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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 Beneits
Subcategory Beneit Limits (Applies to Beneit Plan
Subcategory)
Admission 1 time(s) per Admission $1,000
Beneit calendar year ICU Supplemental $1,000
Admission 1
Coninement 15 days per year Coninement 2 $200
Beneit 15 days per year ICU Supplemental $200
Coninement 3
1. ICU Supplemental Admission Beneit is paid in addition to the Admission Beneit if the
covered person is admitted to an Intensive Care Unit.
2. If the Admission Beneit is payable for a Coninement, the Coninement Beneit will begin to
be payable the day after Admission.
3. ICU Supplemental Coninement Beneit is paid for a day for which we pay a Coninement
Beneit and the covered person is conined 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
* During the two months in a year that have three pay periods (January and July), beneits will
only be deducted from the irst two paychecks.
28 2020 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 Beneits
Subcategory Beneit Limits (Applies to Beneit Plan
Subcategory)
Admission 1 time(s) per Admission $1,000
Beneit calendar year ICU Supplemental $1,000
Admission 1
Coninement 15 days per year Coninement 2 $200
Beneit 15 days per year ICU Supplemental $200
Coninement 3
1. ICU Supplemental Admission Beneit is paid in addition to the Admission Beneit if the
covered person is admitted to an Intensive Care Unit.
2. If the Admission Beneit is payable for a Coninement, the Coninement Beneit will begin to
be payable the day after Admission.
3. ICU Supplemental Coninement Beneit is paid for a day for which we pay a Coninement
Beneit and the covered person is conined 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
* During the two months in a year that have three pay periods (January and July), beneits will
only be deducted from the irst two paychecks.
28 2020 Benefits Guide
