CO-OPMED HEALTH

INSURANCE
Affordable Health for Credit
Unions
BASE PLAN BENEFITS
• We care about our members and we make this offer with your
welfare in mind. In an effort to assist with the rising cost of
healthcare.
• A comprehensive Medical insurance plan designed exclusively for
Credit Union members and exclusively administered by Guardian
Life Of the Caribbean Ltd.

• THE COOPMED ADVANTAGE provides extensive medical

insurance coverage essential to obtain quality healthcare for
emergency surgery, hospitalization, as well as vision and dental
care with special coverage for members continuing above age 65.
All bona fide members of a Credit Union who have completed
three month of continuous membership are eligible to join the
plan.

 
.
 WHO IS ELIGIBLE TO JOIN?
•

Members 18-54 years old.

All bona fide members of a Credit Union who have completed one month of
continuous membership are eligible to join the plan.

Members as well as their eligible dependents can apply for medical coverage under
the plan by supplying medical evidence of insurability.

Eligible dependents are the lawful or common­law spouse of the member (up to 65)
and any unmarried, unemployed children; including adopted and stepchildren who
are under 19 years or under 25 years if a full-time student attending a recognised
university or any other institute of higher learning.

Senior members
Special provision is made for eligible members over 65 to continue coverage
provided they were members prior to age 55.
The Major Medical Maximum for members over age 65 is $75,000. Lifetime. (Special
conditions apply.) .
 GENERAL CONDITIONS
•

Each member who has enrolled in the plan will be provided with a booklet giving
details of the plan.

Premiums are due and payable monthly and in advance.

Initial coverage is for one year; however a member can terminate coverage by giving
one (1) month's notice in writing to GUARDIAN LIFE OF THE CARIBBEAN LIMITED.

Premiums
Member only............... $84.80
Member and one......... $148.55
Member and family.......$206.30
 HOW TO CLAIM

The medical claim form fully completed and signed by the doctor and the member,
together with all bills, receipts and any other supporting documents should be
submitted to Guardian Life Of the Caribbean Limited. Claims should be submitted
within ninety (90) days from the date of treatment.

• PAYMENT OF CLAIM BENEFITS

Settlement of claims under this plan is on a reimbursement basis in accordance with

the schedule of benefits. Settlement should be made within five (5) working days of
the claim being received by Guardian Life Of the Caribbean Limited.
•
LIFE BENEFIT: $10,000 per covered member.
SCHEDULE OF
BENEFITS

Base Plan Benefits.

Hospital Plan Benefits.

Daily room and board.........................$150.
Period of confinement per disability ...60 days.
Other hospital services per disability..$1,500.

Surgery Benefit
Disability Maximum ...........................$1,500.
Anaesthesia Benefits ..25% of Surgery R&C
.

Maternity
Normal delivery ................................$1,000.
Caesarean Section!
Extra Uterine Pregnancy....................$2,000.
Miscarriage-Dilation & Curettage........$750.
Waiting Period 10 months
 MEDICAL BENEFIT
• Medical Benefits
Office Visit Maximum
Payable from first visit..................... $ 40.
Hospital Visit Maximum.................... $ 50.
Home Visit Maximum .......................$ 50.
Disability Maximum ..........................31 visits.
Specialist Consultation (On referral)
Visit Maximum................................ $ 60.
Disability Maximum ..........................5 visits.

Diagnostic X-Ray And Laboratory Benefit

Disability Maximum......................... $ 250.

Prescribed Drugs
Disability Maximum .........................$ 250
Deductible per Disability ..................$ 10
 PREVENTATIVE CARE
Annual Medical Examination

• For members only...$100

• Annual Pap For Females..$  35

• Annual Mammogram for Females over age 35…$100

Annual Test For Prostate Cancer For Males..$50

Annual Glaucoma Test For Members Only $50

Vaccinations Children up to 2 years$ 100

•
 SUPPLEMENTARY MAJOR
MEDICAL BENEFIT

Maximum Benefit (under 65) .. $150,000

• Maximum Benefit (over 65) .... $ 75,000.

• Benefit Period (under 65) …….3 years.

• Benefit Period (over 65) …….. Lifetime.

