HomeMy WebLinkAboutgr00090_000008_pg079-4 -
000079
* Life and Accidental Death and Dismemberment benefits reduce
50% upon attainment of age 65.
** Non-Occupational (Off the Job)
* ** Indemnity is payable on the FIRST day of disability caused
by non - occupational accidental injury and from the EIGTH
day of disability caused by non- occupational partional
illness. The maximum period for which Indemnity is payable
for either cause is THIRTEEN weeks per period of disability.
Maternity benefits are not included.
EMPL 7YEF . LLL DEPENDENT HEALTH INSURANCE,
Lls ital Expense
Room & Board daily benefit $20.00
Room & Board Maximum No. of days (70)
Other Hospital charges up to $400.00
Surgical Expense
Maximum Benefit $300.00
Maternity Expense
Hospital Expense (Dep. wife
Normal Delivery (Dep. wife
Caesarean Section(Dep. wife
Extra - Uterine (Dep. wife
Miscarriage or Abortion
(Dep. wife
In Hospital Medical Expense
Per treatment maximum
Maximum No. of days
employee dependent
3.80 7.18
incl. incl.
.73 1.73
only $150.00 - 2.96
only $125.00 incl. incl.
only $250.00 incl. incl.
only)$250.00 incl. incl.
only)$ 62.50 .indl. incl.
Di_ganostic X Ray & Laboratory
Up to (Non - Schedules)
Supplemental Accident Expense
$4.00 .20 .35
70 days
E,_ _xper se
$25.00 .25 .60
up to
$150.00 .20 .33
$5.18 $13.15
$18.33
TOTALS
Total Employee and Dependents
SCHEDULE OF RATES
AND MONTHLY COST Monthly rate Monthly,,,_Prem.
(1) Employee is Class I Single @ 8.82 8.82
(10) Employees in Class I with Depd. @ 21.97 219.70
TOTAL MONTHLY PREMIUM
Presented by: Norman A. Lockert, Agent
Penn Mutual Life
2637 Park Avenue South
Minneapolis, Minnesota
FE-3-2545
$228.52
May 14, 1962