UnitedHealthcare Hospital Indemnity FAQs: Answers on HospitalWise, AdvantageGuard and More
These answers cover the questions people ask most about UnitedHealthcare hospital indemnity plans. Licensed Vivna agents wrote each one in plain English. Because rules change by state, every answer shows where it applies. Call 888-730-6001 anytime for free help.
Vivna Insurance is an appointed, authorized broker for UnitedHealthcare. We are an independent agency, not UnitedHealthcare. Hospital indemnity plans are supplemental coverage, not major medical insurance. Plans and availability vary by state.
Hospital Indemnity Basics
Start here to learn how hospital indemnity plans pay and how they compare. Then see how to enroll and file claims.
β What is hospital indemnity or fixed benefit insurance?
Hospital indemnity, or fixed benefit, insurance pays a set cash amount for a covered service.
For example, it can pay for a hospital stay. The payment is not based on your actual bill. Also, these plans supplement other health coverage rather than replace it.
π Where this applies: Every state where this plan is sold
β What UnitedHealthcare hospital indemnity and fixed benefit plans are there?
UnitedHealthcare's options are AdvantageGuard, Health ProtectorGuard, Guard plans, HospitalWise and Hospital SafeGuard GI.
Golden Rule Insurance Company, a UnitedHealthcare company, underwrites these products. Each pays fixed cash amounts for covered care. However, they differ in ages, benefits and underwriting.
π Where this applies: Every state where this plan is sold
β Who is the insurance company behind UnitedHealthcare hospital indemnity plans?
Golden Rule Insurance Company, a UnitedHealthcare company, underwrites and administers these plans.
The company has served people buying their own coverage for over 80 years. It also holds an A+ (Superior) rating from A.M. Best.
π Where this applies: Every state where this plan is sold
β Is a UnitedHealthcare hospital indemnity plan major medical or ACA coverage?
No, a UnitedHealthcare hospital indemnity plan is not major medical or ACA coverage.
The brochures say these products supplement health insurance and are not a substitute for ACA minimum essential coverage. Also, they provide limited benefits and should not replace comprehensive coverage.
π Where this applies: Every state where this plan is sold
β Does a fixed benefit plan count as minimum essential coverage?
No, none of these plans is considered minimum essential coverage under the Affordable Care Act.
The Health ProtectorGuard flyer also notes that lacking major medical coverage may mean an extra payment with your taxes.
π Where this applies: Every state where this plan is sold
β Is a hospital indemnity plan a good replacement for my health insurance?
No, the brochures say these plans should not substitute for comprehensive health insurance.
Instead, they work best alongside a major medical plan, Medicare or other coverage. A licensed agent can also compare these with ACA plans.
π Where this applies: Every state where this plan is sold
β Do UnitedHealthcare hospital indemnity plans pay if I have other insurance?
Yes, these plans pay benefits regardless of any other insurance you have.
Also, the fixed amount does not change based on what your other plan pays.
π Where this applies: Every state where this plan is sold
β Do I need other health insurance to buy one of these plans?
For Hospital SafeGuard GI, buying it does not depend on having other coverage.
Still, the brochures for all four products describe them as supplements to comprehensive health insurance.
π Where this applies: Every state where this plan is sold
β Is there a deductible, coinsurance or copay on these fixed benefit plans?
No, Health ProtectorGuard and Guard plans have no deductible, coinsurance or copays.
Similarly, Hospital SafeGuard GI has no deductible before benefits begin. Overall, these plans simply pay the fixed amount for each covered service.
π Where this applies: Every state where this plan is sold
β Can I spend hospital indemnity cash benefits on anything?
Generally yes, since AdvantageGuard and HospitalWise pay the cash benefits directly to you.
You can use the money however you see fit. However, if you assign benefits to a hospital or provider, the payment goes to them instead.
π Where this applies: Every state where this plan is sold
β Is a hospital indemnity plan a Medicare supplement policy?
No, AdvantageGuard is not a Medicare supplement policy.
It does not fully supplement Original Medicare or a Medicare Advantage plan. Instead, it is a separate, limited-benefit hospital indemnity policy.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β How does a fixed benefit plan work with the plan I already have?
The fixed benefit plan pays its set amount no matter what your other plan pays.
So the cash can help with copays and other out-of-pocket costs. However, if you have a major medical plan, you may need to stay in its network.
π Where this applies: Every state where this plan is sold
β How do AdvantageGuard, Health ProtectorGuard, HospitalWise and Hospital SafeGuard GI differ?
These plans differ in ages, benefits and underwriting.
AdvantageGuard is for ages 60 to 90 and focuses on hospital stays, with optional riders. HospitalWise is guaranteed issue for ages 18 to 64, with three plan levels. Hospital SafeGuard GI is also guaranteed issue for ages 18 to 64, and it adds outpatient and accident benefits. By contrast, Health ProtectorGuard and Guard plans are health-underwritten and cover a broad mix of everyday and hospital care.
π Where this applies: Every state where this plan is sold
β Which UnitedHealthcare fixed benefit plans are guaranteed issue?
HospitalWise and Hospital SafeGuard GI are guaranteed issue, with no medical questions.
AdvantageGuard is guaranteed issue or simplified issue, depending on the benefits you choose. By contrast, Health ProtectorGuard and Guard plans are subject to health underwriting.
π Where this applies: Every state where this plan is sold
β Which UnitedHealthcare hospital indemnity plan can I buy if I am over 65?
Among these four products, only AdvantageGuard accepts new applicants 65 and older.
Its issue ages are 60 through 90. By contrast, the others are for issue ages 18 to 64.
π Where this applies: Every state where this plan is sold
β Which of these plans include telehealth visits?
Health ProtectorGuard and Guard plans include unlimited $0 virtual visits through HealthiestYou by Teladoc Health.
Hospital SafeGuard GI offers HealthiestYou as an optional benefit for extra premium. However, the AdvantageGuard and HospitalWise brochures do not list a telehealth benefit.
π Where this applies: Every state where this plan is sold
β Which UnitedHealthcare fixed benefit plans pay for doctor office visits?
Health ProtectorGuard, Guard plans and Hospital SafeGuard GI all pay set amounts for doctor and urgent care visits.
However, HospitalWise pays for them only on Bundle 1 and Bundle 2. AdvantageGuard offers an optional ER and urgent care rider, but no doctor office visit benefit.
π Where this applies: Every state where this plan is sold
β Which UnitedHealthcare fixed benefit plans pay for prescriptions?
Health ProtectorGuard pays a set amount per prescription fill on all three plans.
Guard 5000 and Guard 6000 also pay per fill, but Guard 4000 does not. AdvantageGuard has an optional rider for provider-given injectable drugs. By contrast, HospitalWise and Hospital SafeGuard GI include only the Optum Perks discount card.
