Page 21 - ABM 2021 Benefits Guide SVC 30+
P. 21
VOLUNTARY HOSPITAL
ACCIDENTAL INJURY INDEMNITY
INSURANCE Hospital indemnity coverage, available through
Cigna Cigna, pays a beneit when you are admitted to
the hospital for a covered stay. This coverage
Accidental injury coverage is designed to help can complement your health insurance to help
meet the out-of-pocket expenses and extra you pay for the costs associated with a hospital
bills which can follow an accidental injury, stay. It can also provide funds which can be
whether minor or catastrophic. When you have used to help pay the out-of-pocket expenses
an accident, Cigna will provide cash beneits your medical plan may not cover, such as
directly to you to help cover expenses that may coinsurance, copays, and deductibles.
not be fully covered by your medical insurance.
As outlined below, you have the option to Pre-existing condition limitations apply.
choose between the Low Plan and the High A summary of the plan can be found on
Plan. Beneitfocus.
Summary of Beneits* Summary of Beneits*
Low Plan High Plan Hospital Admission (per coninement, per $1,000
Ambulance (ground) $400 $500 calendar year)
Ambulance (air) $1,200 $2,000
Emergency Room $200 $300 Hospital Coninement (per day beneit) $200
Treatment Hospital ICU Coninement (per day beneit) $350
Urgent Care $150 $150
Primary Care Physician $150 $150
Physician Follow-Up $50 $125
Physical Therapy $50 $75
Appliance Beneit $175 $175
Hospitalization Beneits
Hospital/ICU Admission $1,000 $1,500
Hospital Coninement $200 $300
(per day beneit)
ICU Coninement $400 $600
(per day beneit)
Covered Injuries and Surgical Procedures
Burns Up to $7,500 Up to $10,000
Coma $5,000 $15,000
Concussion $100 $200
Tendon, Ligament, and $200/$200/$100 $600/$600/$200
Rotator Cuf
Dislocations (separated Up to $2,500 Up to $3,000
joint)
Fracture (broken bone) Up to $2,500 Up to $5,000
* This list is not all-inclusive.
ABM 21
ACCIDENTAL INJURY INDEMNITY
INSURANCE Hospital indemnity coverage, available through
Cigna Cigna, pays a beneit when you are admitted to
the hospital for a covered stay. This coverage
Accidental injury coverage is designed to help can complement your health insurance to help
meet the out-of-pocket expenses and extra you pay for the costs associated with a hospital
bills which can follow an accidental injury, stay. It can also provide funds which can be
whether minor or catastrophic. When you have used to help pay the out-of-pocket expenses
an accident, Cigna will provide cash beneits your medical plan may not cover, such as
directly to you to help cover expenses that may coinsurance, copays, and deductibles.
not be fully covered by your medical insurance.
As outlined below, you have the option to Pre-existing condition limitations apply.
choose between the Low Plan and the High A summary of the plan can be found on
Plan. Beneitfocus.
Summary of Beneits* Summary of Beneits*
Low Plan High Plan Hospital Admission (per coninement, per $1,000
Ambulance (ground) $400 $500 calendar year)
Ambulance (air) $1,200 $2,000
Emergency Room $200 $300 Hospital Coninement (per day beneit) $200
Treatment Hospital ICU Coninement (per day beneit) $350
Urgent Care $150 $150
Primary Care Physician $150 $150
Physician Follow-Up $50 $125
Physical Therapy $50 $75
Appliance Beneit $175 $175
Hospitalization Beneits
Hospital/ICU Admission $1,000 $1,500
Hospital Coninement $200 $300
(per day beneit)
ICU Coninement $400 $600
(per day beneit)
Covered Injuries and Surgical Procedures
Burns Up to $7,500 Up to $10,000
Coma $5,000 $15,000
Concussion $100 $200
Tendon, Ligament, and $200/$200/$100 $600/$600/$200
Rotator Cuf
Dislocations (separated Up to $2,500 Up to $3,000
joint)
Fracture (broken bone) Up to $2,500 Up to $5,000
* This list is not all-inclusive.
ABM 21
