When coverage begins: Coverage is effective as of the first day of the month after the administrator receives your enrollment form and first premium payment.

When coverage ends: Your coverage remains in effect if premiums are paid, the Master Policy is in force, and you remain a member, until you reach age 100.

Spouse or partner coverage terminates when your coverage terminates, premiums are not paid, or your spouse or partner ceases to be eligible according to the terms of the policy.

Spouse or partner continuation: If the member dies while a spouse or partner is covered under the policy, the surviving spouse or partner may continue the benefits in force on the date of the member’s death. We must receive your spouse or partner’s written request and the required premium to continue coverage within 31 days of the premium due date next following the member’s date of death.

Satisfaction guarantee: Once you receive your Certificate of Insurance you have a full 30 days to review it. If you’re not satisfied, return it within 30 days of receipt; premiums paid will be refunded, minus any claims paid.

Confined or Confinement means the assignment to a bed in a medical facility or being held in a hospital for 24 consecutive hours or more.

Hospital does not include convalescent homes; convalescent, rest or nursing facilities; facilities affording primarily custodial, educational or rehabilitory care; facilities primarily for care of the aged/elderly, care of persons with substance abuse issues/disorders, or care of persons with mental and nervous disorders; or a distinct unit within a hospital that primarily treats or is dedicated to the care of persons with substance abuse issues/disorders or mental and nervous disorders.

Skilled Nursing Facility means an appropriately licensed health care facility or a distinct unit within a hospital or other institution which provides skilled nursing care and related services 24 hours per day, 7 days per week; is under the direct supervision of a physician and has a physician or medical professional available at all times; has a planned program of policies and procedures developed with and reviewed by one of more physicians; and is not mainly a place for rest, custodial care, care of the aged/elderly, care of persons with substance abuse issues/disorders, care of persons with mental or nervous disorders, or a hotel or similar establishment.

Refer to the policy for a complete list of terms and definitions.

No benefits are payable under the policy for any illness or injury that results from or is caused by a covered person’s suicide or attempted suicide, whether sane or insane, or intentional self-infliction.

In addition, no benefits will be paid under the policy, unless required by law, for:

• Any mental and nervous disorder, unless specifically allowed by a provision of the certificate of insurance; 
• Substance abuse, unless specifically allowed by a provision of the certificate; or
• Custodial care, unless specifically allowed by a benefit provision of the certificate or any rider attached to the policy (if applicable).

If a covered person is insured under any other hospital indemnity policy underwritten by Hartford Life and Accident Insurance Company, any claim for benefit is only payable under one policy. The covered person (or their beneficiary or estate, in the event of death) may elect under which policy benefits are payable.

We will return the amount of premium paid for any other hospital indemnity policy that is declined by the covered person retroactive to the later of:

• the last date any benefit was paid for any covered person under the other hospital indemnity policy, or 
• the effective date of insurance for the covered person under the other hospital indemnity policy.

The plan does not pay benefits for any covered illness or covered injury that results from, or is caused or contributed to by, a pre-existing condition until 6 months after a covered person is continuously insured under the policy. A pre-existing condition limitation of 6 months will also apply to any benefit amount increase or the addition of any benefit under the policy.

If a covered person becomes confined as the result of a pre-existing condition prior to completing this 6-month limitation period, benefits will only be payable for any day of confinement that extends after the end of the limitation period.

THIS IS A HOSPITAL CONFINEMENT INDEMNITY POLICY. THE POLICY PROVIDES LIMITED BENEFITS. This limited health benefit plan (1) does not constitute major medical coverage, and (2) does not satisfy the individual mandate of the Affordable Care Act (ACA) because the coverage does not meet the requirements of minimum essential coverage.

This is not Medicare Supplement Insurance. This insurance pays a fixed dollar amount, regardless of your expenses, for each day you meet the policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when:

• Any expenses or services covered by the policy are also covered by Medicare

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services, regardless of the reason you need them. These include:

• Hospitalization
• Physician services
• Hospice
• Other approved items and services

Before You Buy This Insurance:

√  Check the coverage of all health insurance policies you already have.

√  For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from Hartford Life and Accident Insurance Company.

√  For help understanding your health insurance, contact your state insurance department or state senior insurance counseling program.

Form PA-9055