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Hospital Indemnity Insurance, continued How much does Hospital Indemnity Insurance cover? STANDARD BENEFIT BENEFIT AT UPH FACILITY Hospital Admission $1,000 $1,250 Critical Care Unit Admission $2,000 $2,500 Hospital Con昀椀nement $100/day, up to 30 days $125/day, up to 30 days Hospital Intensive Care $200/day, up to 15 days $250/day, up to 15 days Rehabilitation Facility Bene昀椀t $50/day, up to 30 days $62.50/day, up to 30 days Pregnancy Covered? Yes Yes Pre-Existing Condition Exclusion? No Portable and Transferable? Yes Bi-Weekly Premium Rates Employee $9.39 Employee + Spouse/DP $18.20 Employee + Child(ren) $13.79 Family $22.60 | 30 |

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