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27Employee $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 metlife.com/us or call (888) 608-6665.Filing a ClaimContact MetLife to file a hospital claim. You and your doctor will be required to completea claim form to provide information about your condition and expected recovery.Hospital/ICU Admission: $300 per admission to a max of 4 admissions per year, per insured.Hospital/ICU Confinement: $125 / $250 per day to a max of 31 days per year, per insured.Benefit MaximumsQuestions on how to Enroll?contact Service@thecacompanies.com for assistance.Please submit your enrollment using the link and QR code.https://form.jotform.com/250434767339161