Page 25 - 2020FCSBenefitsGuide
P. 25
Voluntary Accident Insurance
Accidental injury coverage provides a beneit according Beneit Amount
to the schedule below when a covered person suffers Initial and Emergency Care
covered injuries or undergoes a broad range of medical Ground Ambulance/Air Ambulance $400/$1,200
treatments or care resulting from a covered accident. Emergency Care Treatment $400
Diagnostic Exam (x-ray or lab) $50
Who Can Elect Coverage Physician Oice Visit $200
All active, full-time employees of the employer who Hospitalization Beneits
are United States citizens or permanent resident aliens Hospital Admission $2,000
$400
Hospital Stay (per day)
regularly working a minimum of 24 hours per week in Intensive Care Unit Stay (per day) $800
the United States. Fractures and Dislocations
You will be eligible for coverage after 60 days of Per Covered Surgically-Repaired $300-$10,000
Fracture
active service. Per Covered Non-Surgically-Repaired $150-$5,000
Fracture
X Your spouse/domestic partner: Up to age 70, Chip Fracture (percent of fracture 25%
as long as you apply for and are approved for beneit) $300-$6,000
Per Covered Surgically-Repaired
coverage yourself Dislocation
X Your child(ren): Birth to 26; 26+ if disabled, Per Covered Non-Surgically-Repaired $150-$3,000
Dislocation
as long as you apply for and are approved for Follow-Up Care
coverage yourself Follow-Up Visit To The Doctor $200
This accidental injury plan provides 24 hour coverage. Follow-Up Physical Therapy Visits $75
The beneit amounts shown in this summary will Enhanced Accident Beneits
Examples
be paid regardless of the actual expenses incurred. Small Lacerations (less than or equal $150
Beneits are only payable when all policy terms and to 6 inches long and requires 2 or
conditions are met. Please read all the information in more sutures)
this summary to understand terms, conditions, state Large Lacerations (more than 6 $800
inches long and requires 2 or more
variations, exclusions and limitations applicable to sutures)
these beneits. See your certiicate of insurance for Coma (lasting 7 days with $40,000
no response)
more information. Concussion $200
Plus up to 22 additional beneits. See certiicate for details, including
limitations and exclusions; certiicate can be found on FCS Intranet
Wellness, Health Screening Test, Beneit Amount
or Preventive Care Beneit
Examples include (but are not limited to) routine $100 per year per
gynecological exams, general health exams, covered individual
mammography, and certain blood tests. A 30-
day beneit waiting period applies during which
beneits will not be paid.
Florida Cancer Specialists and Research Institute 25
Accidental injury coverage provides a beneit according Beneit Amount
to the schedule below when a covered person suffers Initial and Emergency Care
covered injuries or undergoes a broad range of medical Ground Ambulance/Air Ambulance $400/$1,200
treatments or care resulting from a covered accident. Emergency Care Treatment $400
Diagnostic Exam (x-ray or lab) $50
Who Can Elect Coverage Physician Oice Visit $200
All active, full-time employees of the employer who Hospitalization Beneits
are United States citizens or permanent resident aliens Hospital Admission $2,000
$400
Hospital Stay (per day)
regularly working a minimum of 24 hours per week in Intensive Care Unit Stay (per day) $800
the United States. Fractures and Dislocations
You will be eligible for coverage after 60 days of Per Covered Surgically-Repaired $300-$10,000
Fracture
active service. Per Covered Non-Surgically-Repaired $150-$5,000
Fracture
X Your spouse/domestic partner: Up to age 70, Chip Fracture (percent of fracture 25%
as long as you apply for and are approved for beneit) $300-$6,000
Per Covered Surgically-Repaired
coverage yourself Dislocation
X Your child(ren): Birth to 26; 26+ if disabled, Per Covered Non-Surgically-Repaired $150-$3,000
Dislocation
as long as you apply for and are approved for Follow-Up Care
coverage yourself Follow-Up Visit To The Doctor $200
This accidental injury plan provides 24 hour coverage. Follow-Up Physical Therapy Visits $75
The beneit amounts shown in this summary will Enhanced Accident Beneits
Examples
be paid regardless of the actual expenses incurred. Small Lacerations (less than or equal $150
Beneits are only payable when all policy terms and to 6 inches long and requires 2 or
conditions are met. Please read all the information in more sutures)
this summary to understand terms, conditions, state Large Lacerations (more than 6 $800
inches long and requires 2 or more
variations, exclusions and limitations applicable to sutures)
these beneits. See your certiicate of insurance for Coma (lasting 7 days with $40,000
no response)
more information. Concussion $200
Plus up to 22 additional beneits. See certiicate for details, including
limitations and exclusions; certiicate can be found on FCS Intranet
Wellness, Health Screening Test, Beneit Amount
or Preventive Care Beneit
Examples include (but are not limited to) routine $100 per year per
gynecological exams, general health exams, covered individual
mammography, and certain blood tests. A 30-
day beneit waiting period applies during which
beneits will not be paid.
Florida Cancer Specialists and Research Institute 25
