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) |
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| 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) |
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| 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) |
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| 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 |
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| With surgery | $125 | $300 |
| Removal of foreign object | $25 | $75 |
Fracture (surgical) |
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| 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 |
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| With stitches or staples | $100 | $200 |
| Without stitches or staples | $25 | $50 |
Paralysis |
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| 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 |
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| Air | $500 | $750 |
| Ground or water | $100 | $250 |
Blood, plasma or platelets transfusion |
$50 | $300 |
Emergency dental |
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| 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 |
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| Open | $200 | $500 |
| Arthroscopic | $125 | $250 |
Ruptured disc |
$200 | $500 |
Tendon, ligament or rotator cuff |
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| 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 |
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| 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 |