Bene昀椀ts Overview HOSPITAL BENEFITS EMPLOYEE SPOUSE CHILD HOSPITAL ADMISSION We will pay the amount shown, when because of a covered accident, you are injured, require hospital con昀椀nement, and are con昀椀ned to a hospital for at least 24 hours within 6 months after the accident date. We will pay this bene昀椀t once per $1,000 $1,000 $1,000 calendar year. We will not pay this bene昀椀t for con昀椀nement to an observation unit. We will not pay this bene昀椀t for emergency room treatment or outpatient surgery or treatment. HOSPITAL CONFINEMENT (per day) We will pay the amount shown when, because of a covered accident, you are injured and those injuries cause con昀椀nement to a hospital for at least 24 hours within 90 days after the accident date. The maximum period for which you can collect the Hospital Con昀椀nement $200 $200 $200 Bene昀椀t for the same injury is 365 days. This bene昀椀t is payable once per hospital con昀椀nement even if the con昀椀nement is caused by more than one accidental injury. We will not pay this bene昀椀t for con昀椀nement to an observation unit. We will not pay this bene昀椀t for emergency room treatment or outpatient surgery or treatment. HOSPITAL INTENSIVE CARE (per day) We will pay the amount shown when, because of a covered accident, you are injured, and those injuries cause con昀椀nement to a hospital intensive care unit. $400 $400 $400 This bene昀椀t is paid up to 30 days per covered accident. Bene昀椀ts are paid in addition to the Hospital Con昀椀nement Bene昀椀t. MEDICAL FEES (for each accident) We will pay up to the amount shown for X-rays and doctor services when, because of a covered accident, you are injured and those injuries cause you to receive initial treatment from a doctor within 72 hours after the accident. $125 $125 $75 If you do not exhaust the maximum bene昀椀t paid during the initial treatment, we will pay the remainder of this bene昀椀t for treatment received due to injuries from a covered accident and for each covered accident up to one year after the accident date. PARALYSIS (lasting 90 days or more and diagnosed by a physician within 90 days) Quadriplegia $10,000 $10,000 $10,000 Paraplegia $5,000 $5,000 $5,000 Paralysis means the permanent loss of movement of two or more limbs. We will pay the appropriate amount shown if, because of a covered accident, you are injured, the injury causes paralysis which lasts more than 90 days, and the paralysis is diagnosed by a doctor within 90 days after the accident. The amount paid will be based on the number of limbs paralyzed. If this bene昀椀t is paid and you later die as a result of the same covered accident, we will pay the appropriate Death Bene昀椀t, less any amounts paid under the Paralysis Bene昀椀t. The plan has limitations and exclusions that may affect benefits payable. The plan has limitations and exclusions that may affect benefits payable. This brochure is for illustrative purposes only. Refer to your certificate for complete details, definitions, limitations, and exclusions. This brochure is for illustrative purposes only. Refer to your certificate for complete details, definitions, limitations, and exclusions.