π Where this applies: Every state where this plan is sold
β Which of these plans can cover my children?
Health ProtectorGuard, Guard plans, HospitalWise and Hospital SafeGuard GI can cover eligible children, generally until age 26.
However, AdvantageGuard does not cover dependent children. Instead, it covers the primary insured and a spouse or domestic partner.
π Where this applies: Every state where this plan is sold
β Which plans have the longest free look period?
Hospital SafeGuard GI gives you 30 days to return the policy for a refund.
By contrast, the other brochures list 10 days, or longer where a state requires it.
π Where this applies: Every state where this plan is sold
β Which of these plans use a provider network?
AdvantageGuard and Hospital SafeGuard GI list no network restrictions.
Health ProtectorGuard and Guard plans let you use any provider, with discounts from UnitedHealthcare Choice Plus providers. Hospital SafeGuard GI also offers discounts through the MultiPlan Network for Limited Benefit Plans.
π Where this applies: Every state where this plan is sold
β When does coverage start on a UnitedHealthcare hospital indemnity plan?
Coverage starts once Golden Rule approves your complete application and you pay the first full premium.
The policy must be issued within 45 days of applying, then delivered and accepted.
π Where this applies: Every state where this plan is sold
β What if my age was wrong on my hospital indemnity application?
Premiums are adjusted to your correct age, and past premiums may be refunded or owed.
However, if you would not have qualified, premium minus benefits paid is refunded and coverage is void.
π Where this applies: Every state where this plan is sold
β How do I manage my plan online?
Register at uhcmemberhub.com to manage your plan online.
There, you can view your ID card and plan documents, update contact info, pay premiums and submit claims. You can also find network doctors and send non-urgent questions.
π Where this applies: Every state where this plan is sold
β Do these plans include a prescription discount card?
Yes, in most states these plans include the Optum Perks prescription discount card.
Optum Perks may save 30% to 80% on prescriptions. However, it is a discount program, not insurance, and is open to the general public. Get your card at perks.optum.com/uho.
π Where this applies: Every state where this plan is sold
β How soon do I need to report a claim?
Golden Rule needs notice of claim within 30 days of the loss, or as soon as reasonably possible.
Some states allow longer, such as 60 days in Kentucky and Wyoming. By contrast, Pennsylvania requires notice within 20 days on AdvantageGuard and HospitalWise.
π Where this applies: Every state where this plan is sold
HospitalWise
These answers explain HospitalWise benefits, bundles and rules. Also, see how it pays for hospital stays.
β What is HospitalWise?
HospitalWise is a hospital indemnity plan from Golden Rule Insurance Company, a UnitedHealthcare company.
It pays fixed cash benefits for covered hospital stays. You can then use the money for medical bills, household bills or other costs.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β Who can buy HospitalWise?
The primary insured must be 18 to 64 when applying for HospitalWise.
Your spouse or domestic partner can be added, as defined by your state. Children under 26 are also eligible.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β Do I have to answer health questions for HospitalWise?
No, HospitalWise is guaranteed issue, so there are no medical questions.
However, preexisting condition limits still apply. Also, incorrect or incomplete application details can void coverage or lead to denied claims.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β What HospitalWise plans are available?
There are three HospitalWise plans: Basic, Bundle 1 and Bundle 2.
All three have the same hospital stay benefits. The Bundle plans also add benefits for outpatient care.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β How much does HospitalWise pay for a hospital stay?
All HospitalWise plans pay $1,000 per day for an inpatient stay due to sickness or injury.
The limit is 10 days per period of confinement. Also, observation stays over 24 hours count as inpatient.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β Does HospitalWise pay extra for an ICU stay?
Yes, all plans pay $1,000 per day for ICU care, on top of the inpatient benefit.
The ICU limit is 10 days per period of confinement.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β Does HospitalWise pay for a hospital observation stay?
Yes, a 12- to 24-hour observation stay pays $1,000 per day on all plans.
It is limited to 4 days per calendar year. Also, it is paid instead of the inpatient benefit.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β What does period of confinement mean on HospitalWise?
A period of confinement is one or more hospital stays for the same or related causes.
However, stays must be at least 60 days apart to start a new period.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β What does the HospitalWise Basic plan cover?
Basic covers inpatient hospital stays, ICU stays and observation stays.
However, it does not cover outpatient care, outpatient surgery, diagnostics, ambulance or wellness.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β What does HospitalWise Bundle 1 add?
Bundle 1 pays $500 per ER day, $250 per urgent care day and $100 per doctor office day.
Outpatient surgery pays $1,000 per day, and major diagnostics pay $500 per day. Plus, ambulance pays $250 ground or $2,500 air.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β What does HospitalWise Bundle 2 add?
Bundle 2 pays $750 per ER day, $375 per urgent care day and $150 per doctor office day.
Outpatient surgery pays $2,000 per day, and major diagnostics pay $1,000 per day. Ambulance pays $500 ground or $5,000 air. In addition, wellness pays $75.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β What are the visit limits on HospitalWise Bundle plans?
ER, urgent care and doctor visits share a limit of 4 days per calendar year.
Outpatient surgery and major diagnostics are each limited to 2 days per calendar year. Also, ambulance trips are limited to 4 combined days per calendar year.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β Does HospitalWise pay for ambulance rides?
Yes, Bundle 1 and Bundle 2 pay when the ride results in an inpatient hospital stay.
However, the Basic plan does not include ambulance benefits.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β What major diagnostic tests does HospitalWise cover?
On the Bundle plans, covered tests include CT, MRI, PET scan, angiogram, CTA, EEG and EKG.
The tests must be for diagnosis and treatment of a sickness or injury.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β Does HospitalWise cover wellness visits?
Only HospitalWise Bundle 2 covers wellness visits.
It pays $75 for one wellness exam or procedure per calendar year, after a 30-day waiting period. Examples include an annual physical, vaccines, colonoscopy and mammography.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β Can HospitalWise pay two benefits for the same service on the same day?
No, only one benefit is paid per person, per day for the same or similar service.
If more than one applies, HospitalWise pays the largest amount.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β Is there a waiting period on HospitalWise?
There is no waiting period for most HospitalWise benefits.
However, the Wellness benefit on Bundle 2 has a 30-day waiting period in most states. Preexisting condition limits also apply.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β Does HospitalWise cover preexisting conditions?
HospitalWise does not cover preexisting conditions during your first 6 months of coverage.
A preexisting condition is one you had care, advice, tests or symptoms for in the 6 months before coverage. After 6 months of coverage, the limit no longer applies.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β Does HospitalWise cover a mental health hospital stay?
No, HospitalWise excludes losses related to mental or nervous disorders and substance use disorder.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β Is HospitalWise renewable?
Yes, HospitalWise plans are renewable for life as outlined in the policy.
