hospital indemnity insurance

The documents listed below are called a summary of material modification (SMM). An SMM explains recent updates to your plan that are not yet captured or updated in your summary plan description (SPD) since the last publication date. Be sure to review the SMM for an understanding of important plan updates.

Other General Plan Changes

• New address for benefits correspondence (June 1, 2020)
• New dependent verification requirement (January 1, 2019) | Learn more

Review the Certificate of Insurance to understand what is covered under the plan. If you enroll, you'll be mailed a Certificate, but you can also contact Mercer Voluntary Benefits to request that a current Certificate of Insurance be mailed to you.

• Certificate of Insurance – Hospital Indemnity Low
• Certificate of Insurance – Hospital Indemnity High

• Group Hospital Indemnity Insurance – Aflac brochure

To file a claim for benefits, file online at www.aflac.com/chevron or to file by paper, follow the instructions on the form to submit your completed claim form and supporting documentation. If you need assistance, contact Aflac.

• Hospital Indemnity Insurance claim form
• Hospital Indemnity Insurance – Authorization for direct deposit form
• Hospital Indemnity Insurance – Authorization to release personal health information

You can make changes to this coverage only under the following circumstances:

• During open enrollment. Changes you elect during open enrollment take effect January 1 of the following year.
• During the first 31 days after a qualifying life event that allows for enrollment or a change in your participation in this plan. The ability to make a change and the kinds of changes you can make vary depending on the type of life event.

You need to enroll to be covered by this benefit. Your coverage will begin as follows:

• If you enroll during open enrollment, coverage will begin on January 1 of the following year.
• If you enroll within 31 days of hire or rehire, coverage will begin on the first of the month following enrollment.
• If you enroll within 31 days of a qualifying life event, coverage will begin on the first of the month following enrollment. 

You must be actively at work on the date your coverage is to begin.  

• If you are not actively at work, your coverage will become effective on the date you are next actively at work. 

• There is no waiting period for benefits.
• You and your covered dependents will not have to answer medical questions or otherwise prove you are in good health.
• There are no preexisting condition limitations.

If you are enrolled in this coverage, your participation will end on the first of the month following your termination date.

Coverage can be continued (with certain stipulations) if you change jobs or retire.  You must contact Aflac within 31 days of your termination date.  You can continue your coverage with the same benefits and rates via direct bill.

To be eligible for coverage, when you enroll you’ll be required to attest to meeting certain eligibility requirements, including but not limited to:

• You are actively at work for Chevron at the time of enrollment. 
• The person(s) to be insured has comprehensive health benefits from an insurance policy, an HMO plan, or an employer’s health benefits. You do not have to be enrolled in Chevron health coverage. This means you can have comprehensive health coverage from another source.
• Your spouse is not disabled or unable to work. Spouse includes Domestic Partner as defined in California Family Code Section 297.

When you enroll, you’ll be required to attest to meeting eligibility requirements. 

• You can enroll your spouse for coverage. You can’t enroll your spouse for coverage if he or she is either of the following:
  • Enrolled as an eligible employee.
  • Disabled or unable to work. 
• You will be required to verify the eligibility of any new dependents you enroll in your Chevron health plans by completing the dependent verification process. 

• You can enroll your domestic partner for coverage. You can’t enroll your domestic partner for coverage if he or she is either of the following:
  • Enrolled as an eligible employee.
  • Disabled or unable to work. 
• You will be required to verify the eligibility of any new dependents you enroll in your Chevron health plans by completing the dependent verification process.

Eligibility rules will be enforced at the time of a claim. See the Certificate of Insurance for further details about dependent eligibility.

Dependents Eligible to Participate
You can enroll a dependent child for coverage if the child is:

• Under age 26 
• Is your or your spouse’s natural children, stepchildren (including existing children of new domestic partners), legally adopted children, or children placed for adoption. 
• Newborn children are automatically covered from the moment of birth for 60 days. 
• Newly adopted children are automatically covered for 60 days also. 

Dependents Not Eligible to Participate

• Your other dependents are not eligible for coverage under this plan.
• Your child isn’t eligible under family coverage if enrolled for single coverage as an eligible employee. 

Dependent Verification Process
You will be required to verify the eligibility of any new dependents you enroll in your Chevron health plans by completing the dependent verification process.

Incapacitated Dependent
Dependent children must be younger than age 26; however this limit will not apply to any insured dependent child who is incapable of self-sustaining employment due to mental or physical handicap and is chiefly dependent on a parent for support and maintenance. Proof of a child’s incapacity and dependency must be provided within 31 days after the date when coverage would normally end. Contact the HR Service Center to start the incapacitated dependent certification process in advance of your child turning age 26.