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29Employee $13.26 $6.12Employee + Spouse $25.44 $11.74Employee + Child(ren) $21.98 $10.14Family $34.17 $15.77Refer to your full plan summary for details on covered services.Hospital Indemnity PlanHospital Indemnity InsuranceHospital Indemnity Insurance is here to help cover costs from illness or injury, such as lost income, child care,and medical expenses. Coverage is available for you, your spouse, and children.This plan pays cash benefits directly to you.Covered BenefitsSicknessAccidentsRoutine Pregnancy/complicationsMental and nervous disordersSubstance abuseThis is a fixed indemnity policy, NOT health insurance. This fixed indemnity policy may pay you a limiteddollar amount if you're sick or hospitalized, but you are still responsible for paying the cost of your care.Monthly Hospital Indemnity Cost Bi-Weekly Hospital Indemnity CostVisit guardianlife.com/us or call (800) 627-4200Filing a ClaimContact Guardian to file a hospital claim. You and your doctor will be required tocomplete a claim form to provide information about your condition and expectedrecovery.Please submit your enrollment using the link and QR code.https://form.jotform.com/250215172662147Questions on how to Enroll?contact Service@thecacompanies.com for assistance.Hospital/ICU Admission: $1,000 per admission to a max of 2 admissions per year, per insured.Hospital/ICU Confinement: $100 / $200 per day to a max of 30 days per year, per insured.Normal Pregnancy: Hospital Admission benefits are not payable for birth within first 9 months of coverage.Benefit Maximums