Welcome to PFIAI – Your Trusted Insurance Partner
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
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
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Members Major Medical Benefits
| Maximum Benefit – members under age 65 | $300,000 |
| Maximum Benefit – members over age 65 | $100,000 |
| Benefit Period – members under age 65 | 3 years |
| Benefit Period – members over age 65 | Lifetime |
| Deductible per Calendar year | $300 |
| Maximum deductibles per family | 3 per Calendar year |
| Accumulation Period | 12 months |
| Co-insurance Factor | |
| of the first $75,000 | 75% |
| Thereafter to the maximum of | 100% |
Hospital Room and Board Limit
| Applicable locally and regionally; 80% to a maximum of | $400 |
| Applicable Elsewhere | $2,000 |
Intensive Care Room and Board Limit
| Applicable locally and regionally; 80% to a maximum of | $600 |
| Applicable Elsewhere; 75% to a maximum of | $3,000 |
Pre-existing Condition Clause
| New Entrants only | $500 |
| Maximum per Doctor’s Visits | |
| Office; 75% to a maximum of | $80 |
| Hospital; 80% to a maximum of | $80 |
| Home; 75% to a maximum of | $80 |
Specialist Consultant Benefit
| Maximum Per Consultation; 75% to a maximum of | $100 |
| 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 | $2,000 |
Caesarian Section/ Extra Uterine Pregnancy
| 80% to a maximum of | $3,000 |
| Miscarriage; 80% to a maximum of | $1,000 |
| Waiting Period | 10 months |
Congenital Conditions
| Maximum Benefit; 80% to a maximum of | $100,000 |
| Benefit Period | Lifetime |
Organ Transplants
| Maximum Benefit | $150,000 |
| Benefit Period | Lifetime |
Repatriation of Mortal Remains
| Maximum Benefit; 80% to a maximum of | $6,500 |
Out of Hospital Psychiatric Service
| Maximum per treatment; 80% to a maximum | $60 |
| Maximum Treatment per Calendar Year | 20 |
Physiotherapy Benefit
| Maximum per Treatment; 75% to a maximum of | $60 |
| Maximum Treatment per Calendar Year | 20 |
| Critical Care | $15,000 |
Airfare Benefit
| Maximum per Calendar Year;75% to a maximum of | $3,000 |
| Maximum Trips per Calendar Year | 2 |
Air Ambulance Benefits
| Maximum per Calendar year; 80% to a maximum of | $15,000 |
| Maximum Trips per Calendar Year | 1 |
Group Life
| Group Life | $15,000 |
Medical Benefits
| Maximum Benefit – members under age 65 | 80% |
| Payable from first visit | $60 |
| Hospital Visit Maximum | $60 |
| Home Visit Maximum | $80 |
| Deductible per Calendar year | 31 visits |
| Specialist Consultation (On Referral) Visit Maximum…75% to a maximum of | $100 |
| Maximum | 5 visits |
Diagnostic X-Ray and Laboratory Benefit
| Diagnostic X-Ray and Laboratory Benefit | Disability Maximum 80% of Eligible Benefit |
Prescribed Drugs
| Disability Maximum 80% of Eligible Benefit | |
| Deductible per Disability | $10 |
Preventative Care Benefits
| Annual Medical Examination for members only | $200 |
| Annual Pap Smear for all covered females | $65 |
| Annual Test for Prostate Cancer for all covered males | $75 |
| Annual Mammogram for females over age 35 | $150 |
| Annual Glaucoma Test for members only | $50 |
| Vaccinations for Children up to age 5 years | $200 |
| Annual Lipid Profile Test for members only | $100 |
Dental Care
| Benefit maximum | $1000 |
| Deductible per Calendar year | $765 |
| Preventative care | 75% |
| Basic restorative care | 75% |
| Major restorative care | 75% |
| Waiting period | 6 months |
Orthodontia Benefit
| Lifetime benefit maximum | $2000 |
| Calendar maximum | $1,000 |
| Deductible per Calendar year | $75 |
| Benefit | 75% |
| Waiting period | 12 months |
Vision Care
| Calendar year maximum | $500 |
| Deductible per Calendar year | $75 |
| Benefit | 80% |
| Contact lens when medically | $250 |
| Waiting period | 6 months |
