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Hospital Income Insurance — Arizona

Hospital Income Insurance is currently available through State Farm Mutual Automobile Insurance Company. Please read a brief description of the State Farm® Hospital Income Insurance Policy available in Arizona.

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General Descriptions of Benefits

  • Daily Benefit: State Farm pays $250 per day for up to 365 days when you are confined to a hospital for which a charge for room and board is made, for treatment of a covered sickness or injury.
  • Intensive Care Benefit: State Farm pays an additional daily benefit of $250 for up to 14 days for the same or related condition when you are confined in an intensive care unit.
  • Extended Care Benefit: State Farm pays one–half of the daily benefit per day ($125) for up to 60 days per calendar year when you are confined in a qualified extended care facility. The extended care must begin within 30 days of a hospital confinement of at least three days and be for the same or related condition requiring the hospital confinement.
  • Emergency Accident Benefit: You will receive $250.00 for each day you sustain an injury and receive emergency medical treatment within 72 hours of the injury. Only one Emergency Accident Benefit is paid when multiple injuries are sustained as the result of any one accident. This benefit is payable up to a maximum of three times per calendar year per covered person.
  • Outpatient Surgery and Intravascular Catheterization Benefit: State Farm pays $250.00 for each day you undergo an outpatient surgical operation (as identified in the policy) or intravascular catheterization (as defined in the policy).

Benefits for outpatient surgery performed as the result of an injury are paid in addition to the Emergency Accident Benefit.

Only one Outpatient Surgery and Intravascular Catheterization Benefit will be payable when multiple, bilateral, or incidental procedures are performed during the same treatment session.

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Disclosure

This is a supplement to health insurance and is not a substitute for major medical coverage. Lack of major medical coverage (or other Minimum Essential Coverage) may result in an additional payment with your taxes. If you do not currently have major medical coverage that qualifies as Minimum Essential Coverage under the Affordable Care Act, you are not eligible for this product.

If you currently have a health spending arrangement such as a Health Savings Account (HSA), or if you plan to open one in the future, please consult your tax advisor about the features offered in this supplemental medical policy, and the possible tax implications of combining these plans.

This is a marketing tool intended for use in the sale of insurance. Completion of an application for a State Farm® insurance policy will require contact with a State Farm agent/insurance producer.

This information provides only a brief description of coverage. It is not a contract. A complete statement of coverage is found only in the Hospital Income policy. See policy series 97024ZAZ for exact terms and conditions.

Exclusions, Exceptions, and Limitations

This policy does not cover Confinement or any loss incurred which is caused by or results from: 1. Injury or Sickness as the result of war, declared or undeclared, or any act or hazard of war; 2. Normal pregnancy and childbirth; however, complications of pregnancy shall be considered as a Sickness; 3. Any attempt at suicide, whether sane or insane, or any intentionally self-inflicted Injury; 4. Mental or nervous disease or disorder for more than 30 days per calendar year for the same or related illness or illnesses; 5. Routine well-baby care for newborn children; 6. Any type of hernia or hemorrhoids or any ailment or disease of the tonsils, adenoids, or reproductive organs if the Confinement begins within 90 days after this policy becomes effective for the Covered Person. This exception shall not be applicable when the attending Physician certifies that such diseases or conditions are treated on an emergency basis; or 7. Cosmetic and/or elective surgery unless caused by Injury or done for reconstructive purposes due to Sickness or Injury.

Pre-existing Condition Limitations. This policy does not cover any loss incurred which is caused by or results from a Pre-existing Sickness or Physical Condition as defined herein, subject to the Time Limit on Certain Defenses provision.

State Farm Mutual Automobile Insurance Company
Bloomington, IL

SHI-AZ.2

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