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Hospital Confinement (HPHI 1-00*)
Pays the Daily Benefit selected for Hospital Confinement (resident bed patient) due to a covered Injury or Sickness beginning with the first day up to 365 days. |
$100.00 |
$250.00 |
$250.00 |
Hospital Injury Indemnity (HRHI 1-00*)
Pays an ADDITIONAL Daily Benefit Amount for Hospital Confinement (resident bed patient) as the result of a covered INJURY, for up to 365 days.
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$150
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$150
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$150
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First Hospital Confinement Benefit
(HRFHC 1-00*)
Pays the Benefit Amount for the Insured's First Hospital Confinement for a covered Sickness or Injury during the Calendar Year based on the total number of days of Hospital Confinement. The Benefit is not cumulative and will not exceed $5,000.
1 day = $500 2 days = $1,000
3 days = $2,000 4 days = $3,000
5 days = $4,000 6 days = $5,000 |
Up to $5000
(see schedule) |
Up to $5000
(see schedule) |
Up to $5000
(see schedule) |
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Intensive Care Unit (HRICU 1-00*)
Pays the Daily Benefit selected, IN ADDITION to other policy benefits, for up to 20 days confinement in a Hospital's Intensive Care Unit for a covered Injury or Sickness beginning on the first day of confinement. |
$400.00 |
$800.00 |
$1200.00 |
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Private Duty Nurse (HRICU 1-00*)
Pays a Daily Benefit for required services of a Private Duty Nurse for at least 8 hours a day while confined in a Hospital for a covered injury or Sickness. Payable for up to 30 days for any Period of Confinement. |
$100.00 |
$100.00 |
$100.00 |
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Surgical Plus Benefit (HRSUR+ 1-00*)
SURGICAL Pays the % listed in the Surgical Schedule times the Maximum Surgical Benefit shown here and on the Policy Schedule for surgery performed due to a covered Injury or Sickness by a Physician in an approved facility. (If more than one surgical procedure is performed at the same time, only one benefit, the largest, will be paid.)
ANESTHESIA Pays 25% of the amount paid under the Surgical benefit for anesthesia administered by a Physician in connection with such surgery.
MAMMOGRAPHAY SCREENING Pays 4% of the Maximum Surgical Benefit shown in the Policy Schedule for Mammography Screening according to the Rider Schedule.
PAPANICOLAOU TEST (Pap Smear) Pays 1% of the Maximum Surgical Benefit for one Papanicolaou screening test per year for ages 18 and over.
|
Up to $2000
(see schedule) |
Up to $3500
(see schedule) |
Up to $5000
(see schedule) |
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Emergency Accident (HREA 1-00*)
Pays the specified Benefit for Emergency Care rendered within 72 hours of the Injury by a Physician in a Hospital Emergency Room or Physician's office. Pays for up to four different Covered Injuries in a Calendar Year per insured category (4 for employee, 4 for spouse, 4 for all children, not each child). |
$100.00 |
$100.00 |
$100.00 |
|
Outpatient Sickness (HROS 1-00*)
Pays the specified Benefit for treatment in an Out-of-Hospital facility (including a Physician's Office), due to a covered Sickness. Pays one and one-half (1.5) times the benefit selected per sickness for treatment in a Hospital Emergency Room. Pays for up to four different covered Sicknesses in a Calendar Year per insured category (4 for employee, 4 for spouse, and 4 for all children, not each child.) |
$50 |
$75.00 |
$100.00 |
Accidental Death and Dismemberment (HRADD 1-00*)
Within 90 days of a covered Injury, pays for LOSS of: Life; or both hands or feet; or one hand and one foot; or sight of both eyes. Pays DOUBLE for loss of life while a fare-paying passenger in a common carrier. Pays ONE-HALF for LOSS of one hand; or one foot; or sight of one eye. |
Employee
$5000.00
Spouse
$5000.00
Child
$5000.00 |
Employee
$25000.00
Spouse
$10000.00
Child
$5000.00 |
Employee
$30,000.00
Spouse
$15,000.00
Child
$5000.00
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* Or appropriate state addition
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