Page 29 - Apricity Benefits Guide
P. 29
2020
Apricity Benefits Overview
VOLUNTARY ACCIDENT INSURANCE
Accidents happen—and they can lead to costly medical bills and loss of income. The voluntary
accident insurance plan provides a cash beneit to help with the costs associated with out-
of-pocket expenses and bills—expenses that your medical insurance may not take care of,
including ambulance transport, wheelchairs, crutches and other medical appliances, surgery and
anesthesia, bandages, stitches, and casts. Coverage is completely portable, which allows you to
keep the coverage if leaving the Company. No medical examinations or questions are needed to
apply for coverage. Coverage is available for you, your legal spouse and children from live birth to
age 26. Highlights of MetLife’s accident insurance coverage include:
Covered Service Beneit Payment
Injuries
Closed Fractures (chip fractures are paid at 25%) $320-$4,000
Open Fractures (chip fractures are paid at 25%) $640-$8,000
Closed Dislocations (partial dislocations are paid at 25%) $240-$3,000
Open Dislocations (partial dislocations are paid at 25%) $480-$6,000
Second- and Third-Degree $200-$12,800
Concussions $200
Cuts/Lacerations $35-$600
Eye Injuries $300
Medical Services and Treatment
Ambulance $450-$1,650
Physician Follow-Up $50 per visit
Therapy Services (including Physical Therapy) $30 per visit
Major Diagnostic Exams (1 per accident) $300
Medical Appliances ($1,000 limit) $150 per appliance
Surgical Procedures $150-$2,000
Hospital Coverage (Accident)
Admission $1,000
Coninement (non-ICU coninement paid for up to 365 days. ICU $500 per day for non-ICU $725 per day for
coninement paid for 30 days) ICU
Inpatient Rehab (up to 15 days per accident and 30 days per year) $100 per day
Accidental Death
Employee receives 100% of amount shown, spouse receives 50% and $50,000
children receive 10% of amount shown
Dismemberment, Loss, and Paralysis
$500-$50,000
Other Beneits
Lodging (pays for lodging for companion up to 31 nights per calendar $150 per night
year, provided that lodging is at least 50 miles from insured’s primary
residence)
Note: Covered services/treatments must be the result of a covered accident as deined in the group policy/certiicate. See the Outline
of Coverage for more details.
Table of Contents Your Quick Guide to Savings and Group Auto and Home Insurance .33
About Your Beneits Program. . . . . . .2 Spending Accounts .............16 Group Legal Services ............33
Beneits Basics ...................3 Dental Beneits .................18 Employee Assistance Program ....34
Medical/Prescription Drugs Beneits . 6 Dental Plan Summary ............20 Medicare Part D Creditable
Comparing Medical Plan Options ..7 Vision Beneits ..................21 Coverage Notice ...............35
First Stop Health ................11 Voluntary Disability Insurance .....22 Premium Assistance Under Medicaid
Medical Plan Summary ..........12 Life and AD&D Insurance ........25 and the Children’s Health Insurance
Program (CHIP) .................42
Pharmacy Plan Summary .........13 Voluntary Accident Insurance ....29 Contact Information .............46 29
Flexible Spending Accounts ......14 Voluntary Critical Illness Insurance . 31
Apricity Benefits Overview
VOLUNTARY ACCIDENT INSURANCE
Accidents happen—and they can lead to costly medical bills and loss of income. The voluntary
accident insurance plan provides a cash beneit to help with the costs associated with out-
of-pocket expenses and bills—expenses that your medical insurance may not take care of,
including ambulance transport, wheelchairs, crutches and other medical appliances, surgery and
anesthesia, bandages, stitches, and casts. Coverage is completely portable, which allows you to
keep the coverage if leaving the Company. No medical examinations or questions are needed to
apply for coverage. Coverage is available for you, your legal spouse and children from live birth to
age 26. Highlights of MetLife’s accident insurance coverage include:
Covered Service Beneit Payment
Injuries
Closed Fractures (chip fractures are paid at 25%) $320-$4,000
Open Fractures (chip fractures are paid at 25%) $640-$8,000
Closed Dislocations (partial dislocations are paid at 25%) $240-$3,000
Open Dislocations (partial dislocations are paid at 25%) $480-$6,000
Second- and Third-Degree $200-$12,800
Concussions $200
Cuts/Lacerations $35-$600
Eye Injuries $300
Medical Services and Treatment
Ambulance $450-$1,650
Physician Follow-Up $50 per visit
Therapy Services (including Physical Therapy) $30 per visit
Major Diagnostic Exams (1 per accident) $300
Medical Appliances ($1,000 limit) $150 per appliance
Surgical Procedures $150-$2,000
Hospital Coverage (Accident)
Admission $1,000
Coninement (non-ICU coninement paid for up to 365 days. ICU $500 per day for non-ICU $725 per day for
coninement paid for 30 days) ICU
Inpatient Rehab (up to 15 days per accident and 30 days per year) $100 per day
Accidental Death
Employee receives 100% of amount shown, spouse receives 50% and $50,000
children receive 10% of amount shown
Dismemberment, Loss, and Paralysis
$500-$50,000
Other Beneits
Lodging (pays for lodging for companion up to 31 nights per calendar $150 per night
year, provided that lodging is at least 50 miles from insured’s primary
residence)
Note: Covered services/treatments must be the result of a covered accident as deined in the group policy/certiicate. See the Outline
of Coverage for more details.
Table of Contents Your Quick Guide to Savings and Group Auto and Home Insurance .33
About Your Beneits Program. . . . . . .2 Spending Accounts .............16 Group Legal Services ............33
Beneits Basics ...................3 Dental Beneits .................18 Employee Assistance Program ....34
Medical/Prescription Drugs Beneits . 6 Dental Plan Summary ............20 Medicare Part D Creditable
Comparing Medical Plan Options ..7 Vision Beneits ..................21 Coverage Notice ...............35
First Stop Health ................11 Voluntary Disability Insurance .....22 Premium Assistance Under Medicaid
Medical Plan Summary ..........12 Life and AD&D Insurance ........25 and the Children’s Health Insurance
Program (CHIP) .................42
Pharmacy Plan Summary .........13 Voluntary Accident Insurance ....29 Contact Information .............46 29
Flexible Spending Accounts ......14 Voluntary Critical Illness Insurance . 31
