American Family Life Assurance Company of Columbus
Hospital Confinement Indemnity Policy Forms A49100DC, A49200DC, A49300DC, and A49400DC provide a series of benefits for a covered sickness or injury. These policies are intended to supplement the costs associated with hospital confinement and the treatment of sickness or injury. Policy Form A4910HDC is compatible for use with HSA plans. The policies will be marketed through payroll deduction to applicants age 18 through 75.
Policy Form A49100DC provides the following benefits: Hospital Confinement, Rehabilitation Facility, Hospital Emergency Room, Hospital Short Stay, Waiver of Premium Benefit, and Continuation of Coverage.
Policy Form A49200DC provides the benefits included in Policy Form A49100DC and the following additional benefits: Physician Visit, Medical Diagnostic and Imaging, and Ambulance.
Policy Form A49300DC provides the benefits included in Policy Form A49200DC and the following additional benefits: Surgical Schedule and Invasive Diagnostic Exams.
Policy Form A49400DC provides the benefits included in Policy Form A49300DC and the following additional benefits: Daily Hospital Confinement and Hospital Intensive Care Unit Confinement.
Policy Form A4910HDC provides the following benefits: Hospital Confinement, Daily Hospital Confinement Benefit, Hospital Intensive Care Unit Confinement, and Waiver of Premium. This policy is intended to be HSA compatible.
Payroll Application Forms A49001cDC, A49001GcDC, and A49004DC will be used to make application for the policy on a payroll basis.
Request for Change/Application for Reinstatement and/or Additions Application Form A49003DC will be used to make personal changes to the policy and to reinstate a lapsed policy.