Why Choose Everest?

• Everest is a leading global reinsurance and insurance organization with extensive product and distribution capabilities, a strong balance sheet and an innovative culture. Throughout our history, Everest has maintained its discipline and focus on creating long term value through underwriting excellence and strong risk and capital management.
• For over 40 years, Everest has been a global leader in reinsurance with a broad footprint, deep client relationships, underwriting excellence, responsive service and customized solutions. Our insurance arm draws upon impressive global resources and financial strength to tailor each policy to meet the individual needs of our customers.
• Our diverse leaders rely on deep knowledge and decades of industry experience to deliver long-term value for our shareholders. We aim to provide strength and stability through a smart, nimble, and disciplined approach.
• Everest Reinsurance Company is rated A+ Superior by the A.M. Best Company (5/7/21). A.M. Best is an independent global rating organization that examines insurance companies and publishes its opinion on their financial strength.
• Everest Re is a longstanding U.S. property and casualty reinsurer offering a diverse range of products. We rely on proven financial strength, underwriting excellence, and industry proficiency to customize smart solutions for our clients.

Summary of Benefits

	Embedded Plan	Buy-Up Plan
Hospital Confinement	$50 Daily Hospital Confinement Benefit 5 covered days per confinement period 30 covered days per certificate year	$50 Daily Hospital Confinement Benefit 5 covered days per confinement period 30 covered days per certificate year
ICU Confinement	$50 Daily ICU Confinement Benefit 5 covered days per confinement period 30 covered days per certificate year	$50 Daily ICU Confinement Benefit 5 covered days per confinement period 30 covered days per certificate year
Emergency Room	$50 Daily Emergency Room Benefit 1 covered day per certificate year	$50 Daily Emergency Room Benefit 1 covered day per certificate year
Laboratory	N/A	$25 Laboratory Benefit 1 covered day per certificate year
Diagnostic X-Ray	N/A	$25 Diagnostic X-Ray Benefit 1 covered day per certificate year
Advanced Diagnostic Testing	N/A	$25 Advanced Diagnostic Testing Benefit 1 covered day per certificate year
Physician's Office Visit	N/A	$25 Daily Physician’s Office Benefit 1 covered day per certificate year
Urgent Care Facility	N/A	$25 Daily Urgent Care Benefit 1 covered day per certificate year

Description of Benefits

Daily Hospital Confinement Benefit
The Daily Hospital Confinement Benefit is paid for each day a covered person is confined in a hospital. The Hospital Confinement must begin while this certificate and coverage are in force for such covered person. If more than one type of Confinement, with the exception of a Hospital Intensive Care Unit Confinement, occurs for a covered person for the same day, only the highest Confinement benefit is payable.

Hospital Intensive Care Unit Confinement Benefit
The Hospital Intensive Care Unit Confinement Benefit is paid for each day a covered person is confined in a Hospital Intensive Care Unit. The Hospital Intensive Care Unit Confinement must begin while this certificate and coverage for such covered person are in force. The Daily Hospital Confinement Benefit and Hospital Intensive Care Unit Confinement Benefit will be paid concurrently. If another type of Confinement occurs for a covered person for the same day, only the highest Confinement benefit is payable.

Emergency Room Benefit
The Emergency Room Benefit is paid for each day a covered person receives Emergency Services. The Emergency Room Benefit will not cover services rendered by a free-standing Urgent Care Facility or a Hospital-owned Urgent Care Facility. Only one Emergency Room Benefit will be payable for: (1) Injuries sustained in any one Accident; or (2) the use of an Emergency Room for the same or related Emergency Services.

Laboratory Benefit
The Laboratory Benefit is paid for each day a covered person has laboratory tests performed as ordered by a Physician. The Laboratory Benefit will not be paid for any Laboratory Tests performed while the covered person is confined in a hospital. Wellness and Preventative Care tests are not payable under this benefit. Interpretation of Laboratory Tests are not payable under this benefit.

Diagnostic X-Ray Benefit
The Diagnostic X-Ray Benefit is paid for each day a covered person incurs a charge for an X-Ray is performed as ordered by a Physician. The Diagnostic X-Ray Benefit will not be paid for any X-Ray performed while the covered person is confined in a hospital. Wellness and Preventative Care tests are not payable under this benefit. Interpretation of an X-Ray or Diagnostic Laboratory Test are not payable under this benefit.

Advanced Diagnostic Testing Benefit
The Advanced Diagnostic Testing Benefit is paid when a covered person has Advanced Diagnostic Testing performed as ordered by a Physician. The Advanced Diagnostic Testing Benefit will not be paid for any tests performed while the covered person is confined in a hospital. Wellness and Preventative Care tests are not payable under this benefit. Interpretation of any of the tests identified in this benefit are not payable under this benefit.

Physician Office Visit Benefit
The Physician’s Office Visit Benefit is paid for each day a covered person incurs charges for treatment, care, or advice provided during a Physician’s Office Visit. Services must be rendered by a Physician or Medical Professional, acting within the scope of his or her license, in a medical office or clinic of the Physician. If a Covered Person has multiple services, procedures, or visits on the same day by the same or different Physicians, Everest will only pay the Physician’s Office Visit Benefit once per day.

Urgent Care Facility Benefit
The Urgent Care Facility Benefit is paid, for each day a Covered Person receives treatment in an Urgent Care Facility. This benefit is only payable once per day, even if treatment is received for more than one covered medical condition. This benefit will not be paid for Immunizations, any Mental Illness, Substance Abuse, routine health examinations, normal pregnancy examinations, well baby examinations, Therapy Services or for any day for which any Confinement Benefit is payable. If Treatment in an Urgent Care Facility, Emergency Room (ER), a Physician or Medical Professional’s office/ clinic or Telemedicine or Virtual Care occurs on the same day, only the highest applicable benefit is payable.

How to Access Primary Benefits

To view more details about your membership benefits package please feel free to use our Member Services Portal. You may use the Member Services Portal to view your benefits at any time. You may also use the Member Services Portal to access and download your Certificate of Insurance and ID Card.

Frequently Asked Questions

Is my policy ACA compliant?
This coverage is not required to comply with certain federal market requirements, principally those contained in the Affordable Care Act (ACA). Review your Certificate carefully to be sure you are aware of and understand any exclusions and limitations regarding coverage of pre- existing conditions or health benefits (such as hospitalization, emergency services, maternity care, preventive, care, prescription drugs, and mental health and substance use disorder services). Your coverage also has lifetime and/or annual limits on health benefits. If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage.

How does a Fixed Indemnity product work?
A Fixed Indemnity product like Pinnacle works differently than other plans you may have had in the past. Fixed indemnity health insurance is a type of medical insurance that pays a pre-determined amount on a per-period or per-incident basis, regardless of the total charges incurred.

What are my payouts for this policy?
Your payouts are the same no matter the cost of care. Fixed Indemnity products are paid regardless of any other coverage you may currently have.

Are deductibles, coinsurance, or copayments applicable?
There is no deductible, coinsurance, or copayment applicable to benefits the fixed indemnity plan covers. The reimbursement rate is fixed and typically sent to the insured and not to the provider of service. Because the indemnity plan benefit is paid directly to you, you have the flexibility to decide how you pay those out-of-pocket medical expenses.

Can I access my Fixed Indemnity benefits right away?
This Fixed Indemnity plan provides benefits for both accidental injuries or sickness occurring on or after the effective date of your coverage.

Can I use any doctor, clinic, or hospital?
Yes. Covered insureds can use any licensed medical provider.