Coverage can end for nonpayment, claim fraud or death on a single policy. It also ends if you stop being a permanent United States resident.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β If I cancel HospitalWise, when does coverage end?
Coverage ends at the end of the period you have already paid for.
In Mississippi, however, it ends on the date your request is received or a later date you choose.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β How do I file a HospitalWise claim?
Print a claim form at uhcmemberhub.com and send it with the required information.
Give notice within 30 days of the loss, or as soon as reasonably possible. Benefits are then paid directly to you unless you assign them.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β How long is the HospitalWise free look period?
You can return a HospitalWise policy within 10 days for a premium refund.
However, Connecticut, Iowa, Louisiana, Minnesota, Oklahoma, South Carolina and Utah allow 30 days.
π Where this applies: Most states Vivna serves, except California, Colorado, New Hampshire, New Jersey and New Mexico
β Which HospitalWise benefits are not available in some states?
Connecticut has no Outpatient Care, Outpatient Surgical or Outpatient Major Diagnostic benefit.
Idaho also drops observation and wellness. Kansas has no Outpatient Care, Major Diagnostic or Wellness benefit. In addition, Illinois and Virginia have no Wellness benefit.
π Where this applies: Connecticut, Idaho, Illinois, Kansas and Virginia
β How long can my child stay on HospitalWise in Florida?
In Florida, a child under 31 can stay covered if unmarried and without other health coverage.
Foster children are also eligible.
π Where this applies: Florida
β Does HospitalWise pay past 10 hospital days in Texas or Pennsylvania?
Yes, after the 10-day maximum, Texas and Pennsylvania pay $50 per day for the rest of the stay.
However, this extra benefit lasts up to 31 days.
π Where this applies: Pennsylvania and Texas
β Is Optum Perks included with HospitalWise in Pennsylvania?
No, Optum Perks is not included with HospitalWise in Pennsylvania.
π Where this applies: Pennsylvania
β Does HospitalWise pay for a second opinion in Maryland?
Yes, Maryland adds a $100 second opinion benefit per confinement when the hospital requires one.
Maryland also has no waiting period for the Wellness benefit.
π Where this applies: Maryland
β Which states offer HospitalWise?
HospitalWise is available in every state except Massachusetts, New Hampshire, New Jersey, New Mexico, New York and Vermont.
π Where this applies: Most states Vivna serves, except New Hampshire, New Jersey and New Mexico
AdvantageGuard
Here you can see what AdvantageGuard pays and which riders you can add. Plus, learn who can apply.
β What is AdvantageGuard?
AdvantageGuard is a hospital indemnity policy from Golden Rule Insurance Company, a UnitedHealthcare company.
It pays fixed cash benefits for covered hospital stays, regardless of your actual expenses. The policy is also designed to supplement other coverage, including Medicare.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β Who is AdvantageGuard designed for?
AdvantageGuard is for people ages 60 through 90 at the time of issue.
It helps with out-of-pocket hospital costs that other coverage, like Medicare, may leave behind.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β Can I keep AdvantageGuard along with my Medicare Advantage plan?
Yes, AdvantageGuard is separate from any Medicare Advantage plan you have with another company.
It pays regardless of other insurance. However, it does not fully supplement Medicare Advantage, so it is extra cash help only.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β Does AdvantageGuard ask health questions?
It depends on the AdvantageGuard benefits you choose.
Plans are either guaranteed issue, with no underwriting, or simplified issue, with some medical questions.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β Can my spouse be on my AdvantageGuard policy?
Yes, your spouse, or your domestic partner as defined by your state, is eligible.
However, the primary insured must be 60 or older when applying. Dependent children are not eligible.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β How much does AdvantageGuard pay per day in the hospital?
You choose a daily amount and a day limit when you apply for AdvantageGuard.
With a 1-day limit per confinement, you can choose $50 to $3,000 per day. However, with a 3, 4, 5, 6, 7 or 10-day limit, you can choose $50 to $1,000 per day. Either way, amounts go up in $50 steps.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β What does period of confinement mean on AdvantageGuard?
On AdvantageGuard, a period of confinement is one or more hospital stays for the same or related causes.
A new period starts only if stays are at least 60 days apart. Also, your day limit applies to each period of confinement.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β Does AdvantageGuard pay for a hospital observation stay?
Yes, an observation stay of 12 to 24 hours pays 100% of your chosen inpatient daily benefit.
It is limited to 4 days per person, per calendar year. However, AdvantageGuard pays observation over 24 hours as an inpatient stay.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β Does AdvantageGuard cover a hospital stay for mental health?
Yes, AdvantageGuard pays $250 per day for an inpatient stay for a mental or nervous disorder.
It is limited to 7 days per person, per calendar year. However, the plan excludes substance use disorder treatment.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β What optional riders can I add to AdvantageGuard?
In most states, optional riders cover cancer, provider-given prescription drugs, ER and urgent care, and skilled nursing.
Other riders also cover outpatient surgery, major diagnostic tests, ambulance trips and wellness visits. Each rider adds to your premium.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β When can I add riders to AdvantageGuard?
You can add AdvantageGuard riders only when you apply for the policy.
Riders apply to everyone on the policy. They also require additional premium.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β How does the AdvantageGuard cancer rider work?
You choose a lifetime amount from $2,500 to $50,000, in $2,500 steps.
The rider pays on a first diagnosis after a 30-day waiting period. Life-threatening cancer pays 100%, while cancer in situ and benign brain tumor pay 25%. In addition, skin cancer pays $500.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β Can the AdvantageGuard cancer rider pay more than once?
Each qualifying event on the cancer rider pays once per lifetime.
Overall, the total paid will not exceed the benefit amount you chose.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β What does the AdvantageGuard outpatient prescription drug rider cover?
The rider pays $100 to $500 daily for brand prescription drugs injected in an outpatient provider setting.
Benefits are limited to 6 days per calendar year and 20 days per lifetime. Also, a 30-day waiting period applies in most states.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β What does the AdvantageGuard ER and urgent care rider pay?
The ER benefit pays $100 to $500 per day, in $100 steps.
Urgent care pays 50% of your chosen ER amount. Visits are limited to 4 combined days per calendar year. Plus, no hospital admission is required.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β Does AdvantageGuard cover a skilled nursing facility stay?
Yes, the optional rider pays for a skilled nursing facility stay.
In most states, it pays $100 to $500 per day for days 21 to 100 of a qualified stay. However, the stay must begin within 30 days of an inpatient hospital stay.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β What do the AdvantageGuard outpatient surgery and diagnostic riders pay?
Outpatient surgery pays $250 to $2,500 per day, up to 2 days per calendar year.
Major diagnostic tests pay $100 to $500 per day, also up to 2 days per calendar year. Covered tests include CT, MRI, PET, angiogram, CTA, EEG and EKG.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β Does AdvantageGuard pay for ambulance rides?
