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Guardian’s Group Hospital Indemnity Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY. In Colorado, Hospital Indemnity is referred to as Accident Sickness Indemnity Coverage. Products are not available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. This is a limited plan of supplemental health insurance that provides the specified financial support, as a lump sum or indemnity payment, following a covered hospitalization. This is not minimum essential coverage as defined by federal law. This coverage will not reimburse for hospital or medical expenses. Generic Policy Form # GP-1- HI-15. The state approved form is the governing document. In Washington, the Certificate Form is the state approved form governing document.

Summary of Plan Limitations and Exclusions

An advertisement that refers to any dollar amount, period of time for which a benefit is payable, cost of policy, or specific policy benefit or the loss for which a benefit is payable shall also disclose any related exclusions, reductions, and limitations without which the advertisement would have the capacity and tendency to mislead or deceive.

  • In order to be eligible for coverage: Employees must be legally working: (a) in the United States or (b) outside the United States, for a US based employer, in a country or region approved by Guardian.

    • The policy has exclusions and limitations that may impact the eligibility for benefits.

    • Employees must be working full-time on the effective date of coverage; otherwise, coverage becomes effective after the completion of the specific waiting period.

    • A pre-existing condition includes any condition for which a covered person, in the look back period prior to coverage in this plan, (1) receives advice or treatment from a doctor; (2) undergoes diagnostic procedures, other than routine screening in the absence of symptoms or suspicion of disease process by a doctor; (3) are prescribed or take prescription drugs; or (4) receives other medical care or treatment, including consultation with a doctor. No benefit will be paid until the earlier of a specified amount of treatment free time or after the insured is covered for a certain number of months. Please refer to the plan documents for specific time periods. State variations may apply.

    • If the plan is new (not transferred): During the exclusion period, this Hospital Indemnity plan does not pay charges relating to a pre-existing condition. If this plan is transferred from another insurance carrier, the time an insured is covered under that plan will count toward satisfying Guardian's pre-existing condition limitation period. Please refer to the plan details for specific time periods. State variations may apply.

    • If the plan is new (not transferred): During the exclusion period, this Hospital Indemnity plan does not pay charges relating to a pre-existing condition. If this plan is transferred from another insurance carrier, the time an insured is covered under that plan will count toward satisfying Guardian's pre-existing condition limitation period. Please refer to the plan details for specific time periods. State variations may apply.

  • And this plan will not pay benefits for:

    • Treatment relating to a covered person: taking part in any war or act of war (including service in the armed forces), commission of or attempt to commit a felony, an act of terrorism, or participating in an illegal occupation, riot or insurrection;

    • Suicide or any intentionally self-inflicted injury;

    • Elective surgery;

    • Surgery to correct vision or hearing, unless a result of a covered Injury, medically necessary surgery for glaucoma, cataracts or other sickness or injury;

    • Dental care, dental x-rays, or dental treatment;

    • Gastric or intestinal bypass services including lap banding, gastric stapling, and other similar procedures to facilitate weight loss; the reversal, or revision of such procedures; or services required for the treatment of complications from such procedures. This exclusion does not apply to completion of a weight reduction program that may be payable under the Health Screening benefit;

    • Rest cures or custodial care, or treatment of sleep disorders;

    • Cosmetic surgery. This exclusion does not apply to reconstructive surgery:

      1. on an injured part of the body following infection or disease of the involved part;

      2. of a congenital disease or anomaly of a covered dependent newborn or adopted infant; or

      3. on a non-diseased breast to restore and achieve symmetry between two breasts following a covered Mastectomy;

    • Treatment or removal of warts, moles, boils, skin blemishes or birthmarks, bunions, acne, corns, calluses, the cutting and trimming of toenails, care for flat feet, fallen arches or chronic foot strain;

    • Service, treatment or loss related to alcoholism or drug addiction, except for drugs prescribed by the covered person’s doctor and taken as prescribed;

    • Care or treatment for mental or nervous disorders;

    • Services, treatment or loss rendered in any veterans administration or federal hospital, except if there is a legal obligation to pay;

    • Services or treatment provided by a doctor, nurse or any other person who is employed or retained by a covered person or covered person’s spouse, parent, brother, sister, child, domestic partner or partner in a civil union;

    • Surgery and treatment, procedures, products or services that are experimental or investigative;

    • Hospital Confinement and/or Hospital Admission due to any covered person’s giving birth within the first nine months after the covered person’s effective date under this Plan as a result of a normal pregnancy, including cesarean section. Complications of pregnancy will be covered to the same extent as any other covered sickness; State variations may apply;

    • Treatment of a covered dependent child’s children;

    • Sickness or injury sustained while on active duty in the armed forces of any country. This does not include Reserve or National Guard duty for training.