hospital indemnity insurance

supplemental health coverage

Group Hospital Indemnity Insurance with Aflac is a supplemental health benefit because it provides financial assistance to enhance your current medical and disability coverage.

Even if you have health insurance, you could face unanticipated out-of-pocket expenses your medical plan doesn’t cover with an inpatient hospital stay. Group Hospital Indemnity Insurance can help with the out-of-pocket costs associated with a covered hospital stay, including benefits for hospital admission, confinement, and intensive care.

the basics

The Group Hospital Indemnity Insurance Plan  pays you, unless otherwise assigned, a cash benefit for costs associated with a covered hospital stay.

  • The Plan is insured by Aflac and administered by Mercer Voluntary Benefits.

  • Plan benefits include a Hospital Admission Benefit, Hospital Confinement Benefit, Hospital Intensive Care Benefit, Intermediate Intensive Care Step-Down Unit and a Mammography Benefit

  • There are two different levels of coverage you can purchase, Hospital Indemnity Low and Hospital Indemnity High. Both levels cover the same kinds of care; the difference is the amount of benefits paid to you.

  • This coverage is voluntary. You must enroll to be covered.

  • This coverage is available to you at group rates. You pay the entire cost of coverage through regular payroll deductions on an after-tax basis. The cost of your coverage is based on the type of coverage you select (employee-only or family) and if you select the Hospital Indemnity Low or Hospital Indemnity High option. You can view premiums online when you enroll, or you can call the Chevron HR Service Center.

plan facts at-a-glance

recent plan changes

Things change; be sure you're informed. The documents provided 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). Be sure to review the SMM for an understanding of important plan updates.

  • N/A
summary plan description (SPD)
Certificate of Insurance

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.

Other Information
To file a claim for benefits, follow the instructions on the form to submit your completed claim form and supporting documentation. If you need assistance, contact Aflac.
If you enroll in Group Hospital Indemnity Insurance, you must designate your beneficiaries directly with Aflac on the Aflac Beneficiary Designation Form

enrollment & participation

If you're eligible to participate, enroll:
If you’re eligible, you can enroll at any of the following times: 
Your enrollment election continues from year to year unless you make a permitted election change.

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. This benefit is not available to retirees; however, you can continue this coverage (with certain stipulations) under an individual policy at individual rates if you contact Aflac within 31 days of your termination date. If you choose to continue this coverage under an individual policy, your premiums may change, and you will pay for this coverage through direct bill with the insurer.

who's eligible to participate

Except as described below, you’re generally eligible for this Plan if you’re considered by Chevron to be a common-law employee of Chevron Corporation or one of its subsidiaries that it has designated to participate in the Omnibus Health Care Plan and you meet all of the following qualifications:

  • You’re paid on the U.S. payroll of Chevron Corporation or a participating company.
  • You’re assigned to a regular work schedule (unless you’re on a family leave, disability leave,  short union business leave, furlough leave, military service leave or leave with pay) of at least 40 hours a week, or at least 20 hours a week if such schedule is an approved part-time work schedule under the corporation’s part-time employment guidelines.
  • If you’re a casual employee, you’ve worked (or are expected to work) a regular work schedule for more than four consecutive months.
  • You’re in a class of employees designated by Chevron as eligible for participation in the plan. 
However, you’re still not eligible if any of the following applies to you:
  • You’re not on the Chevron U.S. payroll, or you’re compensated for services to Chevron by an  entity other than Chevron — even if, at any time and for any reason, you’re deemed to be a  Chevron employee.
  • You’re a leased employee or would be a leased employee if you had provided services to Chevron for a longer period of time.
  • You enter into a written agreement with Chevron that provides that you won’t be eligible.
  • You’re not regarded by Chevron as its common-law employee and for that reason it doesn’t withhold employment taxes with respect to you — even if you are later determined to have been Chevron’s common-law employee.
  • You’re a member of a collective bargaining unit (unless eligibility to participate has been negotiated with Chevron).
  • You’re a professional intern.
  • You’re designated by Chevron as a seasonal employee.  
Chevron Corporation, in its sole discretion, determines your status as an eligible employee and whether you’re eligible for the plan. Subject to the plan’s administrative review procedures, Chevron Corporation’s determination is conclusive and binding.  If you have questions about your eligibility for this plan, you should contact the Chevron Human Resources Service Center.

