| POLICY FEATURE |
BENEFIT AMOUNT |
| Maximum Benefit For Any One Injury Or Sickness: |
$100,000 |
$75,000 |
$50,000 |
Daily Hospital Expense Benefit (after $500 deductible)*
For days 1-10 policy pays incurred expenses
For the next 30 days policy pays incurred expenses |
80% up to $4,000 per day
80% up to $2,000 per day |
80% up to $3,000 per day
80% up to $1,500 per day |
80% up to $2,000 per day
80% up to $1,000 per day |
| Daily Intensive Care Benefit |
Daily and Maximum benefits are increased $1,000 each day for up to 10 days in the ICU. |
| ADDITIONAL POLICY FEATURES |
BENEFIT |
Hospital Admissin Benefit
If you or your insured family member is hospitalized, the policy will pay an admission benefit. |
$100 per hospital stay - benefit is not ties to incurred expenses - it can be used how you see fit. |
Outpatient (Non-Surgical) Benefit
Policy pays incurred expenses for outpatient services including:
1. outpaitient hospital expenses;
2. diagnostic imaging such as x-rays, MRIs, etc, and;
3. radiation treatment such as for cancer. |
80% up to $500
For any one injury or sickness |
80% up to $400
For any one injury or sickness |
80% up to $300
For any one injury or sickness |
Surgical Expense Benefit
Policy pays 100% of surgical charges up to the benefit amount listed in the policy schedule whether inpatient or outpatient. The largest applicable surgical benefit will be paid for any one injury or sickness. |
80% up to $10,00 |
80% up to $7,500 |
80% up to $7,500 |
+ up to 20% of surgical benefit for Assistant Surgeon
+ up to 25% of surgical benefit for Anesthesiologist |
Physician Charges
OUTPATIENT: Policy pays for one doctor visit each day during an inpatient hospital stay. |
80% of the doctor's fee, up to $50 per day
Maximum of $2,000
for any one injury of sickness |
Physician Charges
INPATIENT: Policy pays for doctor visits at a doctor's office, clinic, or your home for injury or sickness, plus one physical exam each year. Total benefits paid for office visits and exam cannot exceed maximum benefit. |
80% up to $25 per visit
80% up to $50 for one physical exam per year
$250 maximum per year
NOTE: you may choose to double the benefit amount as shown below. |
Registered Nurse Benefit
Policy pays incurred expenses for full-time care from a registered nurse during a hospital stay. |
80% up to $100 per 8-hour shift
Up to three (3) shifts per day for no more than 90 days
for any one injury or sickness |
Ambulance Benefit
Policy pays incurred expenses for ambulance service to or from a hospital. |
80% up to $200
for any one injury or sickness |
Return or Premium Benefit
In the event the insured family member's death is due to an accident, we will refund double the premiums paid for the insured family member. |
Double premiums refunded |
| THESE OPTIONAL BENEFITS WILL NOT BE CONTINUED WHEN THE POLICY TERMINATES |
A. Additonal Physician charges Benefit
You may double the benefits paid for ourpatient physician charges and the annual physical exam.
Age 0-63 |
80% up to $50 per visit
80% up to $100 for one physical exam per year
$500 maximum per year |
B. Critical Illness Benefit (including cancer)
Applicants must qualify for this optional benefit rider.
See the Agent Manual for rules.
Choice of $10,000, $20,000, $30,000 or $50,000 benefit amount.
Age 18-63
Rider Form R-CILS2 |
Eligible Applicants may add a rider which pays a one-time cash benefit of up to $50,000 for first diagnosis of critical illness including: heart attack, stroke, end stage renal failure, major organ transplant (heart, lung, liver, kidney, pancreas or bone marrow), complete paralysis of two or more limbs, third degree burns to 20% or more of the body, loss of two limbs, total loss of eyesight. In addition the rider covers first diagnosis of cancer (leukemia, Hodgkin's disease, malignant neoplasm). The benefits for this rider will reduce by half at age 65. |
C. Accident Benefit
Applicants must qualify for this optional benefit rider.
See the Agent Manual for rules.
Choice of $10,000 or $20,000 benefit amount.
Age 18-63
Rider Form R-ACC2 |
Eligible Applicants may add a rider which pays ONE of the following accident benefits: accidental death benefit (up to $20,000), a lump sum amount for specified injuries (up $20,000), a weekly hospital stay benefit (up to $500) for no more than 25 weeks for any one accident, or a first aid medical care benefit (up to $80) for any one accident. |