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Group Hospital Indemnity Medical Coverage
Even a minor trip to the hospital can present you with unexpected
expenses and medical bills, and even with major medical insurance, your
plan may only pay a portion of your entire stay. Hospital Indemnity
Insurance is designed to provide inancial assistance to enhance your
current coverage. Employees can use the beneit to meet the out-of-
pocket expenses and extra bills that can occur. Beneits are paid directly to
you based on the amount of coverage listed, regardless of the actual cost
of treatment.
X 30-day waiting period—no beneits will be paid for a covered loss
which occurs during the beneit waiting period
Hospital Benefits
Benefit Limits (Applies
Subcategory to Subcategory) Benefit Plan
Admission 1 time(s) per calendar Admission $1,000
Benefit year ICU $1,000
Supplemental
Admission 1
Confinement 15 days per year Confinement 2 $200
Benefit 15 days per year ICU $200
Supplemental
Confinement 3
1 . ICU Supplemental Admission Benefit is paid in addition to the Admission Benefit if
the covered person is admitted to an Intensive Care Unit .
2 . If the Admission Benefit is payable for a Confinement, the Confinement Benefit
will begin to be payable the day after Admission .
3 . ICU Supplemental Confinement Benefit is paid for a day for which we pay a
Confinement Benefit and the covered person is confined in an Intensive Care Unit .
You may elect coverage and pay premium with after tax contributions as
shown below. Please see the additional beneit summary in ADP/WFN.
Coverage Tier Bi-Weekly Weekly
Employee $11 .68 $5 .39
Employee/Spouse $25 .03 $11 .55
Employee/Child(ren) $20 .05 $9 .25
Family $33 .41 $15 .42
28 2019 Benefits Guide
Even a minor trip to the hospital can present you with unexpected
expenses and medical bills, and even with major medical insurance, your
plan may only pay a portion of your entire stay. Hospital Indemnity
Insurance is designed to provide inancial assistance to enhance your
current coverage. Employees can use the beneit to meet the out-of-
pocket expenses and extra bills that can occur. Beneits are paid directly to
you based on the amount of coverage listed, regardless of the actual cost
of treatment.
X 30-day waiting period—no beneits will be paid for a covered loss
which occurs during the beneit waiting period
Hospital Benefits
Benefit Limits (Applies
Subcategory to Subcategory) Benefit Plan
Admission 1 time(s) per calendar Admission $1,000
Benefit year ICU $1,000
Supplemental
Admission 1
Confinement 15 days per year Confinement 2 $200
Benefit 15 days per year ICU $200
Supplemental
Confinement 3
1 . ICU Supplemental Admission Benefit is paid in addition to the Admission Benefit if
the covered person is admitted to an Intensive Care Unit .
2 . If the Admission Benefit is payable for a Confinement, the Confinement Benefit
will begin to be payable the day after Admission .
3 . ICU Supplemental Confinement Benefit is paid for a day for which we pay a
Confinement Benefit and the covered person is confined in an Intensive Care Unit .
You may elect coverage and pay premium with after tax contributions as
shown below. Please see the additional beneit summary in ADP/WFN.
Coverage Tier Bi-Weekly Weekly
Employee $11 .68 $5 .39
Employee/Spouse $25 .03 $11 .55
Employee/Child(ren) $20 .05 $9 .25
Family $33 .41 $15 .42
28 2019 Benefits Guide
