Page 15 - Guide
P. 15
Voluntary Accident Coverage 2017 Beneits Enrollment
Accident coverage is designed to help meet the out-of-pocket expenses and extra
bills which can follow a minor or catastrophic accidental injury, either at work or on-
the-go! Cash beneits for covered accidents are paid directly to you by Unum, based
on the amount of coverage listed in the schedule of beneits.
Summary of Benefits*
Ambulance (ground/air) $400/$1,500
Medical Imaging Test (MRI, MR, CT, CAT, EEG) $200
Emergency Room Treatment $150
Hospitalization Benefits
Hospital Admission $1,000
Hospital Confinement—Per Day Benefit (up to 365 days per $200
accident)
Intensive Care Unit (ICU) Admission $1,500
ICU Confinement—Per Day Benefit (up to 15 days per accident) $400
Covered Injuries and Surgical Procedures
Burns Up to $10,000
Coma $10,000
Concussion $150
Surgery (open abdominal or thoracic) $1,500
Tendon, Ligament, or Rotator Cuff Surgical Repair $800
Dislocations (non-surgical/surgical) Up to $3,000/up to $6,000
Fractures (non-surgical/surgical) Up to $3,750/up to $7,500
Emergency Dental Work (crown/extraction) $300/$100
Eye Injury $300
Torn Knee Cartilage $750
Prosthetic Device (1/2+) $750/$1,500
Ruptured Disc with Surgical Repair $800
* This list is not all-inclusive. Wellness Benefit
This benefit pays $50 per
Semi-Monthly Accident Premiums calendar year per insured
individual if a covered
health screening test is
Coverage Level You Pay performed, including blood
Employee $5.91 tests, chest x-rays, stress
Employee + Spouse $9.35 tests, mammograms, and
colonoscopies. A full list of
Employee + Child(ren) $11.03 covered tests will be provided
Family $14.46 in your certificate.
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Accident coverage is designed to help meet the out-of-pocket expenses and extra
bills which can follow a minor or catastrophic accidental injury, either at work or on-
the-go! Cash beneits for covered accidents are paid directly to you by Unum, based
on the amount of coverage listed in the schedule of beneits.
Summary of Benefits*
Ambulance (ground/air) $400/$1,500
Medical Imaging Test (MRI, MR, CT, CAT, EEG) $200
Emergency Room Treatment $150
Hospitalization Benefits
Hospital Admission $1,000
Hospital Confinement—Per Day Benefit (up to 365 days per $200
accident)
Intensive Care Unit (ICU) Admission $1,500
ICU Confinement—Per Day Benefit (up to 15 days per accident) $400
Covered Injuries and Surgical Procedures
Burns Up to $10,000
Coma $10,000
Concussion $150
Surgery (open abdominal or thoracic) $1,500
Tendon, Ligament, or Rotator Cuff Surgical Repair $800
Dislocations (non-surgical/surgical) Up to $3,000/up to $6,000
Fractures (non-surgical/surgical) Up to $3,750/up to $7,500
Emergency Dental Work (crown/extraction) $300/$100
Eye Injury $300
Torn Knee Cartilage $750
Prosthetic Device (1/2+) $750/$1,500
Ruptured Disc with Surgical Repair $800
* This list is not all-inclusive. Wellness Benefit
This benefit pays $50 per
Semi-Monthly Accident Premiums calendar year per insured
individual if a covered
health screening test is
Coverage Level You Pay performed, including blood
Employee $5.91 tests, chest x-rays, stress
Employee + Spouse $9.35 tests, mammograms, and
colonoscopies. A full list of
Employee + Child(ren) $11.03 covered tests will be provided
Family $14.46 in your certificate.
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