Page 17 - 2018-19 Optimas Enrollment
P. 17
Optimas
VOLUNTARY ACCIDENT Wellness (Health
COVERAGE Screening)
Benefit
Optimas partners with Reliance Standard to offer you the ability to purchase This beneit pays $75 once
accident coverage. This plan pays a benefit directly to you when you or a covered per year per covered person
family member becomes injured as the result of a covered accident. You can use if a covered health screening
the benefit to help offset unexpected expenses associated with an accident such test is performed, including
as lost wages, transportation costs, copays, and deductibles. Voluntary accident blood tests, chest x-rays,
coverage is guaranteed issue if you are an eligible employee—no health questions stress tests, mammograms,
and colonoscopies. A full
are required! list of covered tests will be
provided in your certiicate.
Summary of Benefits*
Ambulance (ground/air) $150/$750
Medical Imaging Test (MRI, MR, CT, CAT, EEG)— $200
Limited to One per Accident
Emergency Treatment (physician office/ $200
specialist or urgent care)
Primary Care Physician/Physician Follow-Up— $75
Once per Accident
Hospitalization Benefits
Initial Hospital Admission $1,000
Hospital Daily Benefit—365-Day Maximum $250
Initial ICU Admission $1,500
ICU Daily Benefit—30-Day Maximum $500
Covered Injuries and Surgical Procedures
Burns—2nd Degree/3rd Degree—Up to $1,600/$12,800
Skin Grafts 25% of burn benefit
Coma $7,500
Concussion $150
Tendon, Ligament, Rotator Cuff, and Ruptured $900/$900/$750
Disc Repair
(repair of 1/multiple/exploratory only)
Additional Benefits
Lodging (per night)—For 1 Person $150 per day (up to 30 days
if 100+ miles from residence)
Transportation—3 Round Trip Maximum $450 (100+ miles from
residence)
* This list is not all-inclusive.
Accident Premiums
Coverage Level
Weekly Bi-Weekly Monthly
Employee $2.82 $5.65 $12.24
Employee + Spouse $4.74 $9.47 $20.52
Employee + Child(ren) $5.90 $11.80 $25.56
Family $7.86 $15.72 $34.05
Please note these are pre-tax premiums. 17
VOLUNTARY ACCIDENT Wellness (Health
COVERAGE Screening)
Benefit
Optimas partners with Reliance Standard to offer you the ability to purchase This beneit pays $75 once
accident coverage. This plan pays a benefit directly to you when you or a covered per year per covered person
family member becomes injured as the result of a covered accident. You can use if a covered health screening
the benefit to help offset unexpected expenses associated with an accident such test is performed, including
as lost wages, transportation costs, copays, and deductibles. Voluntary accident blood tests, chest x-rays,
coverage is guaranteed issue if you are an eligible employee—no health questions stress tests, mammograms,
and colonoscopies. A full
are required! list of covered tests will be
provided in your certiicate.
Summary of Benefits*
Ambulance (ground/air) $150/$750
Medical Imaging Test (MRI, MR, CT, CAT, EEG)— $200
Limited to One per Accident
Emergency Treatment (physician office/ $200
specialist or urgent care)
Primary Care Physician/Physician Follow-Up— $75
Once per Accident
Hospitalization Benefits
Initial Hospital Admission $1,000
Hospital Daily Benefit—365-Day Maximum $250
Initial ICU Admission $1,500
ICU Daily Benefit—30-Day Maximum $500
Covered Injuries and Surgical Procedures
Burns—2nd Degree/3rd Degree—Up to $1,600/$12,800
Skin Grafts 25% of burn benefit
Coma $7,500
Concussion $150
Tendon, Ligament, Rotator Cuff, and Ruptured $900/$900/$750
Disc Repair
(repair of 1/multiple/exploratory only)
Additional Benefits
Lodging (per night)—For 1 Person $150 per day (up to 30 days
if 100+ miles from residence)
Transportation—3 Round Trip Maximum $450 (100+ miles from
residence)
* This list is not all-inclusive.
Accident Premiums
Coverage Level
Weekly Bi-Weekly Monthly
Employee $2.82 $5.65 $12.24
Employee + Spouse $4.74 $9.47 $20.52
Employee + Child(ren) $5.90 $11.80 $25.56
Family $7.86 $15.72 $34.05
Please note these are pre-tax premiums. 17
