Page 25 - GESMN 2019 Benefits Enrollment Guide
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Accident Coverage
Accident coverage is offered to eligible employees who work 20+ hours per week.
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.
Summary of Benefits*
Ambulance (ground/air)
Emergency Care Treatment $200
Physician Office Visit $100
Diagnostic Exam Up to $75
Follow-Up Physician Office Visit $100
Hospitalization Benefits
Hospital/ICU Admission $1,000
Hospital Confinement (per day benefit) $200
ICU Confinement (per day benefit) $400
Covered Injuries and Surgical Procedures
Burns Up to $900
Coma $10,000
$150
Surgery (open abdominal, thoracic) $1,500
Tendon, Ligament, and Rotator Cuff Up to $400
Dislocations (separated joint) Up to $2,000 for non-surgical, up to $4,000 for
surgical
Fracture (broken bone) Up to $2,000 for non-surgical, up to $4,000 for
surgical
Paralysis (paraplegia/quadriplegia) $3,000/$6,000
* This list is not all-inclusive
Accident Prem iums (bi-weekly)
Employee $5.38
Employee and Spouse $9.18
Employee and Child(ren) $9.34
Family $12.60
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