AFLAC GROUP HOSPITAL INDEMNITY INSURANCE G Policy Series C80000 HI INPATIENT AND OUTPATIENT SURGICAL BENEFITS BENEFIT AMOUNT INPATIENT SURGERY AND ANESTHESIA (performed in hospital or ambulatory surgical center) Payable for each day that, due to a covered accidental injury or sickness, an insured has an inpatient $750 surgical procedure performed by a doctor. The surgery must be performed while the insured is con昀椀ned to a hospital as an inpatient. OUTPATIENT SURGERY AND ANESTHESIA (performed in hospital or ambulatory surgical center) Payable for each day that, due to a covered accidental injury or sickness, an insured has an outpatient $500 surgical procedure performed by a doctor in a hospital on an outpatient basis or ambulatory surgical center. FACILITIES FEE FOR OUTPATIENT SURGERY (performed in hospital or ambulatory surgical center) Payable if due to a covered accidental injury or sickness: · An insured has an outpatient surgical procedure performed in an ambulatory surgical center or in a $100 hospital on an outpatient basis, and · The insured receives an Outpatient Surgery and Anesthesia Benefit under this plan. OUTPATIENT SURGERY AND ANESTHESIA (performed in a doctor’s of昀椀ce, urgent care facility or emergency room; maximum of 4 procedures per calendar year for each insured) $50 Payable for each day that, due to a covered accidental injury or sickness, an insured has an outpatient surgical procedure performed by a doctor in a doctor’s of昀椀ce or urgent care facility. Residents of Massachusetts are not eligible for these bene昀椀ts. TERMS YOU NEED TO KNOW Ambulatory Surgical Center is defined as a licensed surgical center consisting of an operating room; facilities for the administration of general anesthesia; and a post-surgery recovery room in which the patient is admitted and discharged within a period of less than 24 hours. Urgent Care is a walk-in clinic that delivers ambulatory, outpatient care in a dedicated medical facility for illnesses or injuries that require immediate care but that are not serious enough to require a visit to an emergency room. For a complete list of limitations and exclusions please refer to the brochure. Continental American Insurance Company (CAIC), a proud member of the A昀氀ac family of insurers, is a wholly-owned subsidiary of A昀氀ac Incorporated and underwrites group coverage. CAIC is not licensed to solicit business in New York, Guam, Puerto Rico, or the Virgin Islands. AG80075IOPH R1 IV (2/16)