1 (246) 249 9100 info@coopmed.com

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

$166.00

PER MONTH

Member and 1

$282.00

PER MONTH

Member and Family

$387.00

PER MONTH

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

The Maximum benefits schedules and amounts
Maximum Benefit under age 65 Years $300,000.00
Benefit Period under 65 Years 3 Years
Maximum Benefit over age 65 and Retirees $100,000.00
Benefit Period over age 65 and Retirees Lifetime
Deductible Per Calendar Year $300.00
Deductible for Family Per Calendar Year $900.00
Co-Insurance Per Calendar Year
On 1st $75,000.00 75%
Thereafter to the maximum 100%
Accumulation Period per calendar year 12 months

 

Hospital Room and Board Limit
Applicable locally and regionally; 80% to a maximum of $300,000.00
Applicable Elsewhere $2000.00

 

Intensive Care Room and Board Limit
Applicable locally and regionally; 80% to a maximum of $600.00
Applicable Elsewhere; 75% to a maximum of $3000.00

 

Pre-existing Condition Clause
New Entrants only $500.00
Maximum per Doctor’s Visits
Office; 75% to a maximum of $80.00
Hospital; 80% to a maximum of $80.00
Home; 75% to a maximum of $80.00

 

Specialist Consultant Benefit
Maximum Per Consultation; 75% to a maximum of $100.00
Prescribed Drugs 75% of eligible benefit
Diagnostic Test 75% of eligible benefit
Maternity Benefit(not subject to a deductible)
Normal Delivery; 75% to a maximum of $2000.00

 

Caesarian Section/ Extra Uterine Pregnancy
80% to a maximum of $3000.00
Miscarriage; 80% to a maximum of $1000.00
Waiting Period 10 months

 

Congenital Conditions
Maximum Benefit; 80% to a maximum of $100,000.00
Benefit Period Lifetime

 

Organ Transplants
Maximum Benefit $150,000.00
Benefit Period Lifetime
Repatriation of Mortal Remains
Maximum Benefit; 80% to a maximum of $6,500.00

 

Hearing Aid Benefit
% to a maximum of $2,000.00
Benefit Period 1 pair every 5 consecutive years

 

Out of Hospital Psychiatric Service Benefit
Maximum per treatment; 80% to a maximum $60.00
Maximum Treatment per Calendar Year 20

 

Physiotherapy Benefit
Maximum per Treatment; 75% to a maximum of $60.00
Maximum Treatment per Calendar Year 20
Critical Care $15,000.00

 

Airfare Benefit
Maximum per Calendar Year;75% to a maximum of $3,000.00
Maximum Trips per Calendar Year 2

 

Air Ambulance Benefits
Maximum per Calendar year; 80% to a maximum of USD$15,000.00
Maximum Trips per Calendar Year 1

 

Group Life Insurance
Group Life $15,000.00

 

Medical Benefits
Payable from first visit 80%
Payable from first visit $60.00
Hospital Visit Maximum $60.00
Home Visit Maximum $80.00
Deductible Per Calendar Year $300.00
Disability Maximum 31 visits
Co-Insurance Per Calendar Year
Specialist Consultation (On Referral) Visit Maximum…75% to a maximum of $100
Maximum 5 visits

 

Diagnostic X-Ray and Laboratory Benefit
Disability Maximum 80% of Eligible Benefit

 

Prescribed Drugs
Disability Maximum 80% of Eligible Benefit
Deductible per Disability $10.00

 

Preventative Care Benefits
Annual Medical Examination for members only $200.00
Annual Pap Smear for all covered females $65.00
Annual Test for Prostate Cancer for all covered males $75.00
Annual Mammogram for females over age 35 $150.00
Annual Glaucoma Test for members only $50.00
Vaccinations for Children up to age 5 years $200.00
Annual Lipid Profile Test for members only $100.00

 

Dental Care
Benefit maximum $1,000.00
Deductible per Calendar year $75.00
Preventative care 75%
Basic restorative care 75%
Major restorative care 75%
Waiting period 6 months

 

Orthodontia Benefit
Benefit maximum $1,000.00
Deductible per Calendar year $75.00
Preventative care 75%
Basic restorative care 75%
Major restorative care 75%
Waiting period 6 months

 

Vision Care
Calendar year maximum $500.00
Deductible per Calendar year $75.00
Benefit 80%
Contact lens when medically necessary $250.00
Waiting period 6 months

 

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