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. 
To qualify for benefits available to eligible dependents of Chevron employees, you may 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. 
To qualify for benefits available to eligible dependents of Chevron employees, you may be required to verify the eligibility of any new dependents you enroll in your Chevron health plans by completing the dependent verification process. When you enroll a domestic partner, you will be required to complete, sign and notarize the Chevron Affidavit of Domestic Partnership (F-6) form as part of the dependent verification process. By signing the affidavit, you certify that you and your partner meet the qualifications as identified on the Chevron Affidavit of Domestic Partnership (F-6) form. The form will be provided to you with your dependent verification materials or can be requested by contacting the HR Service Center. 
You can enroll a dependent child for coverage if under age 26 and 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. See certificate for details. 
 
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. 
 
Your child isn’t eligible under family coverage if he or she is either of the following: 
  • Enrolled for single coverage as an eligible employee. 
In addition, your “other dependents” are not eligible for coverage under this plan. 
 
You may be required to provide proof of your child’s eligibility before he or she can be enrolled by following the dependent verification process.  
 
Eligibility rules will be enforced at the time of a claim. 
If both you and your spouse are eligible employees, each of you can enroll for employee coverage, or one of you can enroll for employee and spouse or family coverage and include the other as a covered dependent.

contact information

The HR Service Center manages your enrollment in and eligibility for this benefit plan. For all other questions regarding your coverage, contact the insurer or administrator. The administrator and the insurer manage the administration of your plan — for example, claims, what's covered and what's not, certificates of insurance, and more. 

group hospital indemnity insurance plan
  • Plan Type  Supplemental health insurance
  • Eligibility  U.S. Payroll Employees
  • Insurer Aflac
  • Administrator  Mercer Voluntary Benefits 
  • Group Number  23041
  • Phone (Aflac) 1-800-433-3036 | Contact Aflac for claims management and to convert to an individual policy only. Contact Mercer Voluntary Benefits for all other coverage inquiries.
  • Phone (Mercer Voluntary Benefits) 1-800-274-4833  | Contact Mercer for all other non-claim and non-conversion related inquiries. 
  • Website  www.aflac.com/chevron
  • Mobile App   N/A
  • Claims Email  chevronclaims@aflac.com (For document submission only; no reply inbox) or to file a claim online go to www.aflacgroupinsurance.com
  • Claim Form  Forms Library
  • Address  Aflac, Attn: Claims | P.O. Box 84080 | Columbus, GA 31993-4080

Continental American Insurance Company (CAIC), a proud member of the Aflac family of insurers, is a wholly-owned subsidiary of Aflac Incorporated and underwrites group coverage.  CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. AGC1902412  IV (9/19)

This page applies to U.S.-payroll employees. This page provides only certain highlights of benefits or program provisions. It is not intended to be a complete explanation. If there are any discrepancies between this communication and legal plan documents, the legal documents will prevail to the extent permitted by law. This is not a plan text or a summary plan description. There are no vested rights with respect to Chevron health care plans or any company contributions toward the cost of such health care plans. Rather, Chevron Corporation reserves all rights, for any reason and at any time, to amend, change or terminate these plans or to change or eliminate the company contribution toward the cost of such plans. Such amendments, changes, terminations or eliminations may be applicable without regard to whether someone previously terminated employment with Chevron or previously was subject to a grandfathering provision. Some benefit plans and policies described in this document may be subject to collective bargaining and, therefore, may not apply to union represented employees.