Page 19 - ABM 2021 Benefit Guide AMPCO
P. 19
VOLUNTARY HOSPITAL
ACCIDENTAL INJURY INDEMNITY
INSURANCE Hospital indemnity coverage, available through
Cigna, pays a beneit when you are admitted to
Cigna 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. Pre-existing condition limitations apply. A
As outlined below, you have the option to summary of the plan can be found Beneitfocus.
choose between the Low Plan and the High
Plan. Summary of Beneits*
Summary of Beneits* Hospital Admission (per coninement, per $1,000
Low Plan High Plan calendar year)
Ambulance (ground) $400 $500 Hospital Coninement (per day beneit) $200
Ambulance (air) $1,200 $2,000 Hospital ICU Coninement (per day beneit) $350
Emergency Room $200 $300
Treatment
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 19
ACCIDENTAL INJURY INDEMNITY
INSURANCE Hospital indemnity coverage, available through
Cigna, pays a beneit when you are admitted to
Cigna 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. Pre-existing condition limitations apply. A
As outlined below, you have the option to summary of the plan can be found Beneitfocus.
choose between the Low Plan and the High
Plan. Summary of Beneits*
Summary of Beneits* Hospital Admission (per coninement, per $1,000
Low Plan High Plan calendar year)
Ambulance (ground) $400 $500 Hospital Coninement (per day beneit) $200
Ambulance (air) $1,200 $2,000 Hospital ICU Coninement (per day beneit) $350
Emergency Room $200 $300
Treatment
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 19
