Page 31 - Complete Hi-Res 7-product Kit

Other Injuries Your Cash Benefit
Transfusion [$0]
Burn [$0-$0]
Skin graft [00%] of burn benefit

Joint replacement (hip, knee, shoulder) [$0-$0]
Coma [$0]
Concussion [$0]

Dental crown — once per accident [$0]
Dental extraction — once per accident [$0]
Eye (removal of foreign body) — once per eye/accident [$0]
Eye (surgical repair) — once per eye/accident [$0]
Laceration [$0-$0]

Arthroscopic surgery [$0]
Abdominal or thoracic surgery [$0]

Surgical repair of ligaments/tendons, knee cartilage, rotator [$0-$0]
cuff, ruptured disc

Mobility Assistance Your Cash Benefit

Crutches, wheelchair, walker, other [$0-$0]
Prosthesis per limb/device [$0]
Reasonable modifications to home or vehicle [$0]

Accidental Death & Dismemberment (AD&D) Your Cash Benefit

Employee accidental death [$0]
Spouse accidental death [$0]
Child accidental death [$0]

Loss of or loss of use of one hand, foot, arm, leg, or eye [$0]
Loss of or loss of use of any finger, thumb, or toe [$0]
Common carrier enhanced death benefit [0x] benefit amount
Transportation of remains [$0]

Seat belt/helmet AD&D benefit [0%] of AD&D
Common disaster enhanced death benefit [$0]
Catastrophic loss [$0]

[Form Filing Number] Accident Insurance | [Choice Plan] Summary of Benefits