Sample Mini-Med Plan

Hospital Indemnity Policy
(Form AAW-D114)
Pays you a daily benefit if you are confined to a Hospital for at least 24 hours due to a covered injury or sickness.

Daily Hospital Benefit - $250
* - Beginning with the 1st day; and
* - Continuing up to 365 Days.

This plan does not pay in addition to Workers Compensation Benefits.

Policy Riders

Emergency Accident Benefit Amount - $200
Pays actual expenses incurred if an Insured Person sustains a Covered Injury, which requires Emergency Care provided in a Hospital, Ambulatory Surgical Center or a Physician’s Office within 72 hours of such Covered Injury up to the maximum benefit amount. Payment of the benefit is limited to 4 occurrences per policy year, per insured category.

Outpatient Sickness Benefit Amount - $75
Pays you up to the maximum benefit amount if you receive treatment in an Out-of-Hospital facility (including a Physician's Office), due to a covered sickness. We will pay actual charges up to one and one-half (1 1/2) times the maximum benefit amount purchased if treatment is rendered in a Hospital Emergency Room. Outpatient Sickness Treatment includes Physician's Services, Medical Treatments, Prescription Drugs and Supplies. We will pay for up to four covered sicknesses in a policy year per insured category (I.e. 4 for employee, 4 for spouse, and a total of 4 for all children.)

Intensive Care Unit Daily Benefit - $600
Provides a Daily Benefit if an Insured Person is confined to a Hospital's Intensive Care Unit up to a maximum of 20 days per Period of Confinement.

Surgical and Anesthesia Benefits Maximum Benefit - $5,000
● Surgical - Pays actual charges up to the percentage of maximum listed on the schedule of operations for surgery performed in a Hospital (on an inpatient or outpatient basis), in an Ambulatory Surgical Center, or a Physician’s office.
● Anesthesia - Pays actual charges up to 25% of the surgery benefits paid, for anesthesia administered by a physician in connection with such surgery.

First Hospital Admission Rider Benefit Up To - $5,000
Pays the Benefit Amount for an Insured’s First Hospital Confinement according to the following schedule: One day hospital confinement - $500, Two days - $1,000, Three days - $2,000, Four Days - $3,000, Five days - $4,000, and Six days - $5,000. Benefits for the rider will be limited to the First Hospital Admission each Policy Year for each insured. (This includes one continuous Hospital Confinement or several Hospital Confinements for the same or a related cause which are separated by less than 90 days from date of discharge). This benefit is not a cumulative benefit and will not exceed $5,000 for each Insured for each Policy Year.


Premiums for the above plan range from $80 - $90 Single - $240 - $275 Family**

**Premiums are determined at the time of initial application and are subject to change without notice.

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