How It Works
Forms
These form(s) are in Adobe Acrobat Reader (PDF) format and are available for downloading and printing.
If you become injured or ill and are hospitalized, your health insurance will pay a portion of your medical costs. But no plan pays for everything. Your share of the hospital bill with coinsurance, copays and deductibles could be costly—let alone the extra out-of-pocket expenses that might occur.
Hospital Indemnity Insurance pays a fixed daily benefit if you have a covered stay in a hospital, critical care unit, or rehabilitation facility on or after your coverage effective date.* The benefit amount is determined based on the type of facility and the number of days you stay.
The following list is a summary of the benefits provided by Hospital Indemnity Insurance. For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any riders.
Hospital Indemnity Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.
*See the certificate and any riders for a complete description of benefits, exclusions and limitations.
*The definition of “hospital” does not include an institution or any part of an institution used as: a hospice unit, including any bed designated as a hospice or swing bed; a convalescent home; a rest or nursing facility; a free- standing surgical center; an extended care facility; a skilled nursing facility; or a facility primarily affording custodial, educational care, or care for the aged; or care or treatment for persons suffering from mental diseases or disorders or drug or alcohol addiction. “Critical care unit” and “rehabilitation facility” is are also defined in the certificate.
These form(s) are in Adobe Acrobat Reader (PDF) format and are available for downloading and printing.
Answers about the plan, including eligibility, options, enrollment, customer service and more.
Who is the provider?
Who is eligible?
All active employees are eligible. Employees with coverage on themselves may enroll their spouse and eligible children up to age 26 and longer if they are disabled. If both the employee and spouse are covered under the policy as employees, only one, but not both, may cover the same children.
*The use of “spouse” means a person insured as a spouse as described in the certificate of insurance or rider. This may include domestic partners or civil union partners as defined by the group policy. Please contact your employer for more information. The definition of "child" may vary by state. Please contact your employer for more information.
When can I enroll?
What benefits are included in this plan?
The following list includes the benefits provided by Hospital Confinement Indemnity Insurance. The benefit amounts paid depend on the type of facility and number of days of confinement. Any combination of facility confinement and admission benefits payable includes a limit. For a complete description of your available benefits, along with applicable provisions, exclusions and limitations, see your certificate of insurance and any riders.
When you are admitted to a covered medical facility, you become eligible for an admission benefit for the first day of confinement. This benefit is payable once per confinement, up to a maximum of 8 admission(s) per calendar year:
Beginning on day 2, each day that you have a stay in a covered facility, you’ll be eligible for a fixed daily benefit payment. The benefit amount and maximum number of days per confinement varies by facility:
Additional benefits may be payable per day during a confinement and based on a confinement-related event. For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any riders.
Below are a few examples of how your Hospital Confinement Indemnity Insurance benefit could be used (coverage amounts may vary):
Exclusions and Limitations
The standard exclusions and limitations are listed below. For a complete description of your available benefits, exclusions and limitations, see your certificate of insurance and any riders. (These may vary by state and/or your employer’s plan.)
Benefits are not payable for any loss caused in whole or directly by any of the following:
*Exclusions and limitations may vary by state. Consult your certificate of insurance for exact language.
This is a summary of benefits only. A complete description of benefits, limitations, exclusions and termination of coverage will be provided in the certificate of insurance and riders. All coverage is subject to the terms and conditions of the group policy. If there is any discrepancy between this document and the group policy documents, the policy documents will govern. To keep coverage in force, premiums are payable up to the date of coverage termination. Hospital Confinement Indemnity Insurance is underwritten by ReliaStar Life Insurance Company (Minneapolis, MN), a member of the Voya® family of companies. Policy form RL-HI2-POL-18; Certificate form RL-HI2-CERT-20; Spouse Hospital Confinement Indemnity Rider form RL-HI2-SPR-18; Children’s Hospital Confinement Indemnity Rider form RL-HI2-CHR-18; Continuation of Insurance Rider form RL-HI2-CNT-18; Diagnostic Test Benefit Rider form RL-HI2-DGR-18; Wellness Benefit Rider form RL-HI2-WELL-18; Accident Benefit Rider form RL-HI2-ACD-18; Critical Illness Rider form RL-HI2-CIR-18; and Waiver of Premium Rider form RL-HI2-WOP-18. Form numbers, provisions and availability may vary by state and by your employer’s plan.
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