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Benefit coverage for A Plus Benefits

group accident insurance (off-the-job)

BASE ACCIDENT BENEFITS PLAN
Accidental Death* Employee $40,000
Spouse $20,000
Child $10,000
Common Carrier Employee $200,000
Accidental Death* Spouse $100,000
Child $50,000
Dismemberment 1 Employee up to $40,000
Spouse up to $20,000
Child up to $10,000
Dislocation or Fracture 1 Employee up to $4,000
Spouse up to $2,000
Child up to $1,000
Hospital Confinement 2 $1,000
Daily Hospital Confinement 3 $200
Intensive Care 3 $400
Ambulance Regular Ambulance $200
Air Ambulance $600
Accident Physician Treatment* $100
X-ray* $200
Emergency Room Services* $200
BENEFIT ENHANCEMENTS PLAN
Lacerations 2 $50
Burns* < 15% of body surface $100
> 15% or more $500
Skin Graft (% of Burns Benefit)* 50% *Benefits are payable
Brain Injury Diagnosis 4 $150 once/covered accident/
Computed Tomography (CT) Scan and $50 covered person
Magnetic Resonance Imaging (MRI) 1 based on amounts shown
5
Paralysis Paraplegia $7,500 in the Injury Benefit
4
Quadriplegia $15,000 Schedule on reverse
2 once/covered person/year
Coma with Respiratory Assistance 4 $10,000
3 per day, max. 90 days/injury
Open Abdominal or Thoracic Surgery 6 $1,000
4 payable once/covered
Tendon, Ligament, Rotator Cuff Surgery 6 $500 person
or Knee Cartilage Surgery Exploratory $150
5 payable once/covered
Ruptured Disc Surgery 6 $500 person/accident/year
Eye Surgery* $100 6 2 or more procedures
General Anesthesia $100 through same entry point
Blood and Plasma* $300 are considered 1 operation
per day, max. 6
Appliance* $125 7 treatments/accident/
Medical Supplies* $5 covered person
Medicine* $5 8 per trip, max. 3 times/
Prosthesis* One Device $500 accident
Two or More $1,000 9 per day, max. 30 days
Physical Therapy 7 $30 10 per day, max. 30
Rehabilitation Unit 10 $100 days/covered person/
Non-Local Transportation 8 $400 confinement, max. 60
days/year
Family Member Lodging 9 $100 11 per day, max. 2
Post-Accident Transportation 2 $200 treatments/accident/
Accident Follow-Up Treatment 11 $50 covered person
12 per day, max. 2 days/
ADDITIONAL RIDER BENEFIT PLAN covered person/year, 4 if
Outpatient Physician’s Benefit 12 $50 dependents are covered

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