Central Choice Hospital Indemnity plan designs featuring the Daily Surgical Benefits State usage for Daily Surgical Benefit (C-HPHI-14) - AL, AZ, AR, CA, GA, IA, IL, IN, KY, LA, MD, MO, MS, NC, NE, NV, OH, OK, PA, SC, SD, TN, TX, VA, WI, WV, WY; (FL-HPHI14) - DE, MI; (M-HPHI-14) DC
Premier Choice
Select Choice
Enhanced Choice
Essential Choice
Maximum Benefit/Yr* $182,500
BENEFIT
$500
$400
$100
$50
Daily Room Benefit
RIDERS
Lump Sum Indemnity (CUL-HRLS and CHPHILS14-NC) Paid to an insured upon first hospital confinement each year First Hospital Confinement (CUL-HRFHC (2)) Based on duration of first hospital confinement Intensive Care Unit (CUL-HRICU and CHRICU14-LA) Limited to 20 days per confinement Private Duty Nurse (CUL-HRPN) Limited to 30 days per confinement Surgical Plus (CHPHISP14 and CHPHISP14-LA ) Per day when confined and a covered surgical event takes place. Maximum of 5 days per confinement. Anesthesia Daily benefit amount paid for each day that a surgical benefit is paid for inpatient surgery. Routine Benefits Per calendar year for mammography screening/mammogram, pap smear, or PSA test. Emergency Accident ** (CUL-HREA) Limited to 4 different covered injuries per calendar year per insured Specified Injury Rider (CUL-HRSI) See rider for specific amounts (not available in GA, MD NC and VA)
$1,000
$1,000
$500
$100
$1,000
$10,000 over 6 days
$10,000 over 6 days
$5,000 over 6 days
$5,000 over 6 days
$10,000
$2,500 per day
$2,000 per day
$1,000 per day
$500 per day $250 per day
$50,000
$7,500 per confinement $15,000 per confinement $3,000 per confinement $200 per calendar year
$250 per day
$250 per day
$250 per day
$3,000 per day
$2,000 per day
$1,000 per day
$1,000 per day
$600 per day
$400 per day
$200 per day
$200 per day
$200 per calendar year
$200 per calendar year
$200 per calendar year
$200 per calendar year
$250 per accident
$250 per accident
$250 per accident
$250 per accident
$1,000
$25 - $2,000 Depending on injury $100 per sickness Limit 4 different sicknesses per year**
$25 - $2,000 Depending on injury $75 per sickness Limit 4 different sicknesses per year**
$25 - $2,000 Depending on injury $50 per sickness Limit 4 different sicknesses per year**
$25 - $2,000 Depending on injury $25 per sickness Limit 4 different sicknesses per year**
To a maximum of $2,000 per injury
Outpatient Sickness ** (CHPHIOS14 and CHPHIOS14-LA)
$400
* For the Premier Choice Plan, per calendar year per insured person, unless otherwise specified. ** Insured categories are the insured person, the insured person’s spouse (in NV, spouse/domestic partner), and/or all of the insured person’s dependent children. Maximum total of 4 different sicknesses per year for all dependent children, not per child. Daily Surgical Benefits Premiums State usage for Daily Surgical Benefits Premium - AL, AZ, AR, DC, DE, IA, IL, IN, KY, LA, MD, MI, MS, NE, NV, OH, OK, SC, TN, TX, WI, WV, WY (Specified Injury Rider is not available in MD) Monthly Rates Premier Choice Select Choice Enhanced Choice Essential Choice Single $189.00 $158.35 $70.90 $49.15 Single w/Spouse (in NV, Spouse/Domestic Partner) $371.25 $309.95 $135.05 $91.55 Single w/Children $306.55 $255.00 $115.40 $78.70 Family $488.80 $406.60 $179.55 $120.70
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