Specified Disease Organ Transplant Insurance
When an organ transplant is in the works, you need solid coverage and expert support. Insuring transplants separately from your medical policy can stabilize your group’s stop-loss rates and also promote the best patient outcomes.
Turn to AIG for experienced case management and access to our national network of highly regarded, successful transplant hospitals.
Benefits of Specified Disease Organ Transplant Insurance
Patients receive complete coverage for in-network transplant-related claims from first dollar.
Includes evaluations, hospital, physician, procurement, and drugs.
No deductibles, co-insurance, or out-of-pocket expenses for in-network services from qualified transplant centers throughout the United States.
A transplant nurse advisor assists patients through all phases of the process.
Consultation/evaluation: Examination and testing to confirm eligibility; meet transplant team.
Candidacy: Patient is added to organ sharing waiting list and notified when one becomes available.
Procedure: Transplant surgery and hospital stay.
Follow-up: Post-release, patient receives close monitoring for up to a year after surgery.
Learn how Specified Disease Organ Transplant Insurance can help provide stellar care for your people and control healthcare costs for your organization.
The document “Group Organ Transplant Insurance” contains the following general disclaimer:
Transplant benefits are those expenses that are transplant-related. Other non- transplant-related expenses may be considered for payment in accordance with the terms and conditions of your company’s health plan. Non-transplant-related expenses include, but are not limited to, the treatment of underlying disease or unrelated conditions. Transplant policy provisions are subject to eligibility and pre-existing condition limitations.
The document also contains limitations and exclusions (state variations may apply).
Pre-Existing Condition Limitation: If you have a Pre-existing Condition on the Policy Effective Date, you are required to fulfill a
12-month waiting period before benefits are provided under the Policy. The waiting period does not apply if you become eligible for
coverage after the Policy Effective Date, unless you are added to the Medical Plan as a result of the Policyholder acquiring a new group, affiliate, division, and/or subsidiary. If you receive a transplant during a Pre-Existing Condition Waiting Period, that transplant and all related charges are excluded from coverage under the Policy and subsequent renewals.
We will not pay, in whole or in part, for any of the following:
- Any service or supply not directly related to a covered transplant procedure. This includes any service, supply, or prescription drug rendered to monitor or treat the underlying disease and/or an unrelated disease before or after transplant (that is not part of the actual covered transplant procedure).
- Services, supplies, and prescription drugs for treatment of complications related to a covered transplant procedure, unless such complications are determined by us to be the immediate and direct result of a covered transplant procedure.
- Services, supplies and prescription drugs required to meet transplant provider’s patient transplant listing requirements including, but not limited to, programs for: chemical dependency; alcoholism; smoking cessation; and weight loss.
- Nutritional supplements including, but not limited to, full or partial oral or intravenous nutrition after discharge from a transplant hospitalization or outpatient transplant procedure.
- Charges for any transplant-related services or supplies incurred prior to the policy effective date.
- Charges for any transplant-related services or supplies related to a transplant that results from an accident or any disease not specified in the policy.
- Charges for prescription drugs incurred prior to a covered transplant procedure, except for prescription drugs used in mobilization and/or high dose chemotherapy that is part of a covered transplant service.
- Charges for prescription drugs incurred after discharge from a transplant hospitalization, except for immunosuppressants, prophylactic antibiotics, prophylactic antivirals, prophylactic antifungals, and/or prescription drugs used to treat complications directly related to a covered transplant procedure.
- Chemotherapy and/or surgery prior to beginning high dose chemotherapy (including bone marrow/stem cell transplantation).
- Services provided for the removal of a transplanted solid organ, unless the removal is provided during a covered transplant procedure.
- Services, supplies, and/or drugs provided after: 1) a transplanted solid organ has been removed from the transplant recipient; 2) a transplanted solid organ ceases to function; 3) disease has returned in a solid organ or bone marrow/stem cell transplant recipient; or 4) prescription drugs, chemotherapy, radiation or other treatment has been rendered to treat the return of disease or as a prophylactic to the return of disease.
- Services for human leukocyte antigen typing of you or your relatives, compatibility testing, unrelated bone marrow/stem cell searches on registries, and harvest and/ or storage of bone marrow/stem cells when bone marrow/stem cell transplant has not been reviewed and approved by us.
- Services and supplies for immunizations.
- Animal organ or artificial organ transplants.
- Charges for a stand-by physician, unless otherwise approved by us. •Services of a provider who is a member of your immediate family.
- Services, supplies, or hospital care which we determine are not medically necessary for the treatment of illness, diseased condition, or impairment, except as specifically stated as covered.
- Custodial care.
- Hospice care.
- Charges for any experimental and/or investigational treatment, except as specifically stated in the policy.
- Charges paid or payable under workers’ compensation.
- Preventive or routine care (including physicals, premarital examinations, any other routine or periodic examinations), dental services and supplies, education and training, except as specifically stated as covered.
- Research studies or screening examinations.
- Services or supplies to the extent you are not legally obligated to pay for them.
- Expenses incurred before the policy year begins or after it ends, except as stated in the policy.
- Rest cures or sanitarium care.
- Services or supplies furnished by any provider acting beyond the scope of such provider’s license.
- Any service or supply that is a Medicare Part A, Part B, or Part D liability.
- Services or supplies received from a dental or medical department maintained by or on behalf of the policyholder.
- Services provided by any governmental agency to the extent that you are not charged for them, unless otherwise required by state or federal law.
- Services or supplies not specifically stated as covered.
- Telephone consultations, charges for failure to keep a scheduled visit, or charges for completing a claim form.
- Recreational or diversional therapy.
- Materials used in occupational therapy.
- Personal hygiene and convenience items, such as air conditioners, humidifiers, hot tubs, whirlpools, or physical exercise equipment, even if a provider prescribes such items.
- Services and supplies, which are eligible to be repaid under any private or public research fund whether or not such funding was applied for or received.
- Services and supplies for treatment of complications or diseases incurred by a living donor, including, but not limited to, increase length of hospitalization or the costs to treat any complication or disease.
- Services and supplies incurred by any COBRA continuee whose COBRA continuation coverage was not offered and/or elected, and premiums were not paid, within the time frames required by COBRA.
- Prescription drugs for the treatment or prevention of a rejected organ or tissue following the end of the transplant benefit period.
- Services and supplies of any provider located outside the United States of America, except for organ or tissue procurement services, unless otherwise prohibited by United States federal law.
- Biological and/or mechanical devices used as a bridge to transplant unless specifically included in the schedule of benefits.
- Charges for any transplant-related services or supplies incurred during the current policy year when the transplant procedure occurred prior to the policy effective date. However, we will make an exception to this exclusion for covered charges related to a covered transplant procedure you received under a previous organ & tissue transplant policy issued by us to the policyholder, as long as:
- There has been no break in coverage between the transplant policies issued by us; and
- The covered charges are for services or supplies incurred within the transplant benefit period for the covered transplant procedure.