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 1/1/2022
Burns (2nd degree)
   
     Less than 10% of body $100 $200
     Between 10 and 20% of body $250 $500
     20% or more of body $500 $1,000
Burns (3rd degree)
   
     Less than 10% of body $1,000 $2,000
     Between 10 and 20% of body $3,500 $5,000
     20% or more of body $7,500 $10,000
Child organized sports injury
$50 $200
Concussion
$100 $300
Dislocation (surgical)
   
     Hip/thigh $2,000 $4,000
     Knee $1,000 $2,000
     Foot $800 $1,600
     Ankle $800 $1,600
     Wrist $600 $1,200
     Hand $400 $800
     Lower jaw $400 $800
     Shoulder $400 $800
     Collarbone $400 $800
     Ribs $400 $800
     Elbow $400 $800
     Finger $100 $200
     Toe $100 $200
     Non-surgical % 50%  
     Partial (% of non-surgical benefit) 25%  
Eye injury
   
     With surgery $125 $300
     Removal of foreign object $25 $75
Fracture (surgical)
   
     Skull - depressed $3,000 $6,000
     Hip/thigh $2,000 $4,000
     Skull - non-depressed $2,000 $4,000
     Pelvis $1,500 $3,000
     Sternum $1,500 $3,000
     Vertebral body $1,000 $2,000
     Lower leg $1,000 $2,000
     Shoulder blade $1,000 $2,000
     Upper arm $700 $1,400
     Facial excluding lower jaw $700 $1,400
     Foot $500 $1,000
     Ankle $500 $1,000
     Kneecap $500 $1,000
     Forearm $500 $1,000
     Hand or wrist (except fingers) $500 $1,000
     Lower jaw $500 $1,000
     Ribs $500 $1,000
     Vertebral processes $400 $800
     Collarbone $300 $600
     Coccyx $200 $400
     Finger $100 $200
     Toe $100 $200
     Nose $100 $200
     Non-surgical % 50%  
     Chip (% of non-surgical benefit) 25%  
Lacerations
   
     With stitches or staples $100 $200
     Without stitches or staples $25 $50
Paralysis
   
     Quadriplegia $5,000 $10,000
     Paraplegia $2,500 $5,000
     Hemiplegia $2,500 $5,000
     Uniplegia $1,250 $2,500

Emergency care

Current coverage Effective 1/1/2022
Ambulance
   
     Air $500 $750
     Ground or water $100 $250
Blood, plasma or platelets transfusion
$50 $300
Emergency dental
   
     Crown $75 $200
     Extraction $25 $100
Emergency room treatment
$100 $150
Initial physician's office visit
$50 $75

Hospital care

  Current coverage   Effective 1/1/2022
Coma
  $5,000   $10,000
Diagnostic testing
  $50   $100
X-ray
  $50   $100
Hospital stay
Non-ICU ICU Non-ICU ICU
Initial benefit $500 $500 $1,000 $1,000
Daily benefit $100 $200 $200 $400



Accidental death and dismemberment

Current coverage Effective 1/1/2022
     Employee $100,000 $100,000
     Spouse $50,000 $50,000
     Child(ren) $25,000 $25,000

Surgery

Current coverage Effective 1/1/2022
Abdominal, pelvic
$500 $750
Cranial
$500 $750
Knee cartilage
   
     Open $200 $500
     Arthroscopic $125 $250
Ruptured disc
$200 $500
Tendon, ligament or rotator cuff
   
     Open $300 $500
     Arthroscopic $125 $250
Thoracic
$500 $750

Follow-up care

Current coverage Effective 1/1/2022
Appliances
$50 $100
Follow-up physician's office visit
$50 $75
Prosthetics
   
     One $250 $500
     Two or more $250 $500
Transportation
$150 per visit $300 per visit
Rehabilitative therapy
$0 $300 lump sum payment

Support care

Current coverage Effective 1/1/2022
Adult companion lodging
$50 per day $100 per day