Limited Benefit Hospitalization Plan
Without HealthCues PLAN 1500
Difference PLAN 1050
PLAN 1200
PLAN 900 PLAN 750 PLAN 600
Limited Benefit Health Plan Options
$1,500
$1,200
$1,050
$900
$750
$600
Monthly Pre-tax Premium
Initial Hospital Admission Benefit Benefit Payable per Day of Initial Confinement
$1,000 1 Day
$750 1 Day
$750 1 Day
$500 1 Day
$500 1 Day
$250 1 Day
Maximum Number of Days Payable
Daily In-Hospital Benefit Benefit Payable per Day of Initial Confinement
$1,000
$750
$750
$500
$500
$250
29 Days
15 Days
5 Days
5 Days
3 Days
1 Day
Maximum Number of Days Payable
Emergency Room Benefit Benefit Payable per Day
$300
$250
$200
$150
$100
$100
2 Days
2 Days
2 Days
2 Days
2 Days
2 Days
Maximum Number of Days Payable
Ambulance Benefit Benefit Payable per Day
$500
$250
$200
$150
$100
$100
2 Days
2 Days
2 Days
2 Days
2 Days
2 Days
Maximum Number of Days Payable Indemnity Claim Payment Benefit Payable per Month Maximum Number of Months Payable
$1,200
$1000
$875
$750
$625
$500
12 Months
12 Months
12 Months
12 Months
12 Months
12 Months
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