Daily In-Hospital Confinement*
When confined to the hospital due to a covered accident or sickness, the carrier will pay the benefit maximum for up to 30 days per year.

Surgery with Anesthesia**
When surgery with anesthesia is needed due to a covered accident or sickness, the carrier will pay up to the benefit maximum for the surgery. Anesthesia will be paid up to 25% of the amount covered for the surgery.

Intensive Care/Critical Care*
When confined to an intensive care unit due to a covered accident or sickness, the carrier will pay the benefit maximum for up to three (3) days.

Doctor Office Visits
When treated at the doctors office for a covered accident or sickness, the carrier will pay the benefit maximum, for up to five (5) visits. Note: One of these visits may be used for preventative care services.

Preventative Test Care
The carrier will pay the benefit maximum for one (1) covered preventative test.

Diagnostic Testing & Lab
When diagnostic tests and labs are required due to a covered accident or sickness, the carrier will pay the benefit maximum for up to five (5) service dates.

Accidental Medical 
The carrier pays up to the maximum benefit amount for charges due to injuries received in one (1) covered accident - subject to a $100 Policy Year deductible.

Accidental Death and Dismemberment***
In the unfortunate event of the loss of life or limb in a covered accident, the carrier pays:

Up to: $10,000 for the member

Up to: $5,000 for a covered spouse

Up to: $2,500 for covered dependents

*The carrier will not pay concurrently for Daily In-Hospital Confinement and Intensive Care/Critical Care features.
**In some states Surgery with Anesthesia Benefit may be based upon a surgical schedule as shown in your certificate schedule.
***Not Available in Florida.

Daily In-Hospital Confinement*
When confined to the hospital due to a covered accident or sickness, the carrier will pay the benefit maximum for up to 30 days per year.

Surgery with Anesthesia**
When surgery with anesthesia is needed due to a covered accident or sickness, the carrier will pay the benefit maximum for the surgery. Anesthesia will be paid at 25% of the amount covered for the surgery.

Intensive Care/Critical Care*
When confined to an intensive care unit due to a covered accident or sickness, the carrier will pay the benefit maximum for up to three (3) days.

Doctor Office Visits
When treated at the doctors office for a covered accident or sickness, the carrier will pay the benefit maximum, for up to five (5) visits. Note: One of these visits may be used for preventative care services.

Preventative Test Care
The carrier will pay the benefit maximum for one (1) covered preventative test.

Emergency Care/Urgent Care (not included in Select 500 Program)
When treatment is received at a hospital emergency room or urgent care facility due to a covered accident or sickness, the carrier will pay the benefit maximum for one (1) visit.

Diagnostic Testing & Lab
When diagnostic tests and labs are required due to a covered accident or sickness, the carrier will pay the benefit maximum for up to five (5) service dates.

Accidental Medical
The carrier pays up to the maximum benefit amount for charges due to injuries received in one (1) covered accident - subject to a $100 Policy Year deductible.

Accidental Death and Dismemberment ***
In the unfortunate event of the loss of life or limb in a covered accident, the carrier pays:

Up to: $10,000 for the member

Up to: $5,000 for a covered spouse

Up to: $2,500 for covered dependents

*The carrier will not pay concurrently for Daily In-Hospital Confinement and Intensive Care/Critical Care features.
**In some states Surgery with Anesthesia Benefit may be based upon a surgical schedule as shown in your certificate schedule.
***Not Available in Florida.

Daily In-Hospital Confinement*
When confined to the hospital due to a covered accident or sickness, the carrier will pay the benefit maximum for up to 30 days per year.

Hospital Admission
When admitted to the hospital due to a covered accident or sickness, the carrier will pay the benefit maximum in admission costs.

Surgery with Anesthesia**
When surgery with anesthesia is needed due to a covered accident or sickness, the carrier will pay up to the benefit maximum for the surgery. Anesthesia will be paid at 25% of the amount covered for the surgery.

Intensive Care/Critical Care*
When confined to an intensive care unit due to a covered accident or sickness, the carrier will pay the benefit maximum for up to three (3) days.

Doctor Office Visits
When treated at the doctors office for a covered accident or sickness, the carrier will pay the benefit maximum, for up to five (5) visits. Note: One of these visits may be used for preventative care services.

Preventative Test Care
The carrier will pay the benefit maximum for one (1) covered preventative test.

Diagnostic Testing & Lab
When diagnostic tests and labs are required due to a covered accident or sickness, the carrier will pay the benefit maximum for up to five (5) service dates.

Skilled Nursing Facility
When necessary due to a covered accident or sickness, the carrier will pay the maximum benefit amount for up to 10 days in a skilled nursing facility.

Accidental Medical
The carrier pays up to the maximum benefit amount for charges due to injuries received in one (1) covered accident - subject to a $100 Policy Year deductible.

Accidental Death and Dismemberment***
In the unfortunate event of the loss of life or limb in a covered accident, the carrier pays:

Up to: $10,000 for the member

Up to: $5000 for a covered spouse

Up to: $2,500 for covered dependents

*The carrier will not pay concurrently for Daily In-Hospital Confinement and Intensive Care/Critical Care features.
**In some states Surgery with Anesthesia Benefit may be based upon a surgical schedule as shown in your certificate schedule.
***Not Available in Florida.

