for coverage;
  • any intentionally self-inflicted injury or sickness;
  • rest care or rehabilitative care and treatment;
  • immunization shots and routine examinations such as physical examinations, mammograms, pap smears, immunizations, flexible sigmoidoscopy, prostate-specific antigen tests and blood screenings unless the Wellness Benefit is included;
  • routine newborn care, including routine nursery charges;
  • the treatment of mental illness; functional or organic nervous disorder, regardless of cause; alcohol abuse; drug use, unless such drugs were taken on the advice of a physician and taken as prescribed. In such circumstances and with respect to payment of the Daily In-Hospital Indemnity Benefit, benefits will be limited to no more than 10 days in any calendar year;
  • participation in a riot, civil commotion, civil disobedience, or unlawful assembly;
  • committing, attempting to commit, or taking part in a felony or assault, or engaging in an illegal occupation;
  • participation in an organized contest of speed, parachuting, parasailing, bungee jumping, or hang gliding;
  • air travel, except as a fare-paying passenger on a commercial airline on a regularly scheduled route, or as a passenger for transportation only and not as a pilot or crew member;
  • any accident caused by the participation in any activity or event, including the operation of a vehicle, while under the influence of a controlled substance (unless administered by a physician or taken according to the physician’s instructions) or while intoxicated (intoxicated means that condition as defined by the law of the jurisdiction in which the accident occurred);
  • any procedure or treatment to change physical characteristics to those of the opposite sex and other treatment related to sex change;
  • the reversal of tubal ligation and vasectomies;
  • artificial insemination, in vitro fertilization, and test tube fertilization, including any related testing, medications, or physician’s services, unless required by law;
  • any loss incurred while on active duty status in the armed forces (if the insured notifies Transamerica of such active duty, Transamerica will refund any premiums paid for any period for which no coverage is provided as a result of this exception);
  • accidents or sicknesses arising out of and in the course of any occupation for compensation, wage, or profit OR expenses which are payable under Occupational Disease Law or similar law, whether or not application for such benefits has been made;
  • air or ground ambulance transportation (unless the Ambulance Benefit has been included);
  • routine eye examinations or fitting of eye glasses;
  • hearing aids or fitting of hearing aids;
  • dental examinations or dental care other than expenses resulting from an accident;
  • care or treatment of an accident or sickness not specifically provided for in the plan; with respect to the Off-the-Job Accidental Injury Benefit only, charges that the covered person is not legally required to pay, or charges which would not have been made if this coverage had not existed;
  • treatment of an accident or sickness made necessary by or arising from war, declared or undeclared, or any act of war; or
  • any surgical procedure not specifically listed in the Schedule of Surgical Indemnity Benefits.

Group Term Life Insurance Policy
Policy Form Series CP100200 and CC100200

We will not pay a death benefit if an insured dies by suicide, while sane or insane, within two years of the date of his/her insurance starts. In the event of suicide, the Company's liability may be limited to only the return of premiums paid.

In Missouri, suicide is no defense to payment of benefits unless the Company can show the insured intended suicide when he/she applied/enrolled for coverage

If any death benefit is increased, this suicide exclusion starts anew, but will apply only to the amount of the increase.

AD&D Rider
Rider Form Series CR101100

We will not pay any benefits if the loss, directly or indirectly, results from any of the following, even if the means or cause of the loss is accidental:

  • suicide or intentionally self-inflicted injury, while sane or insane. In the event of suicide, the Company's liability may be limited to only the return of premiums paid. In Missouri, suicide is no defense to payment of benefits unless the Company can show the insured intended suicide when he/she applied/enrolled for coverage;
  • commission of or attempt to commit an assault or felony;
  • sickness or mental illness, disease of any kind, or medical or surgical treatment for any sickness, illness or disease;
  • injuries received while under the influence of alcohol, a controlled substance or other drugs as defined by the laws of the State where the accident occurs, except as prescribed by a doctor;
  • any poison or gas voluntarily taken, administered, absorbed, or inhaled (except in the course of employment);
  • flight in any kind of aircraft, except as a fare paying passenger on a regularly scheduled commercial aircraft;
  • any bacterial or viral infection;
  • declared or undeclared war, or any act of war; and
  • taking part in an insurrection.

Termination of Insurance

Your insurance will cease on the earliest of:

  1. The last day of the payroll deduction period during which You cease to be eligible for coverage;
  2. The end of the last period for which premium payment has been made to Us;
  3. The date the Policy terminates; or
  4. The last day of the payroll deduction period during which You terminate employment.

The insurance on a Dependent will cease on the earliest of:

  1. The date Your coverage terminates;
  2. The end of the last period for which premium payment has been made to Us;
  3. The date the Dependent no longer meets the definition of Dependent; or
  4. The date the Policy is modified so as to exclude Dependent coverage.

We will have the right to terminate the coverage of any Covered Person who submits a fraudulent claim under the Policy. Refer to the policy and certificate for complete details.


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