Plan at a glance

Accident insurance

This is an outline of the covered benefits available. The amount aid will depend on the number of benefits you qualify for, the care you receive and the terms and conditions of the policy.

Injuries

Current coverage Effective 1/1/2023
Burns (2nd degree)
   
     Less than 10% of body $200 $300
     Between 10 and 20% of body $500 $750
     20% or more of body $1,000 $1,500
Burns (3rd degree)
   
     Less than 10% of body $2,000 $3,000
     Between 10 and 20% of body $5,000 $7,500
     20% or more of body $10,000 $15,000
Child organized sports injury
$200 $300
Concussion
$300 $450
Dislocation (surgical)
   
     Hip/thigh $4,000 $6,000
     Knee $2,000 $3,000
     Foot $1,600 $2,400
     Ankle $1,600 $2,400
     Wrist $1,200 $1,800
     Hand $800 $1,200
     Lower jaw $800 $1,200
     Shoulder $800 $1,200
     Collarbone $800 $1,200
     Ribs $800 $1,200
     Elbow $800 $1,200
     Finger $200 $300
     Toe $200 $300
     Non-surgical % 50% 50%
     Partial (% of non-surgical benefit) 25% 25%
Eye injury
   
     With surgery $300 $400
     Removal of foreign object $75 $100
Fracture (surgical)
   
     Skull - depressed $6,000 $9,000
     Hip/thigh $4,000 $6,000
     Skull - non-depressed $4,000 $6,000
     Pelvis $3,000 $4,500
     Sternum $3,000 $4,500
     Vertebral body $2,000 $3,000
     Lower leg $2,000 $3,000
     Shoulder blade $2,000 $3,000
     Upper arm $1,400 $2,100
     Facial excluding lower jaw $1,400 $2,100
     Foot $1,000 $1,500
     Ankle $1,000 $1,500
     Kneecap $1,000 $1,000
     Forearm $1,000 $1,500
     Hand or wrist (except fingers) $1,000 $1,500
     Lower jaw $1,000 $1,500
     Ribs $1,000 $1,500
     Vertebral processes $800 $1,200
     Collarbone $600 $900
     Coccyx $400 $600
     Finger $200 $300
     Toe $200 $300
     Nose $200 $300
     Non-surgical % 50% 50%
     Chip (% of non-surgical benefit) 25% 25%
Lacerations
   
     With stitches or staples $200 $300
     Without stitches or staples $50 $50
Paralysis
   
     Quadriplegia $5,000 $50,000
     Paraplegia $2,500 $25,000
     Hemiplegia $2,500 $25,000
     Uniplegia $1,250 $12,500

Emergency care

Current coverage Effective 1/1/2023
Ambulance
   
     Air $750 $1,500
     Ground or water $250 $350
Blood, plasma or platelets transfusion
$300 $450
Emergency dental
   
     Crown $200 $300
     Extraction $100 $150
Emergency room treatment
$150 $250
Initial physician's office visit
$75 $100

Hospital care

  Current coverage   Effective 1/1/2023
Coma
  $10,000   $15,000
Diagnostic testing
  $100   $200
X-ray
  $100   $150
Hospital stay
Non-ICU ICU Non-ICU ICU
Initial benefit $1,000 $1,000 $2,000 $2,000
Daily benefit $200 $400 $300 $600



Accidental death and dismemberment

Current coverage Effective 1/1/2023
     Employee $100,000 $100,000
     Spouse $50,000 $50,000
     Child(ren) $25,000 $25,000

Surgery

Current coverage Effective 1/1/2023
Abdominal, pelvic
$750 $1,500
Cranial
$750 $1,500
Knee cartilage
   
     Open $500 $1,000
     Arthroscopic $250 $500
Ruptured disc
$500 $1,000
Tendon, ligament or rotator cuff
   
     Open $500 $1,000
     Arthroscopic $250 $500
Thoracic
$750 $1,500

Follow-up care

Current coverage Effective 1/1/2023
Appliances
$100 $125
Follow-up physician's office visit
$75 $100
Prosthetics
   
     One $500 $1,000
     Two or more $500 $1,000
Transportation
$300 per visit $450 per visit
Rehabilitative therapy
$300 lump sum payment -
Inpatient - $150 per day
Outpatient - $450 lump sum payment

Support care

Current coverage Effective 1/1/2023
Adult companion lodging
$100 per day $150 per day