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

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

Emergency care

 
Ambulance
 
     Air $500
     Ground or water $100
Blood, plasma or platelets transfusion
$50
Emergency dental
 
     Crown $75
     Extraction $25
Emergency room treatment
$100
Initial physician's office visit
$50

Hospital care

   
Coma
  $5,000
Diagnostic testing
  $50
X-ray
  $50
Hospital stay
Non-ICU ICU
     Initial benefit $500 $500
     Daily benefit $100 $200

Accidental death and dismemberment

 
     Employee $25,000
     Spouse $12,500
     Child(ren) $6,250

Surgery

 
Abdominal, pelvic
$500
Cranial
$500
Knee cartilage
 
     Open $200
     Arthroscopic $125
Ruptured disc
$200
Tendon, ligament or rotator cuff
 
     Open $300
     Arthroscopic $125
Thoracic
$500

Follow-up care

 
Appliances
$50
Follow-up physician's office visit
$50
Prosthetics
 
     One $250
     Two or more $250
Transportation
$150 per visit

Support care

 
Adult companion lodging
$50 per day