What's Covered

The plan will pay a hospital confinement benefit if you are confined as an inpatient for at least 20 consecutive hours.

A confinement means that on the advice of a doctor, your assignment to a bed as a resident inpatient in a hospital, critical care unit (CCU), or rehabilitation facility. There must be a charge for room and board and the confinement must occur while you are insured by the plan.

Initial confinement: $1,500

The initial confinement benefit applies for confinements of 20 consecutive hours in a hospital, hospital observation unit, critical care unit, or rehabilitation facility as described below. Only one initial confinement benefit is payable for each confinement.

If you are discharged from one of these listed facilities and then re-confined within 14 days due to the same or a related condition, the re-confinement will be considered part of the previous confinement and no additional initial confinement benefit will be available.

The plan will pay a maximum of four initial confinement benefits per calendar year for all covered persons. However, the plan will not pay for more than two initial confinement benefits per calendar year for the same covered person.

Hospital confinement benefit: $150 per day

The hospital confinement benefit will be payable for each day you are confined in a hospital or hospital observation unit for at least 20 consecutive hours. The hospital confinement benefit is payable up to a maximum of 30 days.

Hospital means an institution that is run for the care and treatment of sick or injured persons as inpatients and which fully meets each of the following requirements:

It is operated in accordance with the laws pertaining to hospitals in the jurisdiction in which it is located.
It is under the supervision of a medical staff and has one or more doctors available at all times.
It provides 24 hours a day service by registered graduate nurses (RNs).

It is not an institution or any part of an institution used as: a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; a free-standing surgical center; a rehabilitative facility; an extended-care facility; a skilled nursing facility; or a facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction.

Observation unit means a specified area within a hospital, apart from the emergency room, where a patient can be monitored following outpatient surgery or treatment in the emergency room by a doctor, and that fully meets each of the following requirements:

It is under the direct supervision of a doctor or registered nurse.
It is staffed by nurses assigned specifically to that unit.
It provides care seven days per week, 24 hours per day.

Critical care unit confinement benefit: $300 per day

The critical care unit confinement benefit will be payable for each day you are confined in a critical care unit for at least 20 consecutive hours. The confinement benefit is payable up to a maximum of 30 days.

Critical care unit means a specifically designated part of a hospital commonly referred to as an intensive care unit which meets all of the following requirements:

It provides the highest level of medical care and is restricted to patients who are critically ill or injured and who require intensive comprehensive observation and care.
It is separate and apart from the surgical recovery room and from rooms, beds, and wards customarily used for patient confinement.
It is permanently equipped with special lifesaving equipment for the care of the critically ill or injured.
It is under constant and continuous observation by a specially trained nursing staff assigned exclusively to the intensive care unit on a 24 hour basis.
It is assigned a doctor on a full-time basis.

Critical care unit does not include a sub-acute intensive care unit that provides a level of medical care below intensive care, but above a regular private or semi-private room or ward such as a step-down unit.

Rehabilitation facility confinement benefit: $75 per day

The rehabilitation facility confinement benefit will be payable for each day you are confined in a rehabilitation facility for at least 20 consecutive hours. The rehabilitation facility confinement benefit is payable up to a maximum of 30 days.

Rehabilitation facility means a free-standing facility providing coordinated multidisciplinary physical restorative services to inpatients under the direction of a doctor knowledgeable and experienced in rehabilitative medicine. A rehabilitative facility must meet all the following requirements:

It is licensed and operated pursuant to law.
It provides treatment and care for ill and injured persons on an inpatient basis.
It provides 24 hours a day service by registered graduate nurses (RNs).
It is not an institution or any part of an institution used as: a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; or a facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction.

Observation unit daily benefit: $500 per day

Benefits are payable if you are admitted to a hospital observation unit for at least 4 consecutive hours other than as an inpatient. This benefit is not payable for any day that a facility confinement or admission benefit is payable. The maximum benefit is $500 per day for up to one day per calendar year.

An observation unit is a specified area within a hospital, apart from the emergency room, where a patient can be monitored following outpatient surgery or following treatment in the emergency room by a doctor, and that fully meets each of the following requirements:

It is under the direct supervision of a doctor or registered nurse.
It is staffed by nurses assigned specifically to that unit.
It provides care seven days per week, 24 hours per day.