HEALTH

Hospital Confinement Indemnity Insurance — Connecticut

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

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General Descriptions of Benefits

  • Daily Benefit: State Farm pays $250 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.
  • Emergency Ambulance Benefit: We will pay a licensed ambulance service for the cost of transporting you to the hospital within 72 hours of an injury. The ambulance service will be paid the charges actually incurred up to, but not to exceed the allowable rates established by the Connecticut Department of Public Health. Only one Emergency Ambulance Benefit is payable for ambulance transportation as the result of any one accident.
  • Emergency Accident Benefit: You will receive $250 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. This benefit is not payable when treatment is the result of an accidental ingestion of a controlled drug.
  • Accidental Ingestion of Controlled Drugs Benefit: State Farm will pay you the actual charges incurred up to, but not to exceed $500 per calendar year if you receive outpatient treatment due to accidental ingestion of Controlled Drugs.

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 Confinement Indemnity policy. See policy series 97024ZCT for exact terms and conditions.

State Farm Mutual Automobile Insurance Company
Bloomington, IL

SHI-CT.3