Yes, the optional rider pays for ambulance trips that lead to an inpatient hospital stay.
Ground ambulance pays $100 to $500 per day, and air ambulance pays 10 times your ground amount. Also, trips are limited to 4 combined days per calendar year.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β Does AdvantageGuard cover wellness visits?
Yes, the optional Wellness rider pays $75 for one covered exam or procedure per calendar year.
Examples include an annual physical, vaccines, colonoscopy and mammography. A 30-day waiting period also applies in most states.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β Is there a waiting period on AdvantageGuard?
There is no waiting period for AdvantageGuard standard benefits and most riders.
However, in most states the Cancer, Outpatient Prescription Drug and Wellness riders have a 30-day waiting period. Preexisting condition limits still apply.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β Does AdvantageGuard cover preexisting conditions?
AdvantageGuard does not pay losses caused by a preexisting condition during your first 6 months of coverage.
After 6 months, this limit no longer applies.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β What counts as a preexisting condition on AdvantageGuard?
It is a condition you got advice, care or treatment for in the 6 months before coverage starts.
The definition also includes tests or screenings in that time that lead to later care. In addition, symptoms that would have prompted a prudent person to seek care count too.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β Is AdvantageGuard renewable?
Yes, AdvantageGuard is renewable for life as outlined in the policy.
Coverage ends for nonpayment, your request, claim fraud or death on a single policy. It also ends if you stop being a permanent United States resident.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β How do I file an AdvantageGuard claim?
Print a claim form at uhcmemberhub.com, fill it out and send it with the required information.
Golden Rule should get notice within 30 days of the loss, or as soon as reasonably possible. Also, benefits are paid directly to you.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β Does AdvantageGuard limit which hospitals or doctors I can use?
No, the AdvantageGuard flyer lists no network restrictions.
However, if you also have a major medical plan, that plan may require certain networks for full coverage.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β How long is the AdvantageGuard free look period?
You can return an AdvantageGuard policy within 10 days for a refund of premium paid.
However, Connecticut, Louisiana, Minnesota, New Hampshire, South Carolina and Utah allow 30 days.
π Where this applies: Most states Vivna serves, except California, Colorado, New Jersey and New Mexico
β Which states pay extra on AdvantageGuard after my hospital days run out?
In many states, AdvantageGuard keeps paying a smaller daily amount for up to 31 days.
States paying $50 per day include CT, DE, FL, ID, IL, IA, KS and ME. NH, OK, PA, TX, UT, VA and WV also pay $50 per day. In addition, Arkansas pays $80 and South Carolina pays $30.
π Where this applies: AR, CT, DE, FL, ID, IL, IA, KS, ME, NH, OK, PA, SC, TX, UT, VA, WV
β Are all AdvantageGuard riders available in every state?
No, some states exclude certain riders, and Connecticut and Idaho exclude several.
Virginia excludes the Cancer, Skilled Nursing and Wellness riders. In addition, Illinois excludes Cancer and Wellness, and Kansas excludes Outpatient Major Diagnostic. Michigan also excludes Wellness, and New Hampshire has no Cancer rider.
π Where this applies: CT, ID, IL, KS, MI, NH, VA
β What is different about AdvantageGuard in Florida?
After your chosen hospital days run out, Florida pays $50 per day for up to 31 days.
Florida members also get at least 45 days notice of premium changes. In addition, past premiums are not adjusted if your age was misstated.
π Where this applies: Florida
β Does the AdvantageGuard cancer rider work differently in North Dakota?
Yes, in North Dakota only life-threatening cancer qualifies under the AdvantageGuard cancer rider.
As a result, cancer in situ, benign brain tumor and skin cancer are not covered under the rider.
π Where this applies: North Dakota
β Are there extra AdvantageGuard benefits in Maryland?
Yes, Maryland adds a $100 second opinion benefit per confinement when the hospital requires one.
Maryland also has no waiting period on the Cancer, Outpatient Prescription Drug and Wellness riders. In addition, fully disclosed preexisting conditions are covered unless excluded by a signed waiver.
π Where this applies: Maryland
β Does AdvantageGuard pay for a hospital stay after breast cancer surgery in Montana?
Yes, Montana's inpatient benefit covers stays after a mastectomy, lumpectomy or lymph node dissection for breast cancer.
π Where this applies: Montana
β What is different about AdvantageGuard skilled nursing coverage in some states?
Most states pay for days 21 to 100 of a skilled nursing stay.
However, Idaho, New Hampshire, Pennsylvania and Utah pay starting on day 1.
π Where this applies: Idaho, New Hampshire, Pennsylvania and Utah
β Which states offer AdvantageGuard?
AdvantageGuard is available in every state except California, Massachusetts, New Jersey, New Mexico, New York, Oregon and Vermont.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
Hospital SafeGuard GI
These answers cover Hospital SafeGuard GI benefits and limits. In addition, see how its enrollment rules work.
β What is Hospital SafeGuard GI?
Hospital SafeGuard GI (HSGGI) is a guaranteed issue fixed indemnity plan from Golden Rule Insurance Company.
It pays set amounts for hospital stays, outpatient surgery, doctor visits, ER, ambulance, diagnostics and wellness. Plus, it pays benefits regardless of other insurance.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Do I need to answer health questions for Hospital SafeGuard GI?
No, Hospital SafeGuard GI plans are not subject to medical underwriting.
However, preexisting condition limits still apply to most hospital benefits.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Who can buy Hospital SafeGuard GI?
You and your spouse must be 18 to 64 when applying.
In Delaware and Maryland, the range is 18 to 60 instead. Children can also be covered from birth through age 25, or as your state requires.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β What Hospital SafeGuard GI plans are available?
There are four plans: Plan 500, Plan 750, Plan 1000 and Plan 2000.
The plan number matches the daily hospital benefit. Also, higher plans pay more for most services.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How much does Hospital SafeGuard GI pay per day in the hospital?
Hospital SafeGuard GI pays $500, $750, $1,000 or $2,000 per hospital day, depending on your plan.
That said, the limit is 31 days per period of confinement.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Hospital SafeGuard GI pay extra for ICU care?
Yes, ICU or CCU care pays the same daily amount as your hospital benefit, on top of it.
However, the limit is 31 days per period of confinement.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Hospital SafeGuard GI pay a hospital admission benefit?
Yes, Hospital SafeGuard GI pays $1,000, $1,500, $2,000 or $2,500 by plan for the first inpatient day.
This is in addition to the daily benefit. However, it pays only once per calendar year.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Hospital SafeGuard GI pay for inpatient surgery?
Yes, inpatient surgery pays $500, $500, $1,000 or $1,500 per day by plan.
