Members 18-55 years old
All bona fide members of a Credit Union who complete three (3) months continuous membership are eligible to join the plan. Members as well as their eligible dependents can apply for coverage under the plan by supplying medical evidence of insurability. Eligible dependents are the lawful or common law spouse of the member(up to 55) and any unmarried, unemployed children, adopted and step children who are under 19 or under 25 years and full time students attending a recognized university or any other institute of higher learning.
Senior Members
Special provision is made for eligible members over 65 years to continue coverage beyond age 65 at new Retiree Rates.
General Conditions
Each member who has applied for coverage and is accepted in the plan will be provided with a membership card and booklet giving details of the plan benefits. Initial coverage is for one year; however a member can terminate coverage by giving 1 month’s notice in writing to Guardian Life of the Caribbean Ltd.
Member Only
$166
PER MONTH
Member & 1
$282
PER MONTH
Family
$387
PER MONTH
CoopMED Application
DECLARATION OF INSURABILITY
ENROLLMENT CARD
Payment of Claim Benefits
Settlements under this plan is on a reimbursement basis in accordance with the schedule of benefits. Settlement should be made within ten(10) working days of the claim being received by Guardian Life of the Caribbean Ltd.
How to Claim?
The fully completed medical form, signed by the doctor and the member, along with the bills,receipts and any other supporting documents should be submitted to Guardian Life of the Caribbean Ltd. Claims must be submitted to Guardian of the Caribbean Limited within 90 days from the date of the first expenses.
When Does CoopMED Coverage Begin?
Any member who wishes to join the plan will be required to complete an application form. Members whose applications have been approved will be enrolled on the first day of the month following approval. Coverage will commence as soon as the member has been accepted into the plan and the premium due has been paid. In cases where a member is over the age of 40, a medical examination is mandatory.
Schedule of Benefits
Comprehensive Major Medical
| Maximum Benefit – members under age 65 | $300,000 | Physiotherapy Benefit | |
| Maximum Benefit – members over age 65 | $100,000 | Maximum per Treatment; 75% to a maximum of | $60 |
| Benefit Period – members under age 65 | 3 years | Maximum treatment per Calendar Year | 20 |
| Benefit Period – members over age 65 | Lifetime | Critical Care | $15,000 |
| Deductible per Calendar year | $300 | Airfare Benefit | |
| Maximum deductibles per family | 3 per Calendar year | Maximum per Calendar Year;75% to a maximum of | $3,000 |
| Accumulation Period | 12 months | Maximum Trips per Calendar Year | 2 |
| Co-insurance Factor | Air Ambulance Benefits | ||
| of the first $75,000 | 75% | Maximum per Calendar year; 80% to a maximum of | USD $15,000 |
| Thereafter to the maximum of | 100% | Maximum Trips per Calendar Year | 1 |
| Hospital Room and Board Limit | Group Life | $15,000 | |
| Applicable locally and regionally; 80% to a maximum of | $400 | ||
| Applicable Elsewhere | $2,000 | Medical Benefits | |
| Office Visit Maximum | 80% | ||
| Intensive Care Room and Board Limit | Payable from first visit | $60 | |
| Applicable locally and regionally; 80% to a maximum of | $600 | Hospital Visit Maximum | $60 |
| Applicable Elsewhere; 75% to a maximum of | $3,000 | Home Visit Maximum | $80 |
| Disability Maximum | 31 visits | ||
| Pre-existing Condition Clause | Specialist Consultation (On Referral) Visit Maximum…75% to a maximum of | $100 | |
| New Entrants only | $500 | Maximum | 5 visits |
| Maximum per Doctor’s Visits | Diagnostic X-Ray and Laboratory Benefit | ||
| Office; 75% to a maximum of | $80 | Disability Maximum 80% of Eligible Benefit | |
| Hospital; 80% to a maximum of | $80 | ||
| Home; 75% to a maximum of | $80 | Prescribed Drugs | |
| Disability Maximum 80% of Eligible Benefit | |||
| Specialist Consultant Benefit | Deductible per Disability | $10 | |
| Maximum Per Consultation; 75% to a maximum of | $100 | ||
| Preventative Care Benefits | |||
| Prescribed Drugs | 75% of eligible benefit | Annual Medical Examination for members only | $200 |
| Annual Pap Smear for all covered females | $65 | ||
| Diagnostic Test | 75% of eligible benefit | Annual Test for Prostate Cancer for all covered males | $75 |
| Annual Mammogram for females over age 35 | $150 | ||
| Maternity Benefit(not subject to a deductible) | Annual Glaucoma Test for members only | $50 | |
| Normal Delivery; 75% to a maximum of | $2,000 | Vaccinations for Children up to age 5 years | $200 |
| Annual Lipid Profile Test for members only | $100 | ||
| Caesarian Section/ Extra Uterine Pregnancy | |||
| 80% to a maximum of | $3,000 | Dental Care | |
| Miscarriage; 80% to a maximum of | $1,000 | Benefit maximum | $1,000 |
| Waiting Period | 10 months | Deductible per Calendar year | $75 |
| Preventative care | 75% | ||
| Congenital Conditions | Basic restorative care | 75% | |
| Maximum Benefit; 80% to a maximum of | $100,000 | Major restorative care | 75% |
| Benefit Period | Lifetime | Waiting period | 6 months |
| Organ Transplants | Orthodontia Benefit | ||
| Maximum Benefit | $150,000 | Lifetime benefit maximum | $2,000 |
| Benefit Period | Lifetime | Calendar maximum | $1,000 |
| Deductible per Calendar year | $75 | ||
| Repatriation of Mortal Remains | Benefit | 75% | |
| Maximum Benefit; 80% to a maximum of | $6,500 | Waiting period | 12 months |
| Hearing Aid Benefit | Vision Care | ||
| % to a maximum of | $2,000 | Calendar year maximum | $500 |
| Benefit Period | 1 pair every 5 consecutive years | Deductible per Calendar year | $75 |
| Benefit | 80% | ||
| Out of Hospital Psychiatric Service Benefit | Contact lens when medically necessary | $250 | |
| Maximum per treatment; 80% to a maximum | $60 | Waiting Period | 6 months |
| Maximum Treatment per Calendar Year | 20 |
