Page 11 - 2016 WFF Guide 1
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Voluntary Group Accident
Group Accident Insurance is designed to help covered employees meet
the out-of-pocket expenses and extra bills which can follow an accidental
injury, whether minor or catastrophic. Lump sum beneits are paid directly
to the employee based on the amount of coverage listed in the schedule
of beneits. This coverage is also available for your spouse and dependent
children. The accident plan is guaranteed issue; therefore you will not have
to complete a health questionnaire for yourself or family members to
access this coverage. Please refer to the Covered Treatment/Service chart
for a few examples of the lump sum payments available to you with this
plan. A full description of beneits is available from Human Resources.
C ov ered Treatment/ S erv ice
E mergency room $ 1 5 0
Inpatient hospital daily beneit $ 2 0 0
I ntensiv e care ad mission $ 1 , 5 0 0
A ccid ental d eath ( employee) $ 5 0 , 0 0 0
V ertebrae fracture $ 1 , 2 0 0
H ip fracture $ 2 , 2 5 0
A nk le fracture $ 4 5 0
C ollar bone fracture $ 4 5 0
F inger/ toe fracture $ 7 5
H ip d islocation $ 3 , 0 0 0
K nee d islocation $ 1 , 5 0 0
A nk le d islocation $ 1 , 2 0 0
W rist d islocation $ 4 5 0
F inger/ toe d islocation $ 1 5 0
Third d egree burns $ 2 , 5 0 0 – $ 1 0 , 0 0 0
Coma beneit $ 1 0 , 0 0 0
V oluntary A ccid ent P lan— M onthly P remium
R ates
E mployee only $ 1 2 .3 1
E mployee + spouse $ 1 9 .7 2
E mployee + child $ 2 4 .4 0
F amily $ 3 1 .8 1
2016 Open Enrollment
Voluntary Group Accident
Group Accident Insurance is designed to help covered employees meet
the out-of-pocket expenses and extra bills which can follow an accidental
injury, whether minor or catastrophic. Lump sum beneits are paid directly
to the employee based on the amount of coverage listed in the schedule
of beneits. This coverage is also available for your spouse and dependent
children. The accident plan is guaranteed issue; therefore you will not have
to complete a health questionnaire for yourself or family members to
access this coverage. Please refer to the Covered Treatment/Service chart
for a few examples of the lump sum payments available to you with this
plan. A full description of beneits is available from Human Resources.
C ov ered Treatment/ S erv ice
E mergency room $ 1 5 0
Inpatient hospital daily beneit $ 2 0 0
I ntensiv e care ad mission $ 1 , 5 0 0
A ccid ental d eath ( employee) $ 5 0 , 0 0 0
V ertebrae fracture $ 1 , 2 0 0
H ip fracture $ 2 , 2 5 0
A nk le fracture $ 4 5 0
C ollar bone fracture $ 4 5 0
F inger/ toe fracture $ 7 5
H ip d islocation $ 3 , 0 0 0
K nee d islocation $ 1 , 5 0 0
A nk le d islocation $ 1 , 2 0 0
W rist d islocation $ 4 5 0
F inger/ toe d islocation $ 1 5 0
Third d egree burns $ 2 , 5 0 0 – $ 1 0 , 0 0 0
Coma beneit $ 1 0 , 0 0 0
V oluntary A ccid ent P lan— M onthly P remium
R ates
E mployee only $ 1 2 .3 1
E mployee + spouse $ 1 9 .7 2
E mployee + child $ 2 4 .4 0
F amily $ 3 1 .8 1
2016 Open Enrollment
