Page 13 - Future Steps
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Voluntary Accident Coverage 2017 Beneits Enrollment
Accident coverage is designed to help meet the out-of-pocket expenses and extra
bills which can follow an accidental injury which occurs outside of work, whether Wellness
minor or catastrophic. Indemnity lump sum beneits through Unum are paid directly Benefit
to you based on the amount of coverage listed in the schedule of beneits. The This benefit pays $50 per
accident plan is guaranteed issue, so no health questions are required. calendar year per insured
individual if a covered
health screening test is
Summary of Benefits* performed, including blood
Ambulance (ground/air) $400/$1,500 tests, chest x-rays, stress
tests, mammograms, and
Medical Imaging Test (MRI, MR, CT, CAT, EEG) $100 colonoscopies. A full list of
Emergency Room Treatment $100 covered tests will be provided
Hospitalization Benefits in your certificate.
Hospital Admission $500
Hospital Confinement—Per Day Benefit (up to 365 days $50
per accident)
Intensive Care Unit (ICU) Admission $750
ICU Confinement—Per Day Benefit (up to 15 days per $100
accident)
Covered Injuries and Surgical Procedures
Burns Up to $10,000
Coma $10,000
Concussion $150
Surgery (open abdominal or thoracic) $1,500
Tendon, Ligament or Rotator Cuff Surgical Repair $800
Dislocations (non-surgical/surgical) Up to $3,000/up to $6,000
Fractures (non-surgical/surgical) Up to $3,750/up to $7,500
Emergency Dental Work (crown/extraction) $300/$100
Eye Injury $300
Torn Knee Cartilage $750
Prosthetic Device (1/2+) $750/$1,500
Ruptured Disc with Surgical Repair $800
* This list is not all-inclusive
Bi-Weekly Accident Premiums
Coverage Level You Pay
Employee $4.82
Employee + spouse $7.52
Employee + child(ren) $8.40
Family $11.11
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Accident coverage is designed to help meet the out-of-pocket expenses and extra
bills which can follow an accidental injury which occurs outside of work, whether Wellness
minor or catastrophic. Indemnity lump sum beneits through Unum are paid directly Benefit
to you based on the amount of coverage listed in the schedule of beneits. The This benefit pays $50 per
accident plan is guaranteed issue, so no health questions are required. calendar year per insured
individual if a covered
health screening test is
Summary of Benefits* performed, including blood
Ambulance (ground/air) $400/$1,500 tests, chest x-rays, stress
tests, mammograms, and
Medical Imaging Test (MRI, MR, CT, CAT, EEG) $100 colonoscopies. A full list of
Emergency Room Treatment $100 covered tests will be provided
Hospitalization Benefits in your certificate.
Hospital Admission $500
Hospital Confinement—Per Day Benefit (up to 365 days $50
per accident)
Intensive Care Unit (ICU) Admission $750
ICU Confinement—Per Day Benefit (up to 15 days per $100
accident)
Covered Injuries and Surgical Procedures
Burns Up to $10,000
Coma $10,000
Concussion $150
Surgery (open abdominal or thoracic) $1,500
Tendon, Ligament or Rotator Cuff Surgical Repair $800
Dislocations (non-surgical/surgical) Up to $3,000/up to $6,000
Fractures (non-surgical/surgical) Up to $3,750/up to $7,500
Emergency Dental Work (crown/extraction) $300/$100
Eye Injury $300
Torn Knee Cartilage $750
Prosthetic Device (1/2+) $750/$1,500
Ruptured Disc with Surgical Repair $800
* This list is not all-inclusive
Bi-Weekly Accident Premiums
Coverage Level You Pay
Employee $4.82
Employee + spouse $7.52
Employee + child(ren) $8.40
Family $11.11
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