This benefit covers up to 2 days per calendar year. In addition, the anesthesiologist benefit adds $100 to $300 per day.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Hospital SafeGuard GI pay for outpatient surgery?
Yes, outpatient surgery pays $500, $1,000, $1,500 or $1,500 per day by plan.
This benefit covers up to 2 days per calendar year. In addition, the anesthesiologist benefit adds $100 to $300 per day.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How much does Hospital SafeGuard GI pay for an ER visit?
All plans pay $250 per day for illness and $500 per day for injury.
However, ER visits have a limit of 2 combined days per calendar year.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Hospital SafeGuard GI cover ambulance rides?
Yes, ground or water ambulance pays $500 per day on all plans.
Air ambulance pays $3,000 on Plans 500 and 750, and $5,000 on Plans 1000 and 2000. Overall, the limit is 2 combined days per calendar year.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How much does Hospital SafeGuard GI pay for doctor or urgent care visits?
Plans 500, 750 and 1000 pay $50, $75 or $100 per day.
They cover up to 4 days per calendar year. By contrast, Plan 2000 pays $100 per day, up to 6 days.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Hospital SafeGuard GI pay for lab tests, X-rays and scans?
Yes, Hospital SafeGuard GI pays for non-preventive lab tests, X-rays and scans.
Labs and X-rays pay $50 per day, up to 4 days each per calendar year. However, Plan 2000 pays $75 for labs and $100 for X-rays. MRI, PET or CT scans pay $200 to $400 per day, up to 2 days.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Hospital SafeGuard GI cover wellness or preventive care?
Yes, it pays $50, $100, $150 or $200 by plan for one wellness visit per calendar year.
However, a 30-day waiting period applies, except in Maryland.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β What is the accident benefit on Hospital SafeGuard GI?
The Accidental Loss of Life, Limb or Sight rider pays $20,000 for the primary insured or spouse.
It pays $5,000 for a dependent aged 15 days to 26 years. Also, the loss must occur within 30 days of the accident.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Is the Hospital SafeGuard GI accident rider available everywhere?
No, the accident rider is not available in Virginia.
Maryland allows a loss within 90 days of the accident. In addition, Texas covers dependents from birth to 26.
π Where this applies: Maryland, Texas and Virginia
β Does Hospital SafeGuard GI include telehealth?
Telehealth through HealthiestYou is an optional benefit for an additional premium.
It offers unlimited $0 general doctor visits 24/7 by app, web or phone. However, behavioral health and dermatology visits cost extra.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Can I use any doctor with Hospital SafeGuard GI?
Yes, the plan pays benefits the same no matter which licensed provider you use.
Plus, you may save with the MultiPlan Network for Limited Benefit Plans.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How do I get MultiPlan discounts with Hospital SafeGuard GI?
Assign your benefits to the MultiPlan provider so payment goes directly to them.
Ask your provider for an assignment of benefits form. You can also check multiplan.com/fixedindemnity to see if your doctor participates.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How big is the MultiPlan network for Hospital SafeGuard GI?
MultiPlan offers access to over 4,400 hospitals and 980,000 health care professionals.
However, the MultiPlan network is a discount program, not insurance.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How do Hospital SafeGuard GI claims get paid?
Usually, the provider submits the claim and the plan pays them.
If the benefit is less than the bill, you pay the difference. However, if the benefit is more, the plan sends you the rest by check.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Can I file a Hospital SafeGuard GI claim myself?
Yes, if you paid for covered services, you can submit a claim form and be reimbursed directly.
Also, notice of claim is due within 30 days of the loss, or as soon as reasonably possible.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Hospital SafeGuard GI cover preexisting conditions?
The plan does not pay hospital benefits for preexisting conditions for up to 12 months after coverage starts.
A preexisting condition is one with care, tests or symptoms in the 6 months before coverage.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Which Hospital SafeGuard GI benefits are subject to preexisting condition limits?
The brochure marks hospital stays, ICU, first admission, ER, and inpatient and outpatient surgery and anesthesia.
In other words, those benefits are subject to the preexisting condition limit.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Is there a waiting period on Hospital SafeGuard GI?
Wellness and preventive care has a 30-day waiting period, except in Maryland.
The brochure does not list waiting periods for other benefits. However, preexisting condition limits apply separately.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How long can I keep Hospital SafeGuard GI?
Coverage can continue until the end of the premium period when the primary insured turns 65.
After that, a covered spouse can continue the policy. Coverage also ends for nonpayment, fraud or your request.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Can Golden Rule decline to renew my Hospital SafeGuard GI policy?
The brochure lists a declined renewal, or discontinuing the form statewide, as a termination event.
Also, rates will not change because of your claims or health. In Virginia, Golden Rule may instead cancel with at least 31 days' written notice.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How long is the Hospital SafeGuard GI free look period?
You have 30 days after your policy is issued to return it.
If you return it, you get your paid premium back.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Hospital SafeGuard GI cover mental health care?
No, the plan excludes losses related to mental disorders or substance use disorder.
However, the optional telehealth benefit offers behavioral health visits for an extra charge.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How long can my child stay on Hospital SafeGuard GI in Florida?
In Florida, a child can stay covered until their 31st birthday if unmarried and without other coverage.
Florida members also get at least 45 days' notice of premium changes.
π Where this applies: Florida
β Does Hospital SafeGuard GI pay more for primary care in Delaware?
In Delaware, office, urgent care and wellness benefits include chronic care management and primary care services.
These benefits pay the greater of the plan benefit or 100% of the Medicare rate.
π Where this applies: Delaware
β What is different about Hospital SafeGuard GI in Maryland?
Maryland caps issue age at 60 and adds a $100 second opinion benefit.
Wellness has no waiting period. In addition, hospital benefits can continue up to 12 months if you are confined when coverage ends.
π Where this applies: Maryland
β When are preexisting conditions covered on Hospital SafeGuard GI in North Carolina?
In North Carolina, preexisting conditions are covered 12 months after your coverage effective date.
The look-back period is 6 months.
π Where this applies: North Carolina
β Which states offer Hospital SafeGuard GI?
Hospital SafeGuard GI is available in 36 states.
However, it is not available in Connecticut, D.C., Idaho, Kansas, Massachusetts, Montana, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Oregon, South Dakota, Vermont or Washington.
π Where this applies: AL, AR, AZ, CA, CO, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
Health ProtectorGuard
Health ProtectorGuard pays set amounts for many kinds of care. So review what each benefit pays before you buy.
β What is Health ProtectorGuard?
Health ProtectorGuard (HPG) is a fixed indemnity plan from Golden Rule Insurance Company.
It pays set cash amounts for everyday and unexpected care, like doctor visits, prescriptions and hospital stays. In addition, it supplements your existing health coverage.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β What Health ProtectorGuard plans are available?
