Page 13 - MGC_group_TAA_Final_9-1-2017.pdf

Below is a sample list of benefit payouts. For a more comprehensive listing see the policy certificate found at www.EnrollAgents.com
HOW DOES MY PLAN WORK?
ACCIDENT COVERAGE
ACCIDENTAL DEATH AND DISMEMBERMENT
Death Benefit Catastrophic Loss
Common Carrier Common Disaster
DISMEMBERMENT
Seatbelts and Airbags
Thumb/Index Same Hand, Four Fingers Same Hand, All Toes Same Foot
Hand, Foot, Sight
Reasonable Accommodation to Home or Vehicle
PORTABILITY CHILDREN AGE LIMITS
ACCIDENT EMERGENCY TREATMENT ACCIDENT FOLLOW-UP VISIT DOCTOR AIR AMBULANCE
AMBULANCE
APPLIANCE BLOOD/PLASMA/PLATELETS
BURNS (2ND DEGREE/3RD DEGREE)
BURN – SKIN GRAFT
CHILD ORGANIZED SPORT
CHIROPRACTIC VISITS
COMA
CONCUSSIONS
DISLOCATIONS
DIAGNOSTIC EXAM (MAJOR)
EMERGENCY DENTAL WORK
EPIDURAL PAIN MANAGEMENT
EYE INJURY
FAMILY CARE
FRACTURE
HOSPITAL ADMISSION
HOSPITAL CONFINEMENT
HOSPITAL ICU ADMISSION
HOSPITAL ICU CONFINEMENT
INITIAL PHYSICIAN’S OFFICE/URGENT CARE FACILITY TREATMENT KNEE CARTILAGE
JOINT REPLACEMENT (HIP/KNEE/SHOULDER) LACERATION
LODGING
OCCUPATIONAL OR PHYSICAL THERAPY PROSTHETIC DEVICE/ARTIFICIAL LIMB REHABILITATION UNIT CONFINEMENT
RUPTURED DISC WITH SURGICAL REPAIR
SURGERY (CRANIAL, OPEN ABDOMINAL, THORACIC) SURGERY – EXPLORATORY OR ARTHROSCOPIC TENDON/LIGAMENT/ROTATOR CUFF TRANSPORTATION
X-RAY
ACCIDENT PLAN
Off Job
Employee: $25,000 Spouse: $12,500 Child: $5,000
Quadriplegia: 100% of AD&D
Loss of speech and hearing (both ears): 100% of AD&D Loss of cognitive function: 100% of AD&D Hemiplegia:50% of AD&D Paraplegia:50% of AD&D
200% of AD&D
200% of Spouse AD&D benefit
Seatbelts: $10,000 Airbags: $15,000
25% of AD&D benefit
Single: 50% of AD&D benefit Multiple: 100% of AD&D benefit
$2,500
Included without Evidence
Birth to 26 years (26 if full time student) subject to state limitations
$175
$50 up to 6 treatments $1,000
$150
$125
$300
9 sq inches to 18 sq inches: $0/$2,000
18 sq inches to 35 sq inches: $1,000/$4,000 Over 35 sq inches: $3,000/$12,000
50% of burn benefit
20% increase to child benefits
$25 per visit up to 6 visits
$10,000
$75
Schedule up to $4,400
$150
$300/Crown $75/Extraction
$100, 2 times per accident
$300
$20/day up to 30 days
Schedule up to $5,500
$1,000
$225/day – up to 1 year
$2,000
$450/day – up to 15 days
$75
$500 $2,500/$1,250/$1,250
Schedule up to $400
$125/day, up to 30 days for companion hotel stay $25/day up to 10 days
1: $500 2 or more: $1,000
$150/day up to 15 days
$500
Schedule up to $1,250 Hernia: $150
$250
1: $500 2 or more: $1,000
$500, 3 times per accident
$30
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