Hospital Confinement Indemnity Insurance — Washington

• 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 in an intensive care or cardiac care specialty unit.
• Extended Care Benefit: State Farm pays one-half of the daily benefit per day for up to 60 days per calendar year when you are confined in a qualified extended care facility the extended care must begin within 14 days of a hospital confinement of at least three days and be for the same or related condition requiring the hospital confinement.
• Emergency Accident Benefit: You will receive $250.00 for each day you sustain an injury and receive for emergency medical treatment within 72 hours of the injury. The 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.
• Outpatient Surgery and Intravascular Catheterization Benefit: State Farm pays $250.00 for each day you undergo an outpatient surgical operation (as identified in the policy) or intravascular catheterization (as identified in the policy).

Benefits for outpatient surgery performed within 12 months of an injury will be paid in addition to the Emergency Accident Benefit.

Only one Outpatient Surgery and Intravascular Catheterization Benefit will be payable when multiple, bilateral, or incidental procedures are performed during the same treatment session.