Page 20 - C:\Users\gscrane\OneDrive - Goodwill Industries, Inc\FlipBooks\Benefits Enrollment Guide\FY21\

FOCUS ON BENEFITS 2021

Goodwill-Easter Seals Minnesota

ACCIDENT COVERAGE

This coverage is designed to help meet the out-of-pocket expenses
and extra bills which can follow an unexpected injury, whether minor
or catastrophic. Benefits through Cigna are paid for accidents which
occur outside of work and payment is sent directly to you based on
the amount of coverage listed in the schedule of benefits. The
accident plan is guaranteed issue, so no health questions are

required. HOW TO FILE A CLAIM
Visit:
Features
https://www.cigna.com/individuals-
Ambulance (ground/air) $200/$600
families/member-
Emergency Care Treatment $200 resources/supplemental-health-claim-
Physician Office Visit $100 form to find forms and file claims
electronically. If you have questions, call
Diagnostic Exam Up to $75
(800) 754-3207
Follow-up Physician Visit $100
Hospital/ICU Admission $1,000
Hospital Confinement per day $200

ICU Confinement per day $400
Burns Up to $900
Coma $10,000

Concussion $150
Surgery (open abdominal, thoracic) $1,500
Tendon, Ligament, and Rotator Cuff Up to $400

Dislocations and Fractures $2,000 non-surgical, $4,000 surgical
Paralysis (paraplegia/quadriplegia) $3,000/$6,000

Status Per Payroll Rates

Employee $5.38
Employee +Spouse $9.18
Employee +Child(ren) $9.34
Family $12.60

19