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Hospital Indemnity Coverage

     Hospital Indemnity Coverage through Voya pays cash benefits directly to you if you have a covered
     stay in a hospital or critical care unit (ICU).  You can use the benefits from this policy to help pay for
     your medical expenses such as deductibles and copays, travel cost, food and lodging, or everyday
     expenses such as groceries and utilities.
          • Benefits are payable for pregnancy as long as the hospitalization occurs on or after your
        effective date of coverage
          • Coverage is guaranteed issue; no medical questions

                                   SUMMARY OF BENEFITS*

      Hospital Admission                      $600 max one time per confinement


      Critical Care Unit (CCU) Admission      $1,200 max one time per confinement

      Hospital Confinement Benefit            $100 per day, max 30 days per confinement

      Critical Care Unit Benefit              $200 per day, max 30 days per confinement


      Observation Unit Daily Benefit          $300 per day, max 1 day per calendar year

     *This is a summary. Refer to plan documents for details.


                                 WEEKLY PAYROLL DEDUCTION  BI-WEEKLY PAYROLL DEDUCTION
       Employee Only                     $1.44                     $2.88


       Employee + Spouse                 $3.91                     $7.82

       Employee + Child(ren)             $2.30                     $5.99

       Employee + Family                 $5.46                     $10.92























     26  •  2022 BUILDERS FIRSTSOURCE OPEN ENROLLMENT BENEFITS GUIDE                                                            2022 BUILDERS FIRSTSOURCE OPEN ENROLLMENT BENEFITS GUIDE  •  27
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