Page 25 - 2019 Franke Enrollment Guide
P. 25
Franke
Benefit Amount Bi-Weekly Post Tax Accident
Schedule of Dislocations Premium*
Hip Joint $2,000 Premium
Knee Joint $1,000
Bones of Foot $1,000 Employee $5.46
Ankle $1,000 Employee + Spouse $9.14
Wrist $800 Employee + $11.30
Elbow $600 Child(ren)
Shoulder $400 Family $14.98
Hand $400 * Employees residing in the state of
Collarbone $400 Washington are not eligible for this
Lower Jaw $400 coverage
Finger or Toe $100
Open Reduction (requires 2 × non-surgical benefit (above) Example
surgery) $ Paid to
Follow-Up Care Broken Ankle You
Follow-Up Physician Office Visit $100 (10 × per accident) Emergency Room $200
Follow-Up Physical Therapy $50 (10 × per accident) X-Ray $25
Additional Benefits Broken Ankle, Closed $800
Burns (small/large) $300/$900 Reduction (no
Skin Grafts 50% of burn benefit surgery)
Lacerations (small/large) $100/$200
General Anesthesia $200 Ankle Brace $150
Abdominal or Thoracic Surgery $1,500 Crutches $150
Tendon, Ligament, Rotator $400/$200 Physical Therapy (10 $500
Cuff, or Knee Surgery (repair/ sessions)
exploratory) Physician Follow-Up $100
Ruptured Disc Surgery $750 Total Payable to $1,925
Eye Injury (surgery/removal of $400/$200 Employee
foreign object)
Emergency Dental (extraction/ $150/$75
broken tooth)
Concussion $150
Coma $10,000
Diagnostic Advanced $75
Appliance $150
Prosthesis $500
Paralysis (paraplegia/ $3,000/$6,000
quadriplegia)
Blood, Plasma, Platelets $200
Transportation $200
Family Lodging $75 per day
Wellness (payable once per year per covered person)
Each Covered Member $75
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Benefit Amount Bi-Weekly Post Tax Accident
Schedule of Dislocations Premium*
Hip Joint $2,000 Premium
Knee Joint $1,000
Bones of Foot $1,000 Employee $5.46
Ankle $1,000 Employee + Spouse $9.14
Wrist $800 Employee + $11.30
Elbow $600 Child(ren)
Shoulder $400 Family $14.98
Hand $400 * Employees residing in the state of
Collarbone $400 Washington are not eligible for this
Lower Jaw $400 coverage
Finger or Toe $100
Open Reduction (requires 2 × non-surgical benefit (above) Example
surgery) $ Paid to
Follow-Up Care Broken Ankle You
Follow-Up Physician Office Visit $100 (10 × per accident) Emergency Room $200
Follow-Up Physical Therapy $50 (10 × per accident) X-Ray $25
Additional Benefits Broken Ankle, Closed $800
Burns (small/large) $300/$900 Reduction (no
Skin Grafts 50% of burn benefit surgery)
Lacerations (small/large) $100/$200
General Anesthesia $200 Ankle Brace $150
Abdominal or Thoracic Surgery $1,500 Crutches $150
Tendon, Ligament, Rotator $400/$200 Physical Therapy (10 $500
Cuff, or Knee Surgery (repair/ sessions)
exploratory) Physician Follow-Up $100
Ruptured Disc Surgery $750 Total Payable to $1,925
Eye Injury (surgery/removal of $400/$200 Employee
foreign object)
Emergency Dental (extraction/ $150/$75
broken tooth)
Concussion $150
Coma $10,000
Diagnostic Advanced $75
Appliance $150
Prosthesis $500
Paralysis (paraplegia/ $3,000/$6,000
quadriplegia)
Blood, Plasma, Platelets $200
Transportation $200
Family Lodging $75 per day
Wellness (payable once per year per covered person)
Each Covered Member $75
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