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The plan also provides medical services/treatments which include:

• Ambulance (ground and air)
• Emergency Care
• Non-Emergency Care
• Physician Follow-Up
• Therapy Services (including physical therapy)
• Medical Testing Benefit (including X-rays, MRIs and CT scans)
• Medical Appliances
• Inpatient Surgery

HOSPITAL INDEMNITY INSURANCE

MetLife Hospital Indemnity Insurance can complement existing medical coverage and help fill financial gaps caused by out-of-pocket
expenses such as deductibles, copayments, and non-covered medical services. Benefits are paid regardless of what is covered by
medical insurance. Payments are made directly to you to spend as you choose.

Benefits and features include:
• 24 hour coverage (on/off the job)
• Benefit Amount: you will have a choice of selecting coverage between two options: High Plan or Low Plan on a Guaranteed Issue.
• Pregnancy: Complications of pregnancy and emergency Cesarean section are covered. (Routine, vaginal delivery of a child or
children or delivery of a child or children by non-emergency Cesarean section, are not covered.)
• Portability: you can take your coverage with you if you leave or retire from the company.

CATEGORY SUBCATEGORY BENEFITS LOW PLAN HIGH PLAN
Accident – Hospital Non-ICU Hospital Admission. $500 $1,000
Admission Benefit Intensive Care Unit Admission. $1,000 $2,000
Non-ICU Hospital Confinement is payable
for up to 31 days per covered person $100 $200
(starting on day 1).
Accident – Hospital
Accident – Hospital Confinement Benefit ICU Accident Hospital Confinement is
Benefits payable for up to 31 days per covered $200 $400
person per accident, but not to exceed 30
days per calendar year.
Inpatient Rehabilitation Benefit is payable
for up to 15 days per covered person per
Rehab $100 $200
accident, but not to exceed 30 days per
calendar year.
Sickness – Hospital Non-ICU Hospital Admission. $500 $1,000
Admission Benefit Intensive Care Unit Admission. $1,000 $2,000

Non-ICU Sickness Hospital Confinement
Sickness – Hospital is payable for up to 31 days per covered $100 $200
Benefits person (starting on day 1).
Sickness – Hospital
Confinement Benefit ICU Sickness Hospital Confinement is
payable for up to 31 days per covered $200 $400
person (starting on day 1).

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