What Do You Mean It's Not Covered: How the Policy Handles In-Patient Care

HOSPITAL IN-PATIENT COVERAGE -- The benefits for confinement in a hospital are: (1) room (other than private room), board, and general nursing care, and (2) miscellaneous hospital services.

HOSPITAL ROOM -- For each day of confinement in one period of confinement, we will pay up to the amount shown on page EI2,5 for the insured person. See page EI2,5 for the number of days we will pay during one period of confinement.

MISCELLANEOUS HOSPITAL SERVICES -- For any one period of confinement, we will pay up to the maximum amount shown on page EI2,5 for the insured person.

Hospital inpatient coverage provides benefits for charges a hospital makes on its own behalf for such things as room and board, nursing care, and miscellaneous services. Benefits for room and board are limited to the semi-private room rate, a maximum dollar amount per day, and a maximum number of days of confinement. Benefits for miscellaneous services are also limited to a maximum dollar amount. The maximum benefits are shown in the benefit schedule which is usually found at the beginning of the policy. An example: You have hospital inpatient coverage with benefits of $300 a day for a maximum of 365 days. You're confined for 10 days in a private room. The hospital charges $325 a day for the private room, and its semi-private room rate is $250. Your policy will only pay $2,500 -- the semi-private room rate for 10 days. There is no coverage for amounts above the semi-private room rate, even if the daily maximum benefit is higher. Another example: With the same coverage, you're confined in a semi-private room for 10 days, and the hospital charges $325 a day for the semi-private room. Your policy would pay $3,000 in this case because the daily maximum benefit amount would apply.