There are three Health ProtectorGuard plans: Select 2000, Preferred 4000 and Premier 5000.
Higher plans pay larger fixed amounts and allow more visits and fills.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Who can buy Health ProtectorGuard or a Guard plan?
You and your spouse must be 18 to 64 when applying, or as your state requires.
Children can be covered from birth through age 25. However, Delaware and Maryland have a maximum issue age of 60.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Do I have to answer health questions for Health ProtectorGuard?
Yes, Health ProtectorGuard and Guard plans are subject to health underwriting.
Also, incorrect or incomplete answers can void coverage or lead to denied claims.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Is there a waiting period on Health ProtectorGuard?
No, the Health ProtectorGuard brochure says there is no waiting period.
However, preexisting condition limits still apply.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Health ProtectorGuard cover preexisting conditions?
In most states, Health ProtectorGuard does not cover preexisting conditions during the first 12 months.
A preexisting condition is one you had care, advice or symptoms for in the 12 months before coverage. The same rule applies to Guard plans as well.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Do any states use a shorter preexisting condition look-back on Health ProtectorGuard?
Yes, Nevada and Wyoming use a 6-month look-back instead of 12 months.
Also, in Missouri, the limit does not apply to a child placed with you for adoption.
π Where this applies: Missouri, Nevada and Wyoming
β Is there a maximum benefit on Health ProtectorGuard?
Yes, the brochure lists a $2 million calendar year maximum and a $5 million lifetime maximum per person.
Individual benefits also have their own visit, day or fill limits.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How much does Health ProtectorGuard pay per day in the hospital?
Select 2000 pays $2,000 per day, Preferred 4000 pays $4,000 and Premier 5000 pays $5,000.
There is no limit on the number of days. Also, observation unit stays of 24 hours or more count.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Do Health ProtectorGuard hospital benefits go up the longer I keep the plan?
Yes, for injury stays the daily amount doubles after the plan has been in force long enough.
It rises to $4,000, $8,000 or $10,000, depending on your plan. However, illness stays do not increase.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β When do the Health ProtectorGuard and Guard plan benefit increases start?
If the plan has been in force over 6 months, increases start the next January 1.
Otherwise, they start January 1 after 12 straight months of coverage. The increase happens only once.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Health ProtectorGuard pay a first-day hospital admission benefit?
Yes, it pays $2,000 on Select 2000 and $3,000 on Preferred 4000 and Premier 5000.
The benefit is paid for the first inpatient day, once per calendar year.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Health ProtectorGuard pay extra for ICU care?
Yes, ICU or CCU care pays $2,000, $4,000 or $5,000 per day by plan, up to 60 days.
This is in addition to the daily hospital benefit.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Health ProtectorGuard pay for doctor visits while I am in the hospital?
Yes, all plans pay $100 per day for an inpatient doctor visit, up to one visit per day.
Guard plans pay the same amount as well.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How much does Health ProtectorGuard pay for an ER visit?
It pays $300 per day on Select 2000, $500 on Preferred 4000 and $1,000 on Premier 5000.
However, ER benefits are limited to 3 days per calendar year.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Health ProtectorGuard cover ambulance rides?
Yes, all plans cover one ambulance trip per calendar year.
Ground or water ambulance pays $1,000 per trip. Air ambulance, by contrast, pays $5,000 per trip.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How does Health ProtectorGuard pay for surgery?
Surgery pays by a 7-tier schedule based on the procedure.
Amounts range from $250 to $25,000 on Select 2000 and $375 to $37,500 on Preferred 4000. Premier 5000, meanwhile, pays $500 to $50,000.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β What kinds of surgeries fall in each Health ProtectorGuard surgical tier?
Tier 1 is major organ transplants, and tier 2 includes surgery like removing the esophagus.
For example, knee or hip replacement falls in tier 5, and appendectomy falls in tier 6. Finally, tier 7 includes tonsil removal and ear tubes.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How are surgical tiers decided on Health ProtectorGuard and Guard plans?
Each procedure is tiered by its relative value unit, a CMS measure, based on its CPT code.
If surgery fits several tiers, the highest amount is paid. Also, several surgeries on one day pay one amount for the highest tier.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Health ProtectorGuard cover organ transplants?
Yes, Health ProtectorGuard covers organ transplants under surgical Tier 1.
It pays $25,000, $37,500 or $50,000 by plan. However, it is payable once per organ type per lifetime, such as heart, liver, kidney or bone marrow.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Health ProtectorGuard pay for the surgeon's assistant and anesthesia?
Yes, the assistant surgeon benefit pays 20% of the surgical benefit when the surgery requires one.
The anesthesiologist benefit pays 30% of the surgical benefit. Guard plans pay the same percentages as well.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β What does not count as surgery on Health ProtectorGuard and Guard plans?
Blood draws, tattoos, cosmetic treatment and most injections do not count as surgery.
Experimental treatment, pregnancy and childbirth, and colonoscopy procedures are also not surgery. However, spinal injections and reconstructive surgery are exceptions.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Health ProtectorGuard pay for outpatient surgery center fees?
Yes, the outpatient facility benefit pays $1,000, $2,000 or $4,000 per day by plan.
It is limited to 10 days per calendar year.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Health ProtectorGuard pay for lab tests and imaging?
Yes, Health ProtectorGuard pays for up to 10 combined tests per calendar year.
Labs pay $30 to $50, and X-rays and similar tests pay $50 to $75. In addition, MRI, PET or CAT scans pay $400, or $1,000 on Premier 5000.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Health ProtectorGuard cover chemotherapy?
Yes, oral chemo pays $1,000 per month for up to 3 months.
However, Premier pays $2,000 per month for up to 6 months. Other chemo, radiation and immunotherapy pay $1,000 to $2,500 per day. That benefit is limited to 40 days, or 60 on Premier.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How much does Health ProtectorGuard pay for a doctor visit?
Doctor office visits pay $80, $100 or $150, depending on your plan.
Specialist and urgent care visits pay $100 to $200. A visit with in-office surgery pays $200 to $250 instead.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How many office visits does Health ProtectorGuard cover each year?
At first, Select 2000 covers 4 visits, Preferred 4000 covers 6 and Premier 5000 covers 10.
After the benefit increase, limits rise to 6, 8 and 12. All visit types count toward one combined limit.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Health ProtectorGuard cover physical therapy or chiropractic care?
Yes, chiropractic, physical, occupational and speech therapy visits pay $35, $45 or $75 by plan.
The limit is 10 visits per calendar year.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How does Health ProtectorGuard pay for prescriptions?
Generic drugs pay $10 or $20 per fill, and brand drugs pay $40 or $60 per fill.
Select and Preferred cover 12 fills at first, rising to 17. Premier, by contrast, covers 20 fills, rising to 25.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β What wellness benefits come with Health ProtectorGuard?
