Page 15 - 2017-18 Optimas Benefits Guide
P. 15
Voluntary Accident Coverage Wellness (Health
Optimas partners with Reliance Standard to offer you the ability to Screening) Benefit
purchase accident coverage. This plan pays a beneit directly to you This beneit pays $75 once per year
when you or a covered family member becomes injured as the result of per covered person if a covered
a covered accident. You can use the beneit to help offset unexpected health screening test is performed,
including blood tests, chest x-rays,
expenses associated with an accident such as lost wages, transportation stress tests, mammograms, and
costs, copays, and deductibles. Voluntary accident coverage is guaranteed colonoscopies. A full list of covered
issue if you are an eligible employee—no health questions are required! tests will be provided in your
certiicate.
Summary of Beneits*
Ambulance (ground/air) $150/$750
Medical Imaging Test (MRI, MR, CT, CAT, EEG)— $200
Limited to One per Accident
Emergency Treatment (physician ofice/specialist or $200
urgent care)
Primary Care Physician/Physician Follow-Up—Once $75
per Accident
Hospitalization Beneits
Initial Hospital Admission $1,000
Hospital Daily Beneit—365-Day Maximum $250
Initial ICU Admission $1,500
ICU Daily Beneit—30-Day Maximum $500
Covered Injuries and Surgical Procedures
Burns—2nd Degree/3rd Degree—Up to $1,600/$12,800
Skin Grafts 25% of burn beneit
Coma $7,500
Concussion $150
Tendon, Ligament, Rotator Cuff, and Ruptured Disc $900/$900/$750
Repair
(repair of 1/multiple/exploratory only)
Additional Beneits
Lodging (per night)—For 1 Person $150 per day (up to 30 days if
100+ miles from residence)
Transportation—3 Round Trip Maximum $450 (100+ miles from
residence)
* This list is not all-inclusive.
Accident Premiums
Coverage Level
Weekly Bi-Weekly Monthly
Employee $2.82 $5.65 $12.24
Employee + Spouse $4.74 $9.47 $20.52
Employee + Child(ren) $5.90 $11.80 $25.56
Family $7.86 $15.72 $34.05
Please note these are pre-tax premiums.
Optimas 15
Optimas partners with Reliance Standard to offer you the ability to Screening) Benefit
purchase accident coverage. This plan pays a beneit directly to you This beneit pays $75 once per year
when you or a covered family member becomes injured as the result of per covered person if a covered
a covered accident. You can use the beneit to help offset unexpected health screening test is performed,
including blood tests, chest x-rays,
expenses associated with an accident such as lost wages, transportation stress tests, mammograms, and
costs, copays, and deductibles. Voluntary accident coverage is guaranteed colonoscopies. A full list of covered
issue if you are an eligible employee—no health questions are required! tests will be provided in your
certiicate.
Summary of Beneits*
Ambulance (ground/air) $150/$750
Medical Imaging Test (MRI, MR, CT, CAT, EEG)— $200
Limited to One per Accident
Emergency Treatment (physician ofice/specialist or $200
urgent care)
Primary Care Physician/Physician Follow-Up—Once $75
per Accident
Hospitalization Beneits
Initial Hospital Admission $1,000
Hospital Daily Beneit—365-Day Maximum $250
Initial ICU Admission $1,500
ICU Daily Beneit—30-Day Maximum $500
Covered Injuries and Surgical Procedures
Burns—2nd Degree/3rd Degree—Up to $1,600/$12,800
Skin Grafts 25% of burn beneit
Coma $7,500
Concussion $150
Tendon, Ligament, Rotator Cuff, and Ruptured Disc $900/$900/$750
Repair
(repair of 1/multiple/exploratory only)
Additional Beneits
Lodging (per night)—For 1 Person $150 per day (up to 30 days if
100+ miles from residence)
Transportation—3 Round Trip Maximum $450 (100+ miles from
residence)
* This list is not all-inclusive.
Accident Premiums
Coverage Level
Weekly Bi-Weekly Monthly
Employee $2.82 $5.65 $12.24
Employee + Spouse $4.74 $9.47 $20.52
Employee + Child(ren) $5.90 $11.80 $25.56
Family $7.86 $15.72 $34.05
Please note these are pre-tax premiums.
Optimas 15