• Deductible per Calendar Year $200.

• Co-insurance Factor On First $50,000 .... 80%.

Thereafter ............................................... 100%.
Carry Over Provision .............................. Last 3 months of Calendar Year.
 Title Hospital Room &
Board
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Applicable Overseas ...................... $ 2,000.
Applicable Locally ............................. $ 200.
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Psychiatric Benefit
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per Treatment... .................... $Fusce
60.
Number of Treatments ............................ 20
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Co-insurance sed magna50%.
Factor ............................ suscipit
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Physiotherapy Benefit
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Maximum per Treatment... .................... $ 60.
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Number adipiscing
of Treatments ............................ 20. elit.
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Coinsurance Factor ............................. 50%.

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egestas.
 MEDICAL BENEFITS
Prescribed Drugs
Disability Maximum..........................$250.
Deductible per Disability...................$10.

Diagnostic X-Ray
And Laboratory Benefit

Disability Maximum...........................$250.
• Airfare Benefit
Maximum per Calendar Year .......... $3,000.
Number of Trips per Calendar Yr ......2.
Co-insurance factor. ........................ 80%
•
Air Ambulance Benefits
Maximum per Treatment...................USD$10,000.
Number of Trips per Calendar Year.. 1
Co-insurance Factor…………………80%.

•
 SUPPLEMENTARY DENTAL
BENEFIT
The Guardian Life Of the Caribbean Ltd will reimburse the insured up to the
maximum stated in the schedule of benefits for the eligible, reasonable and
customary expenses incurred for Dental Care and Treatment, in excess of the
deductible amount and in accordance with the respective co­insurance factors
stipulated in said schedule.

Eligible Expenses

Dental Benefit

Maximum Benefit per Calendar Yr .. $1,000.

Deductible per Calendar Year    $50.
Preventative .................................... 100%.
Basic Restorative ............................. 80%.
Major Restorative ..............................60% .
Waiting Period ...................................3 months.

ORTHODONTIA

Maximum Lifetime Benefits................$ 2,000.

Maximum Benefit per Calendar Yr.......$ 1,000.
Deductible per Calendar Year .............. 50.
Co-insurance .....................................60%.
Waiting Period...................................6 months.
 LIMITATIONS DENTAL
• Eligible expenses shall mean expenses incurred for the following:-

(1) Diagnostic Services and Preventative Treatment such as oral inspection or

examination and cleaning.
(2) Basic Restorative Treatment and basic Services.
(3) Major Restorative Treatment. (4) Orthodontic Treatment.

• DENTAL LIMITATIONS Includes but restricted to:

•
(1) Dental Care which is not prescribed or performed by a Qualified Dental
Practitioner.

• (2). Expenses incurred for cosmetic purposes; except eligible expenses for treatment
required for correction of damage caused by accident or injury where there is no
right of recovery through I monetary payment.

• (3) Expenses for replacement of any lost or stolen denture, bridge or other dental
appliances.
 VISION CARE BENEFITS
Schedule of Benefits

Max. Benefit per Calendar Year ........... $ 500.

Deductible per Calendar Year ................ $ 50.
Co-insurance .......................................... 80%.
Waiting Period ................................ 6 months.

VISION LIMITATIONS

Includes but not limited to:

(1) Examination will be limited to one per person and lenses will be limited to one
person during any (12) twelve consecutive months.

(2) Contact lenses will be covered only after cataract surgery or when visual acuity of
the patient is not correctable to 20/70 in the better eye. By use of conventional type
lenses, but can be improved to 20/70 or better by the use of contact lenses. Other
than above, contact lenses will be up to a maximum of $250. During any (12) twelve
consecutive months.
Contact Us
• Prudential Financial Sales & Services Inc
• #5 OceanCity,St.Philip
• 246-249-9100
•  
• COB Credit Union Barbados Cooperative Credit Union
• Lower Broad Street,St.Michael
• Phone:246-436-4745
•  
• Guardian Life Of the Caribean
• Enfield House
• Collymore Rock, St.Michael
• Phone 246-430-4624
•  
• Barbados Public Workers Cooperative Credit Union
• Belmont Road,St.Michael
• Phone:246-430-5200.