Page 21 - Megatel Homes LLC Benefit Guide Effective 8-1-2023

Voluntary Accident (On and Off The Job):

Mutual of Omaha

Don’t let an accident catch you off guard. Protect your family’s finances with Accident Insurance
from United of Omaha Life Insurance Company. An accident insurance policy supplements your
medical coverage and provides a cash benefit for injuries you or an insured family member sustain
from an accident. This benefit can be used to pay out of pocket medical expenses, help supplement
your daily living expenses and cover unpaid time off work.
Open Closed
Benefit Amount Dislocations Reduction Reduction
Initial Care Class 1 Joint/Joint Group Class 1
Emergency Room $150 Lower jaw (Temporomandibular) $1,800 $900
Urgent Care Center $100 Shoulder (Glenohumeral) $1,800 $900
Initial Physician Office Visit $75 Collarbone and breastbone $1,800 $900
Emergency Transportation Class 1 (Sternoclavicular)
Ground Ambulance $200 Elbow $1,800 $900
Air Ambulance $1,000
Wrist (Radiocarpal and/or intercarpal) $1,800 $900
Open Closed
Fractures Reduction Reduction Hand $1,800 $900
Fingers $450 $225
Bone/Bone Group Class 1 Hip $9,000 $4,500
Skull, depressed (Cranial bones) $6,000 $3,000 Kneecap (Patella) $4,500 $2,250
Skull, non-depressed (Cranial bones) $3,000 $1,500 Ankle $2,700 $1,350
Bones of face (Except nose and lower $1,200 $600
jaw) Foot $2,700 $1,350
Toes $450 $225
Nose (Nasal bones) $900 $450
Lower jaw (Mandible) $1,200 $600 Partial Dislocation - 25% of the closed
reduction amount for the joint/joint
Shoulder blade (Scapula) $1,200 $600 group
Collarbone (Clavicle) $900 $450
Breastbone (Sternum) $1,200 $600
Rib $900 $450 SPECIFIED INJURY BENEFITS
Upper arm (Humerus) $1,200 $600 Fractures and dislocations require treatment within 90 days
Forearm (Radius and/or ulna) $1,200 $600 of an accident. Burns and lacerations require treatment
Wrist (Carpals) $1,200 $600 within 72 hours of an accident. Dental care requires treat-
Hand (Metacarpals, except fingers) $1,200 $600 ment within 30 days of an accident.
Fingers (Phalanges) $400 $200
Vertebral body (Except vertebral processes) $3,000 $1,500 If an insured person sustains both a fracture and disloca-
Vertebral process $1,200 $600 tion as the result of the same accident, the maximum
Tail bone (Coccyx) $900 $450 amount payable is up to 200% of the amount payable for
Pelvis (Except tail bone and hip bones) $3,000 $1,500 the injury with the highest applicable benefit amount.
Hip bones (Illium, ischium and/or pubis) $6,000 $3,000 Additional limitations apply as described in the policy.
Thigh (Femur) $3,000 $1,500
Knee cap (Patella) $1,200 $600
Lower leg (Tibia and/or fibia) $3,000 $1,500 INITIAL CARE & EMERGENCY BENEFITS
Ankle (Talus) $1,200 $600
Foot (Metatarsals and calcaneus, except toes) $1,200 $600 Most Initial Care/Emergency benefits require treatment or
Toes (Phalanges) $400 $200 service within 72 hours of an accident and are payable
Chip Fracture - 25% of the closed reduction once per accident per insured person.
amount for the bone/bone group

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