Page 17 - 2018 Movilitas Benefit Guide
P. 17
Voluntary Accident Wellness Benefit
Accident coverage is designed to help meet the out-of-pocket expenses This beneit pays $50 per calendar
and extra bills which can follow an accidental injury, whether minor or year per insured individual if a
catastrophic. Indemnity lump sum beneits through Voya are paid directly covered health screening test
is performed, including blood
to you based on the amount of coverage listed in the schedule of beneits. tests, chest x-rays, stress tests,
The beneit is payable regardless of other insurance coverage. The mammograms, and colonoscopies .
accident plan is guaranteed issue, so no health questions are required. The A full list of covered tests will be
premiums are paid by convenient payroll deductions. provided in your certiicate. To ile
a wellness or accident claim, please
contact your HR Department for the
Summary of Beneits* appropriate forms .
Ambulance (ground/air) $200/$1,000
Emergency Room Treatment $300
Hospitalization Beneits
Hospital/ICU Admission $1,400
Hospital Coninement (per day beneit) $300 per day (up to 365 days)
ICU Coninement (per day beneit) $600 per day (up to 15 days)
Covered Injuries and Surgical Procedures
Burns $2,500 to $18,000
Coma $7,000
Concussion $250
* This list is not all-inclusive .
Accident Premiums
You Pay
Coverage Level Semi-Monthly
Employee $7 .24
Employee + Spouse $12 .27
Employee + Child(ren) $14 .19
Family $19 .22
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Accident coverage is designed to help meet the out-of-pocket expenses This beneit pays $50 per calendar
and extra bills which can follow an accidental injury, whether minor or year per insured individual if a
catastrophic. Indemnity lump sum beneits through Voya are paid directly covered health screening test
is performed, including blood
to you based on the amount of coverage listed in the schedule of beneits. tests, chest x-rays, stress tests,
The beneit is payable regardless of other insurance coverage. The mammograms, and colonoscopies .
accident plan is guaranteed issue, so no health questions are required. The A full list of covered tests will be
premiums are paid by convenient payroll deductions. provided in your certiicate. To ile
a wellness or accident claim, please
contact your HR Department for the
Summary of Beneits* appropriate forms .
Ambulance (ground/air) $200/$1,000
Emergency Room Treatment $300
Hospitalization Beneits
Hospital/ICU Admission $1,400
Hospital Coninement (per day beneit) $300 per day (up to 365 days)
ICU Coninement (per day beneit) $600 per day (up to 15 days)
Covered Injuries and Surgical Procedures
Burns $2,500 to $18,000
Coma $7,000
Concussion $250
* This list is not all-inclusive .
Accident Premiums
You Pay
Coverage Level Semi-Monthly
Employee $7 .24
Employee + Spouse $12 .27
Employee + Child(ren) $14 .19
Family $19 .22
Movilitas 17
