Page 28 - 2016 Open Enrollment Non-Union
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Beneits Enrollment
What Accident Benefits are Available?
Wellness Benefit This chart includes some of the beneits provided by accident
This coverage provides an annual beneit insurance. The beneit amounts paid depend on the type of injury
payment if you complete a health
screening test. You may only receive and care received. You may be required to seek care for your injury
a beneit once per year, even if you within a set amount of time. Note there may be some variation by
complete multiple health screening tests. state. For a complete description of your available beneits, along
with applicable provisions, exclusions and limitations, see your
Examples of health screening tests include
but are not limited to: Pap test, serum certiicate of insurance and any riders.
cholesterol test for HDL and LDL levels,
mammography, colonoscopy, and stress Event Beneit
test on bicycle or treadmill. Accident Hospital Care
Surgery (open abdominal, thoracic) $2,500
The annual beneit is $50 for Hospital admission $1,400
completing a health screening test Hospital coninement (per day up to $300
If your spouse and/or children are 365)
covered for accident insurance, they Coma (duration of 14 or more days) $7,000
are also covered by the Wellness Transportation (per trip, up to 3 per $400
Beneit; your spouse’s beneit accident)
amount is also $50; the beneit for Medical equipment $250
child coverage is $25 with an annual Physical therapy (per treatment up $50
maximum of $100 for children’s to 6)
beneits Burns (second degree at least 36% of $1,250
body)
Scan Here to Learn More Emergency dental work (while hospital $250 a crown, $125 extraction
conined)
About Your Compass Eye injury (surgery) $300
Accident Insurance Plan Concussion $250
Dislocations Closed/Open Reduction
Hip Joint $2,500/$5,000
Knee $1,500/$3,000
Fractures Closed/Open Reduction
Hip $2,500/$5,000
Leg $1,250/$2,500
Ankle $500/$1,000
Collarbone $500/$1,000
Rib or ribs $450/$900
Accident Rates Emergency Care Beneits
Employee Cost Ground ambulance $200
Employee $13.49 Air ambulance $1,000
Employee + spouse $22.90
Employee + $26.55
child(ren)
Family $35.96
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What Accident Benefits are Available?
Wellness Benefit This chart includes some of the beneits provided by accident
This coverage provides an annual beneit insurance. The beneit amounts paid depend on the type of injury
payment if you complete a health
screening test. You may only receive and care received. You may be required to seek care for your injury
a beneit once per year, even if you within a set amount of time. Note there may be some variation by
complete multiple health screening tests. state. For a complete description of your available beneits, along
with applicable provisions, exclusions and limitations, see your
Examples of health screening tests include
but are not limited to: Pap test, serum certiicate of insurance and any riders.
cholesterol test for HDL and LDL levels,
mammography, colonoscopy, and stress Event Beneit
test on bicycle or treadmill. Accident Hospital Care
Surgery (open abdominal, thoracic) $2,500
The annual beneit is $50 for Hospital admission $1,400
completing a health screening test Hospital coninement (per day up to $300
If your spouse and/or children are 365)
covered for accident insurance, they Coma (duration of 14 or more days) $7,000
are also covered by the Wellness Transportation (per trip, up to 3 per $400
Beneit; your spouse’s beneit accident)
amount is also $50; the beneit for Medical equipment $250
child coverage is $25 with an annual Physical therapy (per treatment up $50
maximum of $100 for children’s to 6)
beneits Burns (second degree at least 36% of $1,250
body)
Scan Here to Learn More Emergency dental work (while hospital $250 a crown, $125 extraction
conined)
About Your Compass Eye injury (surgery) $300
Accident Insurance Plan Concussion $250
Dislocations Closed/Open Reduction
Hip Joint $2,500/$5,000
Knee $1,500/$3,000
Fractures Closed/Open Reduction
Hip $2,500/$5,000
Leg $1,250/$2,500
Ankle $500/$1,000
Collarbone $500/$1,000
Rib or ribs $450/$900
Accident Rates Emergency Care Beneits
Employee Cost Ground ambulance $200
Employee $13.49 Air ambulance $1,000
Employee + spouse $22.90
Employee + $26.55
child(ren)
Family $35.96
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