BENEFITS DETAILS

A. Daily Hospital Confinement Indemnity Benefit

We will pay the Daily Hospital Benefit Amount for each day when a Covered Person is Confined in a Hospital when such confinement is Medically Necessary because of an Injury or Sickness. Benefits will begin on the first day.

We won't pay more than a total of 365 days for Hospital Confinement during the Covered Person's lifetime. Choose either the $100 or $500 daily benefit.

B. Doctor's Office Visit Benefit

We will pay $75 as the Doctor's Office Visit Benefit when a Covered Person receives the medical services of a Doctor, limited to one visit to the Doctor's office per Week, except in Maryland.

We won't pay more than a total of 10 visits to the Doctor's office per Calendar Year per Covered adult and 5 per calendar year for all Covered children combined.

C. Outpatient Benefit

We will pay the Out-of-Pocket Costs incurred for care and services received in an outpatient department of a hospital. Care and services include, but are not limited to: (1) Doctor's treatment; (2) medical supplies; or (3) x-rays or laboratory tests.

We won't pay more than $250 per Outpatient visit up to $1,000 for any one Sickness or Injury or the Maximum Calendar Year Outpatient Benefit shown in the Policy Schedule in any one Calendar Year.

D. Ambulance Transportation Benefit

If a Covered Person requires the use of an ambulance for transportation to a Hospital for Medically Necessary care of a Sickness or Injury, We will pay the Ambulance Benefit shown in the Policy Schedule. This Benefit is limited to a single benefit payment for any one Sickness or Injury.

For purposes of this Benefit, "use of an ambulance service" means the physical transportation of the Covered Person in an ambulance or other appropriate vehicle registered to a licensed medical transportation service for which a charge is normally made.

Discount Benefits Are Not Insurance