Page 19 - Zelis 2022 Executive Benefits Guide

Hospital Indemnity Insurance
This benefit is associate paid and provides a cash benefit to you if you and your family member (if elected) are hospitalized. The benefit pays for hospital admissions and/or confinements for both accident and sickness. This benefit complements the HSA 2800 or HSA 5000 medical plan, and will help reimburse you for your out-of-pocket costs under these plans. However, it can also be paired with your Traditional PPO 1500 plan.
Hospital Admission Benefit Hospital Confinement Benefit
Preexisting Limitation
Portability
Included
$1,000 (Max of 1 Admission Per Year)
Voluntary Benefits Contributions
$100 per day (Max of 15 Days Per Year)
Waived
Critical Illness
$0.50 $0.73 $1.43 $2.68 $4.58 $7.97
Accident Coverage
$4.24 $7.58 15-29
$6.55 $11.72 30-39
$6.77 $11.96 40-49
Plan #1 (per pay period basis)
Plan #2 (per pay period basis)
Associate/Spouse Issue Age
Monthly Rate (per $1,000 of coverage)
Associate Only Associate + Spouse Associate + Child(ren) Family
Premiums (per pay period basis)
$9.08 $16.10 50-59 Hospital Indemnity 60-69
70-99
Associate Only Associate + Spouse Associate + Child(ren) Family
$5.77 $11.53 $9.34 $15.09
Executive Employees 19