All plans pay for a physical exam, screening labs and X-ray, and flu shots.
They also pay for child immunizations and allergy treatments, bone density screening, EKG and stress EKG. Each has its own fixed amount and yearly limit.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How much does Health ProtectorGuard pay for an annual physical?
It pays $100 on Select 2000, $125 on Preferred 4000 and $150 on Premier 5000.
The limit is one exam per calendar year.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Health ProtectorGuard pay for a mammogram?
Yes, Health ProtectorGuard pays for a mammogram for women 30 and older, once per calendar year.
It pays $150 on Select 2000 and $200 on the other plans at first. After the benefit increase, it pays $225 or $300.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Health ProtectorGuard pay for a Pap smear or PSA test?
Yes, a Pap smear or PSA test pays $100, once per calendar year.
Pap smears are for women 18 and older, and PSA tests are for men 40 and older. After the benefit increase, it rises to $150.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Health ProtectorGuard cover a colonoscopy?
Yes, it pays $500 on Select 2000 and $750 on Preferred 4000 and Premier 5000.
The benefit is paid once per calendar year. It covers preventive screening at 50 and older, or at any age if illness related.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Are flu shots and vaccines covered on Health ProtectorGuard?
Yes, adults 18 and older get $25 for one flu shot per calendar year.
Children under 18 get $25 per shot for up to 4 immunizations or flu shots.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Health ProtectorGuard include telehealth?
Yes, all plans include unlimited $0 virtual doctor visits through HealthiestYou by Teladoc Health.
You can connect by phone or video, 24/7. However, visits with psychiatrists, psychologists and dermatologists cost extra. HealthiestYou is not insurance.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Can I see any doctor with Health ProtectorGuard or a Guard plan?
Yes, you can use any provider with Health ProtectorGuard or a Guard plan.
That said, using a UnitedHealthcare Choice Plus provider gets you pre-negotiated lower rates. Network providers also file claims for you.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How big is the network for Health ProtectorGuard discounts?
The UnitedHealthcare Choice Plus network has more than 1.8 million providers and 7,000 hospitals.
According to the brochure, average discount savings are 58%, though savings vary by provider and service. Also, you can search for providers with Find A Doctor on uhone.com.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How do claims work on Health ProtectorGuard and Guard plans?
Show your ID card to a network provider, and they file the claim.
The benefit goes to the provider and reduces what you owe. However, if you use a non-network provider, you can submit the claim yourself.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Can Health ProtectorGuard pay more than my medical bill?
Yes, because benefits are fixed, some pay more than the discounted cost of the service.
If so, the difference is mailed to you as a check.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Can you show how Health ProtectorGuard pays for a hospital stay?
In a brochure example, a 6-night stay on Preferred 4000 cost $6,425 after the network discount.
The plan benefit was $27,000, so $20,575 went to the member. However, examples are illustrations only, and actual results vary.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Health ProtectorGuard pay for a hospital stay that starts on a weekend?
Not for a stay that begins on a Friday or Saturday, unless it is an emergency.
Surgery scheduled for the next day is also an exception. However, this exclusion does not apply in Florida, Texas or Virginia.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Does Health ProtectorGuard cover mental health care?
No, Health ProtectorGuard and Guard plans exclude losses related to mental disorders or substance use disorders.
However, telehealth visits with a psychiatrist or psychologist are available for an extra fee.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β What does Health ProtectorGuard not cover?
Exclusions include cosmetic treatment, infertility, gender-affirming surgery and experimental treatment.
Pregnancy is excluded, except for complications. The plans also exclude care that is not medically necessary and most care outside the United States.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How long can I keep Health ProtectorGuard or a Guard plan?
It is renewable until the primary insured turns 65, as long as premiums are paid.
After that, a covered spouse, or else a covered child, can continue the policy. Coverage also ends for nonpayment, fraud or your request.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Can Golden Rule stop renewing my Health ProtectorGuard plan?
Only if it discontinues and refuses to renew all policies on that form for everyone in your state.
It cannot single you out for claims or health changes.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Is the 12-month rate guarantee on Health ProtectorGuard available in Ohio?
No, the 12-month rate change guarantee does not apply in Ohio.
π Where this applies: Ohio
β How long is the Health ProtectorGuard free look period?
You can return the policy within 10 days for a refund of premium paid.
However, Indiana, Louisiana, Oklahoma and South Carolina allow 30 days. The same applies to Guard plans.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How long can my child stay on Health ProtectorGuard in Florida?
Florida lets your or your spouse's child stay covered under age 31 if unmarried and without other coverage.
In addition, Florida drops the weekend hospital admission exclusion.
π Where this applies: Florida
β Does Health ProtectorGuard cover chiropractic visits in Tennessee?
Yes, but in Tennessee chiropractic visits are paid as doctor office visits.
They are not paid under the separate therapy visit benefit.
π Where this applies: Tennessee
β What happens in Maryland if I am in the hospital when my Health ProtectorGuard coverage ends?
Maryland continues hospital benefits until discharge or 12 months, whichever is first.
However, this does not apply if coverage ended for nonpayment, fraud or your request.
π Where this applies: Maryland
β Which states offer Enhanced Health ProtectorGuard?
Enhanced Health ProtectorGuard is available in 35 states and uses the UnitedHealthcare Choice Plus network.
It is not available in California, Connecticut, D.C., Idaho, Kansas, Massachusetts, Montana, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Oregon, South Dakota, Vermont or Washington. However, Pennsylvania offers a previous product version.
π Where this applies: AL, AR, AZ, CO, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Which states offer Health ProtectorGuard?
Health ProtectorGuard (MultiPlan network) is available only in California.
California has a state-specific version.
π Where this applies: California
Guard Plans
These answers explain what the Guard plans pay for visits, tests and hospital care. Then compare them with other options.
β What are UnitedHealthcare Guard plans?
Guard plans are fixed indemnity plans from Golden Rule, issued on policy form HPG3-CSTM-GRI.
The options are Guard 4000, Guard 5000 and Guard 6000. They pay set amounts for hospital stays, doctor visits, surgery, ER and ambulance.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How do Guard plans pay for a hospital stay?
Guard plans pay a large first-day admission benefit of $4,000, $5,000 or $6,000 by plan.
After that, each inpatient day pays $100, up to 31 days. Injury stays rise to $200 per day after the benefit increase.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How are Guard plans different from Health ProtectorGuard?
Guard plans pay a big first-day hospital benefit, then $100 per day.
By contrast, Health ProtectorGuard pays $2,000 to $5,000 every hospital day, with no day limit. Guard plans also limit surgery to 2 days and list no wellness benefits.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Can you show how a Guard plan pays for a hospital stay?
In a brochure example, a 6-night stay on Guard 5000 cost $6,425 after the network discount.
