Page 17 - Zelis 2022 Executive Benefits Guide

Additional Voluntary Benefits
Administered by Guardian
Accident Insurance
If you were injured from an accident, chances are you will have expenses that you were not anticipating, will you be prepared? Accident Insurance can help you deal with those expenses. Benefit payments can help you with your medical deductibles and copays, and cover household expenses like groceries, mortgage payments and childcare, which can begin to pile up if you have to take some time off from work. You are guaranteed coverage, so please enroll today!
Following is only a partial list of benefits. Your certificate of benefits will show exactly what is covered and excluded.
Benefit Structure
Contribution/Participation Accident Coverage Portability
Child(ren) Age Limits
Accident Follow-Up Visit Doctor Air Ambulance
Ambulance
Appliance Blood/Plasma/Platelets
Burns (2nd degree / 3rd degree
Burn – skin graft Chiropractor Visits
Coma
Concussions
Dislocations
Emergency Dental Work Epidural Pain Management Eye Injury
Fracture
Hospital Admission
Hospital Confinement
Hospital ICU Admission
Hospital ICU Confinement
Initial Physician’s office/Urgent care facility treatment
Joint Replacement (hip/knee/shoulder) Occupational or Physical Therapy
Surgery (Cranial, Open, Abdominal, Thoracic) Surgery – Exploratory or Arthroscopic
X-Ray
Plan #1: Value Plan
Voluntary
On and Off Job
Included without Evidence
Birth to 26 years (26) if full time student) subject to state limits
$25 up to 6 treatments
$500
$100
$100
$300
9 sq inches to 18 sq inches: $0/$2,000 18 sq inches to 35 sq inches” $,1000/$4,000 Over 35 sq inches: $3,000/$12,000
50% of burn benefit
No benefit
$7,500
$50
Schedule up to $3,600 $200/Crown $50/Extraction $100, 2 times per accident $200
Schedule up to $4,500 $750
$175/day up to 1 year $1,500
$350/day up to 15 days
$50
$1,500/$750/$750
$25/per up to 10 days Schedule up to $1,000, Hernia $125 $150
$20
Plan #2: Premier Plan
Voluntary
On and Off Job
Included without Evidence
Birth to 26 years (26) if full time student) subject to state limits
$75 up to 6 treatments $1,500
$200
$100
$300
9 sq inches to 18 sq inches: $0/$2,000 18 sq inches to 35 sq inches” $,1000/$4,000 Over 35 sq inches: $3,000/$12,000
$50 per visit up to 6 visits $12,500
$100
Schedule up to $4,800 $400/Crown $100/Extraction $100, 2 times per accident $300
Schedule up to $6,000 $1,250
$250/day up to 1 year $2,500
$500/day up to 15 days
$100
$3,500/$1,750/1,$750
$35/per up to 10 days Schedule up to $1,500, Hernia $350S $350
$40
Executive Employees 17