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.