Proprietary 8-23 21 METLIFE HOSPITAL PLAN Help with costs due to an unexpected hospitalization You can be better prepared for the costs of an unexpected hospitalization with the MetLife Hospital Plan. This insurance plan pays a cash benefit in addition to any benefits you may receive under a medical plan. You can use the cash benefit for any purpose, including medical plan deductible, child care, groceries or for any other reasons. Plan benefits If you or a covered family member is admitted to the hospital for covered services, you receive: n Admission Benefit: $1,500 lump sum for each hospital admission (up to 4 each calendar year) PLUS an additional $1,000 if admitted to the ICU n Confinement Benefit: $100 per day (up to 100 days per hospital confinement) PLUS an additional $100 per day for each day up to 15 when in the ICU n Newborn Nursery Care: $50 per day (up to 2 days) when receiving Newborn Nursery Care n Inpatient Rehabilitation Benefit: $100 per day (up to 15 days) when receiving inpatient rehabilitation services for injury or sickness. Plan benefits also include a Health Screening Benefit of $50 once per calendar year for each covered person. Eligibility The policy is not intended to be a substitute for medical coverage and certain states may require the insured to have medical coverage to enroll for the coverage. If you elect coverage, you must participate in the plan until the end of the plan year, unless you experience a qualified status change. Plan exclusions and limitations Exclusions and limitations in any policy and certificate issued will be based on the policyholder’s situs state, plan design and states where employees reside. If the policyholder has employees residing in the following states, that state’s Exclusions and Limitations will apply: Alaska, Arkansas, Connecticut, Louisiana, Minnesota, Mississippi, Montana, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, South Carolina, Texas, Utah, Vermont, Washington, West Virginia, and Wisconsin. More about the plan The MetLife Hospital plan is underwritten by MetLife. Eligible individuals need to review the MetLife benefits materials (benefits summary) before they enroll. Read the official plan Benefits Summary, available at www.farmersagentsbenefits.com for details. You may also call MetLife Customer Service at 1-800-GETMET 8 (800-438-6388) if you have questions. Note: This plan does not count as minimum essential coverage under the Affordable Care Act. This is a supplement to health insurance and is not a substitute for major medical coverage or other minimum essential coverage and may result in an additional payment with your taxes.
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