HOSPITAL INDEMNITY RIDER - PANDEMIC INFECTIOUS DISEASE ADMISSION ONLY BENEFIT All Employee benefits under this Rider are payable at 100% of the Benefit Amount shown. All Spouse benefits are payable at 100% of the Benefit Amount shown for the Employee. All Dependent Child(ren) benefits are payable at 100% of the Benefit Amount shown for the Employee. Benefit Waiting Period None Pre-Existing Limitation Period None
EMPLOYEE BENEFITS HOSPITALIZATION BENEFITS Benefit Type Hospital Pandemic Infectious Disease Admission Elimination Period
1 day
Benefit Amount
$3,000 per day
Maximum Benefit Period
1 day
PREMIUM INFORMATION
INITIAL PREMIUM Premium:
Refer to your Schedule of Rates
Contribution(s):
The cost of coverage is paid by the Employee
PREMIUM DUE DATES The Policy Effective Date and the first day of each succeeding modal period.
Premium rates are subject to change in accordance with the Changes in Premium Rates provision of the Administrative Provisions section of this Policy. An Employee’s premium is based on His Age and will increase on the Policy Anniversary Date after the Employee enters a new Age bracket.
GCI-02-1100-1.00V2
6
Made with FlippingBook. PDF to flipbook with ease