Page 17 - CPSS Benefit Guide Class 3 Employee

Accident

Accident Insurance
Accident Insurance provides benefits to help cover the costs
associated with unexpected bills due to covered accidents,
regardless of any other insurance you have. If you purchase
coverage and are hurt in a covered accident, you will receive a
cash benefit for covered injuries that you may spend as you like.

Plan Provision Cash Benefit
Initial Care
Emergency Room $200 Family Medical Leave Act (FMLA)
Urgent Care Center $125 If you have been with the company for 12 months, you
Initial Physician Office Visit $100 may be eligible for up to 12 work weeks of unpaid leave
Emergency Transportation per year under the Family and Medical Leave Act (FMLA).
Ground Ambulance $300
Air Ambulance $1,500 FMLA can be used for an illness of your own, care needed
Fractures (Varies based upon open/closed reduction $200-$6,000 for a family member, care for a newborn and certain other
and bone fracture) medical needs. Contact Human Resources if you have
any questions regarding eligibility or requesting FMLA.
Dislocations (Varies based upon open/closed $225-$1,800
reduction and dislocation)
Lacerations (Varies based upon size of laceration) $50-$100
Burns (Varies based on Total Body Surface Area) $250-$15,000
Dental Care
Crown or Filing Repair $300
Extraction $100
Hospital
Admission $1,500
Daily Confinement (up to 365 days per accident) $300 per day
ICU Confinement (Up to 15 days per accident) $600 per day
Rehab. Facility Confinement (Up to 30 days per $150 per day
accident)
Surgical $150-$2,000
Diagnostic
X-Ray $75
Diagnostic Exam $300
Follow Up Care
Physician Follow-Up Office Visit (Up to 6 per $75
accident)
Therapy Services (Up to 6 per accident) $25

Benefits are not payable for injuries sustained while on the job.

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