Hospital Confinement

Benefits are paid on the first day of a covered hospital stay (whether that is a regular hospital bed or ICU) of 24 hours or more. The benefit is paid one time per hospital stay, regardless of whether the insured is moved from the regular bed to ICU, or vice versa.

Benefits are paid beginning the second day of a covered stay. ICU stays are included with the hospital stay benefit. Each facility has a calendar year maximum number of days as selected, 500 days per lifetime unless otherwise noted in the policy.

Benefits are paid on the first day of a covered substance abuse facility stay. Each facility has a calendar year maximum number of days as selected, 500 days per lifetime unless otherwise noted in the policy.

Benefits are paid on the first day of a covered mental health facility stay. Each facility has a calendar year maximum number of days as selected, 180 days per lifetime unless otherwise noted in the policy.

Benefits are paid on the first day of a covered nursing facility stay which follows a covered hospital stay of 3 consecutive days or more. Each facility has a calendar year maximum number of days as selected, 500 days per lifetime unless otherwise noted in the policy.

Allows coverage to continue following termination of employment or loss of eligibility. Review the certificate of coverage to understand the full details of this provision.

This Rider provides an additional percentage in the amount of benefits payable under the Policy for a Covered Benefit if you are admitted to, confined in, or receive services within the Group Policyholder's Health System Facility for a covered Hospitalization, after your effective date of coverage, subject to the Exclusions provision of the certificate. The benefit payable under this rider is in addition to the benefit amount paid for the covered benefit.

Your plan pays daily benefits for a hospital stay if you or your covered spouse is hospitalized due to childbirth, even for a routine delivery. You'll also receive daily benefits for the newborn or newly adopted child, even if you're the only one enrolled on the plan. This automatic coverage for the newborn or adopted child continues for the first 31 days from birth or adoption. You must enroll your child as a dependent on your plan within 30 days of birth or adoption in order for coverage to continue beyond the first 31 days.

This fixed confinement policy may pay you a limited dollar amount if you're sick or hospitalized. You're still responsible for paying the cost of your care.

- The payment you get isn't based on the size of your medical bill.
- There might be a limit on how much this policy will pay each year.
- This policy isn't a substitute for comprehensive health insurance.
- Since this policy isn't health insurance, it doesn't have to include most Federal consumer protections that apply to health insurance.

Looking for comprehensive health insurance? Visit HealthCare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325) to find health coverage options. To find out if you can get health insurance through your job, or a family member's job, contact the employer.

Questions about this policy? Contact your State Department of Insurance. Find their number on the National Association of Insurance Commissioners' website (naic.org) under 'Insurance Departments.' If you have this policy through your job, contact the employer.

These benefits are designed to be offered to those covered under a High-Deductible Health Plan (HDHP) without the effect of disqualifying a participant from electing an HSA. Please consult with your Benefits Advisor to assist with determination that electing this limited benefit coverage is in fact permitted coverage under the rules applicable to an HSA.

• ✓Submit claims online via My Group Online (MyGO) at www.symetra.com/MyGO — fill in claim details, upload or snap a photo of your itemized bill, and hit submit
• ✓Request an ID card via mail directly from your MyGO account — processed the next business day
• ✓Log in to MyGO on your mobile device to generate an on-demand ID card
• ✓Download and print important forms from MyGO whenever you need them
• ✓View and download your certificate(s) including plan-specific coverage information
• ✓MyGO is available 24 hours a day, 7 days a week from your computer, phone, or tablet
• ✓If you have other group coverage with Symetra, they will automatically check if you are eligible for additional benefits when you submit a claim
• ✓Enroll during annual enrollment — if you miss it, you must wait until the following year unless you have a qualifying life event (marriage, divorce, birth of a child)
• ✓Benefits are paid in full regardless of what other insurance has already paid
• ✓For questions or complaints, contact your State Department of Insurance (find their number at naic.org)

• ⚠If you don't enroll during annual enrollment, you must wait until the next open enrollment period unless you have a qualifying life event

• 👤Team members who want a simple, user-friendly way to manage benefits and submit claims online
• 👤Team members enrolled in an HDHP who want supplemental hospital confinement coverage

Your coverage through Symetra includes the following benefits at no additional cost to you:

Travel Assistance Program: 24/7 emergency medical assistance and other key services.
Identity Theft: Protect yourself from identity theft.
Estate Guidance: Create wills, healthcare and financial power of attorney, and/or final arrangement documents. Get more information at estateguidance.com.

For more information, call 1-833-808-0253, 1-978-651-9223 (international).

Symetra

1-877-377-6773

symetra.com