Page 9 - Luminex 2021 BLUE Triangles 12pg Guide w_Notices V5 - 1-12-2021

VOLUNTARY

BENEFITS CONT’D

THE PLAN ALSO PROVIDES MEDICAL SERVICES/TREATMENTS WHICH INCLUDE:

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

Prudential 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
Confinement Benefit ICU Accident Hospital Confinement is
Accident – Hospital payable for up to 31 days per covered person $200 $400
Benefits per accident, but not to exceed 30 days per
calendar year.

Inpatient Rehabilitation Benefit is payable
for up to 15 days per covered person
Rehab $100 $200
per accident, but not to exceed 30 days per
calendar year.

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