Hospital Indemnity

What is it? Hospital Indemnity Insurance pays a fixed daily benefit if you have a covered stay in a hospital, critical care unit or rehabilitation facility. Hospital Indemnity Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act. Who can be covered? You have the option to enroll yourself as well as your spouse* and children* in Hospital Indemnity Insurance coverage to meet your needs. Employees must be enrolled in order to elect coverage for eligible spouse and eligible dependent children as defined in the Certificate of Coverage and Riders. Why should I consider it? Use your paid benefit for any purpose, such as paying out-of-pocket medical expenses, copays, deductibles, groceries, gas, utilities and more its up to you. Coverage is always guaranteed issue. You can choose to take this coverage with you if you leave your employer or retire, and youll be billed at the same rates via direct billing. ReliaStar Life Insurance Company (Minneapolis, MN), a member of the Voya family of companies Wellness Benefit Your coverage includes a Wellness Benefit, which will pay you an annual benefit when you and covered family members complete an eligible health screening test. These screenings may include a mental health screening, flu immunization, a mammogram and a routine eye or dental exam. $50 for employees, $50 for spouses, and $50 per child, per calendar year For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any riders How much does it cost? This table shows how much you'll pay for Hospital Indemnity Insurance. The premium is deducted from your paycheck. Hospital Indemnity Insurance Help minimize the financial impact that can come with a stay in a hospital or medical facility Group Name: Ball State University Group Number: 752151 Class: All Eligible Employees Coverage Type Daily Benefit Low Plan Bi-Weekly Rates Coverage Type Daily Benefit High Plan Bi-Weekly Rates Employee $100 $5.04 Employee $200 $9.07 Employee + Spouse $100 $10.38 Employee + Spouse $200 $18.77 Employee + Children $100 $8.95 Employee + Children $200 $16.31 Employee + Family $100 $14.29 Employee + Family $200 $26.01 Coverage Type Daily Benefit Low Plan 18 Pay Period Coverage Type Daily Benefit High Plan 18 Pay Period Employee $100 $7.27 Employee $200 $13.10 Employee + Spouse $100 $14.99 Employee + Spouse $200 $27.11 Employee + Children $100 $12.93 Employee + Children $200 $23.56 Employee + Family $100 $20.65 Employee + Family $200 $37.57

What does it cover? Your Hospital Indemnity Insurance coverage provides a benefit payable upon a stay in a covered medical facility or other covered loss. The following is a summary of the benefits provided by this insurance. For a list of standard exclusions and limitations, go to the end of this document. For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any riders. The coverage amounts are listed below. Only one type of facility confinement or admission benefit is payable per day. Any combination of confinement and admission benefits payable will not exceed a total of 158 days during a period of confinement. You can elect coverage under the High Plan or the Low plan. First day of confinement (Admission Benefit) Type of admission Low Plan Admission Benefit amount High Plan Admission Benefit amount Hospital admission $1,100 $2,200 This benefit is payable once per confinement, up to 8 admission(s) per year. Starting day two (Daily Confinement Benefit) Type of facility Low Plan Daily benefit amount is $100 High Plan Daily benefit amount is $200 Hospital confinement, up to 90 days per confinement 1 x the daily benefit amount 1 x the daily benefit amount CCU confinement, up to 30 days per confinement 2 x the daily benefit amount 2 x the daily benefit amount Rehabilitation facility confinement, up to 30 days per confinement 1 x the daily benefit amount 1 x the daily benefit amount Observation Unit, payable once per year At least 4 consecutive hours but less than 20 consecutive hours, other than as an inpatient. Not payable for any day that a facility confinement or admission benefit is payable. $250 $250 Your coverage includes mental health and substance use inpatient care. See your Certificate of Insurance for complete provisions, limitations and exclusions. If you add a child to your family If child coverage is effective before your child is born OR child coverage is elected as a qualifying life event within 30 days of the birth: Your newborn may receive benefits just as any other covered child. If child coverage IS NOT effective before your child is born and IS NOT elected as a qualifying life event within 30 days of birth: $150 one-time benefit payable for your newborns confinement due to birth, no admission benefit is payable. What else is included? The benefits below are also included with your coverage. For a complete description of your benefits, along with applicable provisions, conditions on benefit determination, exclusions and limitations, see your certificate of insurance and any riders. Continuation of Insurance allows you to maintain your coverage for yourself, your spouse and children during an employer- approved leave of absence. Portability If you are in a situation where your eligibility for benefits is changing, such as reduced hours, termination from employment, or a life event such as divorce, you may want to continue your insurance coverage. Portability allows you to continue your coverage under the same group policy by paying your premiums directly to the insurance company.

