Your hospital indemnity coverage
Option1
Coverage Details
Your Bi-weekly premium
$7.37
You and Spouse
$16.21
You and Child(ren)
$9.91
You, Spouse and Child(ren)
$19.82
Benefits
$1,000/$2,000 per admission, limited to 2 admission(s) per insured.
Hospital/ICU Admission
$100/$200per day, limited to30 day(s) per insured per benefit year. $200 per day, limited to 1 day(s) per insured per benefit year.
Hospital/ICU Confinement
Hospital Short Stay
Newborn Nursery Care
$100 per day, limited to2 day(s) per benefityear.
Newborn Increased Admission/Confinement Benefit
25% increase to a newborn benefit.
Child Organized Sport
25% increase to child benefits.
$50 per day, limited to 1 day(s) per insured per benefit year.
Health Screenings
Treatments Covered
Sickness and Injury
Pre-Existing Conditions Limitation - A pre-existing condition includes any condition for which you, in the specified time period prior to coverage in this plan, consulted with a physician, received treatment, or took prescribed drugs. The pre-existing condition limitations apply to late entrants only. Portability - AllowsyoutotakeyourHospitalIndemnitycoveragewith youifyou terminate employment.
3 monthsprior/6 monthstreatment free/12 months after
Included
Child(ren) Age Limits
Childrenage birth to26 years
UNDERSTANDING YOUR BENEFITS – HOSPITAL INDEMNITY The Hospital/ICU Admission requires a hospital stay of at least 20 hours to be payable. Hospital Admission & Hospital ICU Admission benefits are not payable on the same day. Premium will bewaived if you arehospitalized for more than 30 days. Hospital/ICU confinement benefits are not payable on the same dayas Hospital/ICU admission benefit. After initial enrollment, Hospital Indemnity coverage will continue as long as an insured is actively at work.
TheHealth screening benefit is paid for the completion of specified routine wellness screenings such as annual well visits, immunizations, mammography, chest x-ray, and many more. Hospital Short Stay - Must be held in a hospital for observation or treatment for a period of 8 - 19 hours. Hospital Short Stay is not payable on the same day as the Hospital/ICU Admission or Hospital /ICU Confinement.
27
Made with FlippingBook - PDF hosting