Page 12 - The Polyclinic New Hire Guide
P. 12
Accident Benefits
Accident Benefits
Accident Insurance by Unum pays beneits directly to you for accidents which occur
outside of work. The plan provides a lump sum beneit based on the type of injury
(or covered incident) you sustain or the type of treatment you need. Examples of
covered accidents include broken bones, eye injuries, cuts repaired by stitches, burns,
and some emergency room treatments. During open enrollment, you can elect
coverage for yourself and family without any medical questions.
Sample of Covered Treatments/Services
Covered Treatments/Services Coverage
Ambulance (ground/air) $400/$1,500
Medical imaging test (MRI, MR, CT, CAT, EEG) $200
Physician follow-up visit $75
Emergency room treatment $150
Emergency treatment in physician ofice/urgent care
facility $75
Hospitalization Beneits Hospital ICU
Admission $1,000 $1,500
$200 (up to 365 $400 (up to 15
Coninement (per day beneit) days per covered days per covered
accident) accident)
Covered Injuries and Surgical Procedures
Burns Up to $10, 500
Coma $10,000
Concussion $150
Surgery (open abdominal or thoracic/exploratory
without repair/hernia repair) $1,500/$150/$150
Tendon, ligament and rotator cuff (one/two or more/ $800/$1,200/$150
exploratory)
Dislocations (separated joint) Up to $3,000 for closed reduction
Up to $6,000 for open reduction
Up to $3,750 for closed reduction
Fracture (broken bone) Up to $7,500 for open reduction
Sickness Hospital Beneit
$300 per day, to a maximum of 30 days,
Sickness hospital coninement beneit for employees and spouse, and $225 per
day for children.
Pre-existing condition period for sickness hospital 12/12 limit (12 month look-back, 12
coninement beneit months treatment-free)
12
2015 New Employee Benefit Guide
Accident Benefits
Accident Insurance by Unum pays beneits directly to you for accidents which occur
outside of work. The plan provides a lump sum beneit based on the type of injury
(or covered incident) you sustain or the type of treatment you need. Examples of
covered accidents include broken bones, eye injuries, cuts repaired by stitches, burns,
and some emergency room treatments. During open enrollment, you can elect
coverage for yourself and family without any medical questions.
Sample of Covered Treatments/Services
Covered Treatments/Services Coverage
Ambulance (ground/air) $400/$1,500
Medical imaging test (MRI, MR, CT, CAT, EEG) $200
Physician follow-up visit $75
Emergency room treatment $150
Emergency treatment in physician ofice/urgent care
facility $75
Hospitalization Beneits Hospital ICU
Admission $1,000 $1,500
$200 (up to 365 $400 (up to 15
Coninement (per day beneit) days per covered days per covered
accident) accident)
Covered Injuries and Surgical Procedures
Burns Up to $10, 500
Coma $10,000
Concussion $150
Surgery (open abdominal or thoracic/exploratory
without repair/hernia repair) $1,500/$150/$150
Tendon, ligament and rotator cuff (one/two or more/ $800/$1,200/$150
exploratory)
Dislocations (separated joint) Up to $3,000 for closed reduction
Up to $6,000 for open reduction
Up to $3,750 for closed reduction
Fracture (broken bone) Up to $7,500 for open reduction
Sickness Hospital Beneit
$300 per day, to a maximum of 30 days,
Sickness hospital coninement beneit for employees and spouse, and $225 per
day for children.
Pre-existing condition period for sickness hospital 12/12 limit (12 month look-back, 12
coninement beneit months treatment-free)
12
2015 New Employee Benefit Guide
