Page 7 - Retiree News Fall 2019

Pearl Talk
CSEA Retiree Program Specialist Christine Meehan sat down with Pearl Insurance President
Gary Hickey to talk more about the exclusive insurance plans available to CSEA Retiree Members.
Christine Meehan (CM):
Often while I am out in the field, I am asked about Pearl Insurance’s programs for CSEA Retirees. Without any insurance background, I don’t want to overstep, so I tell members to call Pearl Insurance and speak with a representative for more information. As the President of Pearl, you must be an insurance expert!
Gary Hickey (GH): Thank you, Christine. I appreciate the compliment! I am not an expert, but I am a fully licensed insurance professional who has been with Pearl for over 30 years! I’m proud to say that the CSEA Group Sponsored Insurance Program has grown and evolved in the time I have been with this company. We (Pearl) offer an exclusive insurance program of voluntary benefits that members cannot get anywhere else.
CM: Often, I am asked ‘What is Hospital & Home Care Recovery Insurance?’ Can you explain what this plan is?
GH: The Hospital & Home Care Recovery (HHCR) Insurance Plan is designed to provide CSEA Retiree members and spouses/domestic partners with extra money to help cover the cost of hospital stays and recovery afterwards. This valuable plan pays a cash benefit in addition to any other health insurances you may have.
CM: Does the benefit have to be used for medical expenses?
GH: No. It can be used towards medical and home care bills, but
it could also be used for other expenses, such as groceries, utility bills and daily living expenses.
CM: So, what does HHCR cover exactly?
GH: HHCR pays up to $1,000 per hospital stay per year and up to $4,000 per year for home care recovery. There are no limitations on the number of hospital confinements in an accrual year. The only limitation is that 90 days must separate each confinement. Otherwise, it could be considered a successive stay.
CM: If someone is transferred to a rehab facility from a hospital, is this still considered inpatient confinement?
GH: Yes, a rehabilitative facility that meets all the definitions of a hospital but does not have surgical facilities is a covered entity. The definition of hospital also includes skilled nursing facilities.
CM: What is Home Care Recovery?
GH: If you are discharged from the hospital with a home health care plan of treatment approved by a doctor or Medicare, you are eligible to receive $100 per day for up to 20 days for covered services of an RN, LPN, licensed home health aide, homemaker, companion services, speech, occupational or physical therapy. Services must be received within 90 days of discharge after a covered hospital stay. Home care is typically less expensive than nursing home stays and in-home care can bring more personalized service and help people recover more quickly.
Pearl Insurance President Gary Hickey, left, discusses Pearl’s Hospital and Home Care Recovery Insurance Program with CSEA Retiree Program Specialist Christine Meehan.
CM: If the RN or LPN that comes to the home is a relative and not through an agency, can I receive benefits?
GH: Relatives are excluded from performing the services.
CM: Are there any limitations on who is eligible for the HHCR Plan?
GH: The Hospital and Home Care Recovery plan is available to
CSEA members under age 75 and their lawful spouses or domestic partners. Acceptance is guaranteed and there’s no medical exam
or health questions to answer. However, it is important to note that if you or your covered spouse is confined at home or a hospital on the date coverage would have been in effect, the insurance will be effective on the day the covered person is no longer confined and is still otherwise eligible.
CM: What about pre-existing conditions?
GH: Any pre-existing conditions you may already be receiving medical treatment for during the six months prior to your effective date will not be covered under this policy. Once you have been continuously insured under this policy for six months, these limitations do not apply.
CM: Does the HHCR plan terminate at a certain age?
GH: The great news is that there is no termination age. However, at age 80, some benefits reduce to keep plan rates affordable.
The insurance representatives
in our office specialize in the CSEA Retiree Insurance Plans and can provide more information, including full plan rates and details.
FALL 2019
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1.877.VIP.CSEA • www.cseainsurance.com