Daily In-Hospital Confinement*
When confined to the hospital due to a covered accident or sickness, the carrier will pay the benefit maximum for up to 30 days per year.

Hospital Admission
When admitted to the hospital due to a covered accident or sickness, the carrier will pay the benefit maximum in admission costs.

Surgery with Anesthesia**
When surgery with anesthesia is needed due to a covered accident or sickness, the carrier will pay up to the benefit maximum for the surgery. Anesthesia will be paid at 25% of the amount covered for the surgery.

Intensive Care/Critical Care*
When confined to an intensive care unit due to a covered accident or sickness, the carrier will pay the benefit maximum for up to three (3) days.

Doctor Office Visits
When treated at the doctors office for a covered accident or sickness, the carrier will pay the benefit maximum, for up to five (5) visits. Note: One of these visits may be used for preventative care services.

Preventative Test Care
The carrier will pay the benefit maximum for one (1) covered preventative test.

Emergency Care/Urgent Care
When treatment is received at a hospital emergency room or urgent care facility due to a covered accident or sickness, the carrier will pay the benefit maximum for one (1) visit.

Diagnostic Testing & Lab
When diagnostic tests and labs are required due to a covered accident or sickness, the carrier will pay the benefit maximum for up to five (5) service dates.

Skilled Nursing Facility
When necessary due to a covered accident or sickness, the carrier will pay the maximum benefit amount for up to 10 days in a skilled nursing facility.

Accidental Medical
The carrier pays up to the maximum benefit amount for charges due to injuries received in one (1) covered accident - subject to a $100 Policy Year deductible.

Accidental Death and Dismemberment***
In the unfortunate event of the loss of life or limb in a covered accident, the carrier pays:

Up to: $10,000 for the member

Up to: $5,000 for a covered spouse

Up to: $2,500 for covered dependents

*The carrier will not pay concurrently for Daily In-Hospital Confinement and Intensive Care/Critical Care features.
**In some states Surgery with Anesthesia Benefit may be based upon a surgical schedule as shown in your certificate schedule.
***Not Available in Florida.

Daily In-Hospital Confinement*
When confined to the hospital due to a covered accident or sickness, the carrier will pay the benefit maximum for up to 60 days per policy year.

Surgery with Anesthesia**
When surgery with anesthesia is needed due to a covered accident or sickness, the carrier will pay up to 50% of RBRVS, up to the benefit maximum per policy year. Anesthesia will be paid up to 20% of the amount covered for the surgery.

Intensive Care/Critical Care*
When confined to an intensive care unit due to a covered accident or sickness, the carrier will pay the benefit maximum for up to ten (10) days per policy year.

Doctor Office Visits
When treated at the doctor's office for a covered accident or sickness, the carrier will pay the benefit maximum, for up to five (5) visits per policy year. Note: One of these visits may be used for preventative care services.

Preventive Test Care
The carrier will pay the benefit maximum for (1) covered preventive test per policy year.

Diagnostic Testing & Lab Benefit
When diagnostic tests and labs are required due to a covered accident or sickness, the carrier will pay the benefit maximum for up to five (5) service dates per policy year.

Accident Medical
The carrier pays 80% of covered charges, up to the maximum benefit amount per accident - subject to a deductible of $100 per accident.

Accidental Death and Dismemberment***
In the unfortunate event of the loss of life or limb in a covered accident, the carrier pays

Up to: $10,000 for the covered member

Up to: $5,000 for a covered spouse

Up to: $2,500 for covered dependents

*Carrier will not pay concurrently for Daily In-Hospital Confinement and Intensive Care/Critical Care features.
**In some states Surgery with Anesthesia Benefit may be based upon a surgical schedule as shown in your certificate schedule.
***Not Available in Florida.

Daily In-Hospital Confinement*
When confined to the hospital due to a covered accident or sickness, the carrier will pay the benefit maximum for up to 60 days per policy year.

Doctor Office Visits
When treated at the doctor's office for a covered accident or sickness, the carrier will pay the benefit maximum, for up to seven (7) visits per policy year. Note: One of these visits may be used for preventative care services.

Accident Medical
The carrier pays 80% of covered charges, up to the maximum benefit amount per accident - subject to a deductible of $100 per accident.

Accidental Death and Dismemberment***
In the unfortunate event of the loss of life or limb in a covered accident, the carrier pays:

Up to: $25,000 for the member

Up to: $12,500 for a covered spouse

Up to: $6,250 for covered dependents

Mental Health:
The carrier will pay, per policy year, the benefit maximum for:

In-Patient: Up to thirty (30) days

Out-Patient: Up to twenty (20) visits

*Carrier will not pay concurrently for Daily In-Hospital Confinement and Intensive Care/Critical Care features.
**In some states Surgery with Anesthesia Benefit may be based upon a surgical schedule as shown in your certificate schedule.
***Not Available in Florida.