Page 19 - My FlipBook

Americare

Accident Insurance Continued

Surgery—exploratory or arthroscopic $250 Rate per Pay Period
Tendon/ligament/rotator cuff repair 1: $500 Employee only $6.52
2 or more: $1,000
Transportation $500, 3 times per accident Employee + spouse $10.07
(when greater than 50 miles from home) Employee + child(ren) $8.76
X-Ray $30 Family $12.31
Schedule of Fractures
Skull (non-depressed/depressed) $1,100/$2,750
Hip or thigh $1,650 Children are covered up to age 26.
Vertebrae, body of (excluding vertebrae processes) $825
Pelvis $825
Leg $825
Bones of the face or nose $385
Upper jaw, maxilla $385
Upper arm (humerus) $385
Lower jaw, mandible $330
Shoulder blade $330
Vertebral process $330
Forearm $330
Kneecap $330
Foot (except toes) $330
Ankle $330
Rib $275
Coccyx $220
Finger/toe $110
Chip fracture 25% of fracture amount
Open reduction (requires surgery) 2x above amount
Schedule of Dislocations
Hip $2,200
Knee $1,100
Shoulder $330
Ankle $880
Collar bone (sternoclavicular) $550
Collar bone (acromioclavicular and separation) $110
Ankle or foot $880
Lower jaw $330
Wrist or elbow $330
Hand (other than ingers) $330
Finger/toe $110
Open reduction (requires surgery) 2x above amount

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