Page 21 - Harvard Maintenance HPS Field Ops 2022 Benefits Guide
P. 21
Calendar Year 2022
Benefits Enrollment
Voluntary Products
Voluntary Accident Plan Accident Beneits Beneit Amount
Injuries occurring of the job Hospitalization Coninement—Once Per Year $1,000
can be protected with MetLife Daily Hospitalization Admission—Per Day $200
Accident Insurance . This Intensive Care—Per Day $400
plan is designed to pay cash Ambulance—Ground/Air $300/$1,000
directly to you, the employee. X-Ray $150
$200/$75 for
This additional cash support Emergency Room/Urgent Care/Primary Care Physician Physician's Oice
can be used to help pay Laceration Up to $400
any out-of-pocket expenses Burns Up to $10,000
related to the injury. Payments Skin Graft 50% of the burn
are made tax free, to be used beneit
at your direction . Concussion $250
Covers accidents that Paralysis—Paraplegia/Quadriplegia $10,000/$20,000
Coma
$7,500
occur of the job Open Abdominal or Thoracic Surgery $1,500
Beneits are paid for Tendon, Ligament, Rotator Cuf, or Knee Cartilage Surgery— $750/$150
emergency room, doctors Surgery/Exploratory
oice visits, diagnostic Ruptured Disc Surgery $750
imaging or scans, Eye Surgery $300
dislocations, fractures, Blood and Plasma $400
burns, cuts, and more Appliance Up To $750
Receive a $50 Health Prosthesis—1/2+ Devices $750/$1,500
Physical Therapy—Per Day
$35
Screening beneit for Transportation—Per Trip (one trip per year) $300
completing an annual Family Member Lodging—Per Day $100
physical Accident Follow-Up Treatment—Per Day $75
Accident Plan Premiums Accident Example
Coverage Tier Monthly Rate Example: Broken Ankle $ Paid to You
Employee $7 .96 Emergency Room $200
Employee + Spouse $15 .91 Broken Ankle, Closed Reduction (no surgery) $1,000
Employee + Child(ren) $18 .14
Family $22 .44 Ankle Brace $75
Physical Therapy (6 sessions) $210
Physician Follow-up $75
Total Dollars Payable to Employee $1,560
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Benefits Enrollment
Voluntary Products
Voluntary Accident Plan Accident Beneits Beneit Amount
Injuries occurring of the job Hospitalization Coninement—Once Per Year $1,000
can be protected with MetLife Daily Hospitalization Admission—Per Day $200
Accident Insurance . This Intensive Care—Per Day $400
plan is designed to pay cash Ambulance—Ground/Air $300/$1,000
directly to you, the employee. X-Ray $150
$200/$75 for
This additional cash support Emergency Room/Urgent Care/Primary Care Physician Physician's Oice
can be used to help pay Laceration Up to $400
any out-of-pocket expenses Burns Up to $10,000
related to the injury. Payments Skin Graft 50% of the burn
are made tax free, to be used beneit
at your direction . Concussion $250
Covers accidents that Paralysis—Paraplegia/Quadriplegia $10,000/$20,000
Coma
$7,500
occur of the job Open Abdominal or Thoracic Surgery $1,500
Beneits are paid for Tendon, Ligament, Rotator Cuf, or Knee Cartilage Surgery— $750/$150
emergency room, doctors Surgery/Exploratory
oice visits, diagnostic Ruptured Disc Surgery $750
imaging or scans, Eye Surgery $300
dislocations, fractures, Blood and Plasma $400
burns, cuts, and more Appliance Up To $750
Receive a $50 Health Prosthesis—1/2+ Devices $750/$1,500
Physical Therapy—Per Day
$35
Screening beneit for Transportation—Per Trip (one trip per year) $300
completing an annual Family Member Lodging—Per Day $100
physical Accident Follow-Up Treatment—Per Day $75
Accident Plan Premiums Accident Example
Coverage Tier Monthly Rate Example: Broken Ankle $ Paid to You
Employee $7 .96 Emergency Room $200
Employee + Spouse $15 .91 Broken Ankle, Closed Reduction (no surgery) $1,000
Employee + Child(ren) $18 .14
Family $22 .44 Ankle Brace $75
Physical Therapy (6 sessions) $210
Physician Follow-up $75
Total Dollars Payable to Employee $1,560
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