Page 21 - 2019 Intertek
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INTERTEK
UNUM ACCIDENT COVERAGE
Why Accident Coverage?
Accident coverage applies to non-work related accidents only. If you
elect to purchase accident coverage, this plan pays a tax-free beneit
directly to you to help ofset unexpected expenses associated with an
accident (of the job only) for yourself or a covered family member.
How Does It Work?
1. Get the treatment you need
2. File a claim with Unum
3. You’ll receive a beneit for each covered treatment received
Here is a brief summary of the covered medical treatment or service. A
full list of covered services will be provided in your certiicate.
Plan Pays You
Emergency room $150
Urgent care, primary care physician or $75
specialist
Hospital coninement $1,000 + $200 per day (up to 365 days)
Intensive care unit coninement $1,500 + $400 per day (up to 15 days)
Rehabilitation unit coninement $100 per day (up to 15 days, max 30 per
year)
Accidental Death & Dismemberment
Covered employee/spouse/child(ren) $50,000/$20,000/$10,000
Loss of limb(s) Up to $100,000
Fractures (open reduction paid at 2× below amount)
Skull (non-depressed/depressed) $1,500/$3,750
Hip, thigh (femur) $2,250
Pelvis, leg, vertebrae (body) $1,200
Bones of the face or nose, upper jaw, $525
upper arm
Lower jaw, shoulder blade, collar bone, $450
vertebral process, forearm, hand, wrist,
kneecap, foot, ankle
Rib $375
Coccyx $300
Finger, toe $75
Chip fracture 25% of non-surgical beneit
Dislocations (open reduction paid at 2× below amount)
Hip joint $3,000
Knee $1,500
Ankle or bones of the foot $1,200
Collar bone (sternoclavicular) $750
Lower jaw, shoulder, elbow, wrist, hand $450
Collar bone (acromioclavicular and $150
separation), inger, or toe
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UNUM ACCIDENT COVERAGE
Why Accident Coverage?
Accident coverage applies to non-work related accidents only. If you
elect to purchase accident coverage, this plan pays a tax-free beneit
directly to you to help ofset unexpected expenses associated with an
accident (of the job only) for yourself or a covered family member.
How Does It Work?
1. Get the treatment you need
2. File a claim with Unum
3. You’ll receive a beneit for each covered treatment received
Here is a brief summary of the covered medical treatment or service. A
full list of covered services will be provided in your certiicate.
Plan Pays You
Emergency room $150
Urgent care, primary care physician or $75
specialist
Hospital coninement $1,000 + $200 per day (up to 365 days)
Intensive care unit coninement $1,500 + $400 per day (up to 15 days)
Rehabilitation unit coninement $100 per day (up to 15 days, max 30 per
year)
Accidental Death & Dismemberment
Covered employee/spouse/child(ren) $50,000/$20,000/$10,000
Loss of limb(s) Up to $100,000
Fractures (open reduction paid at 2× below amount)
Skull (non-depressed/depressed) $1,500/$3,750
Hip, thigh (femur) $2,250
Pelvis, leg, vertebrae (body) $1,200
Bones of the face or nose, upper jaw, $525
upper arm
Lower jaw, shoulder blade, collar bone, $450
vertebral process, forearm, hand, wrist,
kneecap, foot, ankle
Rib $375
Coccyx $300
Finger, toe $75
Chip fracture 25% of non-surgical beneit
Dislocations (open reduction paid at 2× below amount)
Hip joint $3,000
Knee $1,500
Ankle or bones of the foot $1,200
Collar bone (sternoclavicular) $750
Lower jaw, shoulder, elbow, wrist, hand $450
Collar bone (acromioclavicular and $150
separation), inger, or toe
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