Hospital Indemnity

UnitedHealthcare

ABOUT HOSPITAL INDEMNITY

This is an affordable supplemental plan that pays you should you be inpatient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance.

For full plan details, please visit your benefit website: www.mybenefitshub.com/barbershillisd

EMPLOYEE BENEFITS

Hospital Indemnity Protection Plan is an insurance plan that pays cash directly to you. It can be used to help pay costs from a hospital stay and related treatment, health plan deductible and other out-of-pocket costs.

Eligibility All Active Full Time Employees working a minimum of 15 hours per week You must be Actively at Work with your employer on the day you apply for coverage and the date your coverage takes effect. Benefits Payable Voluntary Coverage Plan Design HIPP HSA Plan Coverage Level Base + Enhanced Pre-existing Conditions Exclusion None Portability Included Base Plan Benefits Option 1 Option 2 Hospital Admission (1 day/plan year) $500 $1,000 Hospital Confinement (up to 364 days/plan year) $100 $150 ICU Confinement (up to 364 days/plan year) $100 $150 Base + Enhanced Plan Benefits Option 1 Option 2 Hospital Admission (1 day/plan year) $500 $1,000 Hospital Confinement (up to 364 days/plan year) $100 $150 ICU Confinement (up to 364 days/plan year) $100 $150 ICU Admission (1 day/plan year) $500 $1,000 Emergency Room (up to 4 days/plan year) $100 $100 Lodging (up to 30 days/plan year) $100 $150 Transportation (up to 30 days/plan year) $150 $200 Monthly Rates Base + Enhanced Plan - Voluntary Option 1 Option 2 Employee Only $10.80 $18.80 With Spouse $19.69 $33.96 With Children $21.66 $37.00 With Spouse & Children $33.31 $56.79