Group Hospital Insurance Certificate

HOSPITAL OBSERVATION STAY BENEFIT We will pay the per day Benefit Amount shown in the Schedule of Benefits, subject to the following conditions and limitations, if the Covered Person receives treatment for a Covered Injury or Covered Illness in a Hospital, including an observation room, or an Ambulatory Surgical Center, for a period in excess of 24 hours on a non-Inpatient basis and a charge is incurred.

Benefit Conditions The Hospital Observation Stay must meet all of the following: 1. Be at the direction and under the care of a Physician.

Benefit Limitations 1. This benefit is not payable if a benefit is payable under the Hospital Stay Benefit or Hospital Intensive Care Unit Stay Benefit.

The exclusions that apply to this benefit are in the Common Exclusions Section.

Exclusions

GHIP1.2-2201.00

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