The plan paid $5,600, leaving the member $825. Still, examples are illustrations only, and actual results vary.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How much do Guard plans pay for an ER visit?
Guard 4000 pays $300 per day, Guard 5000 pays $500 and Guard 6000 pays $600.
That said, ER benefits have a limit of 3 days per calendar year.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Do Guard plans cover ambulance rides?
Yes, Guard plans cover one ambulance trip per calendar year.
Ground or water ambulance pays $500 on Guard 4000 and $600 on Guard 5000 and 6000. By contrast, air ambulance pays $3,000 on all three.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How do Guard plans pay for surgery?
Surgery pays by a 7-tier schedule, up to 2 days per calendar year.
Guard 4000 and 5000 pay $125 to $12,500. Meanwhile, Guard 6000 pays $250 to $25,000.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Do Guard plans pay for outpatient surgery center fees?
Yes, the outpatient facility benefit pays $1,000, $1,500 or $2,000 per day by plan.
That said, this benefit has a limit of 2 days per calendar year.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Do Guard plans pay for X-rays, MRIs and other tests?
Guard 4000 does not cover outpatient tests.
By contrast, Guard 5000 pays $50 per X-ray, $250 per ultrasound or EKG, and $500 per MRI. Guard 6000 pays $100, $500 and $500. Both plans also allow 4 combined tests per calendar year.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β How much do Guard plans pay for doctor visits?
Doctor office visits pay $80, $100 or $120 by plan.
Meanwhile, specialist and urgent care visits pay $100 to $200. All plans cover 4 visits at first, rising to 6 after the benefit increase.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Do Guard plans cover physical therapy or chiropractic care?
Yes, chiropractic, physical, occupational and speech therapy visits pay $25, $35 or $50 by plan.
However, the limit is 10 visits per calendar year.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Do Guard plans pay for prescriptions?
Guard 5000 and Guard 6000 pay $10 per generic fill and $40 per brand fill.
They cover 10 fills at first, rising to 15. However, Guard 4000 has no prescription benefit.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Do Guard plans include wellness or preventive care benefits?
The Guard plans brochure does not list wellness benefits.
By contrast, Health ProtectorGuard plans include wellness benefits like physicals, screenings and flu shots.
π Where this applies: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, RI, SC, TN, TX, UT, VA, WI, WV, WY
β Which states offer Enhanced Guard?
Enhanced Guard is available in the same 35 states as Enhanced Health ProtectorGuard.
It also uses the Choice Plus network. However, it is not available in California, Connecticut, D.C., Idaho, Kansas, Massachusetts, Montana, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Oregon, South Dakota, Vermont or Washington.
π Where this applies: AL, AR, AZ, CO, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MN, MO, MS, NC, NE, NV, OH, OK, PA, RI, SC, TN, TX, UT, VA, WI, WV, WY
Exclusions and Limits
Every hospital indemnity plan has limits and exclusions. For that reason, check them before you rely on a plan.
β Do UnitedHealthcare hospital indemnity plans cover pregnancy or childbirth?
No, all four products exclude pregnancy and childbirth, except for complications of pregnancy.
However, some states add exceptions, such as Virginia for pregnancy after a reported rape.
π Where this applies: Every state where this plan is sold
β Are injuries from risky sports or activities covered?
Generally no, because exclusions include professional, semi-professional and intercollegiate sports, skydiving, hang gliding and bungee jumping.
The plans also exclude motor racing and scuba diving 60 feet or deeper. However, several states remove some of these exclusions.
π Where this applies: Every state where this plan is sold
β Are work injuries covered by these fixed benefit plans?
AdvantageGuard, HospitalWise and Hospital SafeGuard GI exclude injuries covered or required to be covered by workers' compensation.
However, some states modify this rule, such as Virginia and South Dakota.
π Where this applies: Every state where this plan is sold
β Do these plans cover care outside the United States?
These plans cover only emergency treatment outside the United States.
The plans exclude other services received outside the United States. However, Texas removes this exclusion, as does Pennsylvania for HospitalWise.
π Where this applies: Every state where this plan is sold
β Do UnitedHealthcare hospital indemnity plans cover dental or vision care?
No, these plans do not cover routine dental or vision care.
The plans also exclude eye exams and fittings for glasses, contacts or hearing aids. However, AdvantageGuard and HospitalWise cover dental only for accidental injury to natural teeth treated within 6 months.
π Where this applies: Every state where this plan is sold
β Is cosmetic surgery covered on these plans?
No, all four products exclude cosmetic treatment.
However, some states exempt reconstructive surgery, such as after trauma, infection or a congenital condition.
π Where this applies: Every state where this plan is sold
β Do AdvantageGuard and HospitalWise cover weight-loss surgery?
No, both plans exclude weight loss or modification, including all surgery for weight loss.
However, Idaho and Pennsylvania remove this exclusion for some products.
π Where this applies: AdvantageGuard and HospitalWise states (Idaho and Pennsylvania differ)
β Are injuries caused by intoxication covered?
AdvantageGuard, Health ProtectorGuard and Hospital SafeGuard GI exclude losses from legal intoxication or illegal drug use.
The HospitalWise brochure does not list this exclusion. Also, several states change or remove it, including Nevada and South Carolina.
π Where this applies: Every state where this plan is sold
β Do these plans pay for care given by a family member?
No, the plans exclude services performed by a member of your immediate family.
However, Arizona and Texas remove this exclusion on some products.
π Where this applies: Every state where this plan is sold
β Do fixed benefit plans cover a rehab or custodial care stay?
No, the plans exclude hospital stays mainly for rehab, custodial, educational or nursing care.
The exception is when the policy expressly provides for it. Also, AdvantageGuard offers a separate optional skilled nursing rider.
π Where this applies: Every state where this plan is sold
π More Supplemental Insurance Guides
These answers cover the basics of each UnitedHealthcare hospital indemnity plan. When you want more depth, these guides from our licensed agents explain how supplemental coverage fits with health insurance. Then, if a question comes up, call 888-730-6001 anytime.
π Supplemental Insurance Guides
𧩠More UnitedHealthcare FAQ Libraries
π Questions About UnitedHealthcare Hospital Indemnity?
These answers cover the most common hospital indemnity questions, but every family is different. Therefore, our licensed agents compare UnitedHealthcare supplemental plans for free.
Best of all, our help costs you nothing. Request a free quote online, or call 888-730-6001 to speak with an agent today. You can also reach us through our contact page.
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Official resources: the UnitedHealthOne website, HealthCare.gov, and the National Association of Insurance Commissioners.
Vivna Insurance is an appointed, authorized broker for UnitedHealthcare. We are an independent agency, not UnitedHealthcare. Hospital indemnity plans are supplemental coverage, not major medical insurance. Plans and availability vary by state.