Central Choice Hospital Indemnity plan designs Featuring the Surgical Schedule
State Usage for Surgery Schedule (CUL-HPHI2010) - CO, KS, NM; (C-HPHI-11) - ID
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) Paid to an insured upon first hospital confinement each year First Hospital Confinement (CUL-HRFHC) Based on duration of first hospital confinement Intensive Care Unit (CUL-HRICU) Limited to 20 days per confinement Private Duty Nurse (CUL-HRPN) Limited to 30 days per confinement Surgical (CUL-HRSUR and CHPHISS) (Does not apply in KS) Details may vary, see Surgical Schedule Anesthesia Benefit Emergency Accident ** (CUL-HREA) (Does not apply in KS) Limited to 4 different covered injuries per calendar year per insured
$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
$250 per day
$250 per day
$250 per day
$7,500 Per confinement
X X
$10,000 $2,500 $250 per accident
$5,000 $1,250
$5,000 $1,250
$10,000 UNLIMITED times
$250 per accident
$250 per accident
$250 per accident
$1,000
Specified Injury (CUL-HRSI) (Does not apply in KS) See rider for specific amounts
To a maximum of $2,000 per injury
$25 - $2,000 Depending on injury
$25 - $2,000 Depending on injury
$25 - $2,000 Depending on injury
$25 - $2,000 Depending on injury
$100 per sickness
$75 per sickness
$50 per sickness
$25 per sickness
Outpatient Sickness ** (CUL-HROS) (Does not apply in KS)
$400
Limit 4 different sicknesses per year**
Limit 4 different sicknesses per year**
Limit 4 different sicknesses per year**
Limit 4 different sicknesses per year**
* 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, 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. *** Lesser amounts apply for Spouse and Child
Sample Central Choice Surgical Schedule Premiums
Monthly Rates
Premier Choice Select Choice Enhanced Choice Essential Choice
$197.70 $388.65 $330.05 $521.00
$159.15 $311.55 $261.50 $413.90
$66.80
$45.05 $83.35 $73.30 $111.60
Single
$126.85 $111.40 $170.45
Single w/Spouse Single w/Children
Family
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