This is a summary of benefits only. A complete description of benefits, limitations, exclusions and termination of coverage will be provided in the certificate of insurance and riders. All coverage is subject to the terms and conditions of the group policy. If there is any discrepancy between this document and the group policy documents, the policy documents will govern. To keep coverage in force, premiums are payable up to the date of coverage termination. Hospital Confinement Indemnity Insurance is underwritten by ReliaStar Life Insurance Company (Minneapolis, MN), a member of the Voya family of companies. Policy form #RL-HI2-POL-18; Certificate form #RL-HI2-CERT-20; Spouse Hospital Confinement Indemnity Rider form #RL-HI2-SPR-18; Childrens Hospital Confinement Indemnity Rider form #RL-HI2-CHR-18; Continuation of Insurance Rider form #RL-HI2-CNT-18; Diagnostic Test Benefit Rider form #RL-HI2-DGR-18; Wellness Benefit Rider form #RL-HI2-WELL-18; Accident Benefit Rider form #RL-HI2-ACD-18; Critical Illness Rider form #RL-HI2-CIR-18; Waiver of Premium Rider form #RL-HI2-WOP-18; and Absence from Employment Premium Waiver form: #RL-HI2-AEPW-2. Form numbers, provisions and availability may vary by state and by your employers plan. HI2 only Date Prepared: 09/29/2025 2024 Voya Services Company. All rights reserved. CN3856232_0926 3704081_091524 Questions? Enrollment instructions will be provided by your employer. If you have additional questions before you enroll, please call: Voya Employee Benefits Customer Service at (877) 236-7564 Scan the QR code to visit your Employee Benefits Resource Center to learn more about this benefit and review instructions on how to file a claim after your effective date. https://presents.voya.com/EBRC/ballstateuniversity The definition of hospital does not include an institution, or any part of an institution used as: a hospice unit, including any bed designated as a hospice or swing bed; a convalescent home; a rest or nursing facility; a freestanding surgical center; an extended care facility; a skilled nursing facility; or a facility primarily affording custodial, educational care, or care for the aged; Critical care unit and rehabilitation facility are also defined in the certificate. *See the certificate and any riders for a complete description of benefits, exclusions, and limitations. Exclusions and limitations The standard exclusions and limitations are listed below. For a complete description of your available benefits, exclusions, and limitations, see your certificate of insurance and any riders. (These may vary by state and/or your employers plan.) Benefits are not payable for any loss caused in whole or directly by any of the following: Participation or attempt to participate in a felony or illegal activity. Operation of a motorized vehicle while intoxicated. Intoxication means the covered persons blood alcohol content meets or exceeds the legal presumption of intoxication under the laws of the state where the accident occurred. Suicide, attempted suicide or any intentionally self-inflicted injury, while sane or insane. War or any act of war, whether declared or undeclared, undeclared (excluding acts of terrorism). Loss that occurs while on active duty as a member of the armed forces of any nation. We will refund, upon written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion. Misuse of alcohol or taking of drugs, other than under the direction of a doctor. Exception: This exclusion does not apply to a confinement in an eligible hospital or rehabilitation facility for the purpose of treatment for alcoholism or drug addiction. Elective surgery, except when required for appropriate care as determined by a doctor as a result of the covered persons injury or sickness. Riding in or driving any motor-driven vehicle in a race, stunt show or speed test. Operating, or training to operate, or service as a crew member of, or jumping, parachuting, or falling from, any aircraft or hot air balloon, including those which are not motor-driven. Flying as a fare-paying passenger is not excluded. Engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting, kitesurfing or any similar activities. Practicing for, or participating in, any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received.