AFLAC ACCIDENT
GROUP ACCIDENT INSURANCE INITIAL ACCIDENT TREATMENT BENEFIT – MID LT
BENEFIT AMOUNT
INITIAL TREATMENT (once per accident, within 7 days after the accident, not payable for telemedicine services) Payable when an insured receives initial treatment for a covered accidental injury. This benefit is payable for initial treatment received under the care of a doctor when an insured visits the following: Hospital emergency room with X-Ray / without X-Ray $175/$125 Urgent care facility with X-Ray / without X-Ray $175/$125 Doctor’s office or facility (other than a hospital emergency room or urgent care) with X-Ray / without X-Ray $100/$75
$300 Ground $900 Air
AMBULANCE (within 90 days after the accident) Payable when an insured receives transportation by a professional ambulance service due to a covered accidental injury.
MAJOR DIAGNOSTIC TESTING (once per accident, within 6 months after the accident) Payable when an insured requires one of the following exams: Computerized Tomography (CT/CAT scan), Magnetic Resonance Imaging (MRI), or Electroencephalography (EEG) due to a covered accidental injury. These exams must be performed in a hospital, a doctor’s office, a medical diagnostic imaging center or an ambulatory surgical center.
$150
BLOOD/PLASMA/PLATELETS (3 times per accident, within 6 months after the accident) Payable for each day that an insured receives blood, plasma or platelets due to a covered accidental injury.
$200
PAIN MANAGEMENT (once per accident, within 6 months after the accident) Payable when an insured, due to a covered accidental injury, is prescribed and receives a nerve ablation and/or block, or an epidural injection administered into the spine. This benefit is only payable for pain management techniques (as shown above) that are administered in a hospital or doctor’s office. This benefit is not payable for an epidural administered during a surgical procedure.
$75
CONCUSSION (once per accident, within 6 months after the accident) Payable when an insured is diagnosed by a doctor with a concussion due to a covered accident. $350
COMA (once per accident) Payable when an insured is in a coma lasting 30 days or more as the result of a covered accident. For the purposes of this benefit, Coma means a profound state of unconsciousness caused by a covered accident.
$5,000
24 | Spring Harbor 2025 Benefits Guide FRACTURES (once per accident, within 90 days after the accident) Payable when an insured fractures a bone because of a covered accident and is treated by a doctor. If the fracture requires open reduction, 200% of the benefit is payable for that bone. For multiple fractures (more than one fracture in one accident), we will pay a maximum of 200% of the benefit amount for the bone fractured that has the highest dollar amount. For a chip fracture (a piece of bone that is completely broken off near a joint), we will pay 25% of the amount for the affected bone. This benefit is not payable for Up to $2,500 based on a schedule EMERGENCY DENTAL WORK (once per accident, within 6 months after the accident) Payable when an insured’s natural teeth are injured as a result of a covered accident. $30 Extraction $120 Repair with a crown EYE INJURIES Payable for eye injuries if, because of a covered accident, a doctor removes a foreign body from the eye, with or without anesthesia. $175 BURNS (once per accident, within 6 months after the accident) Payable when an insured is burned in a covered accident and is treated by a doctor. We will pay according to the percentage of body surface burned. First degree burns are not covered. Second Degree Less than 10% $50 At least 10% but less than 25% $100 At least 25% but less than 35% $250 35% or more $500 Third Degree Less than 10% $500 At least 10% but less than 25% $2,500 At least 25% but less than 35% $5,000 35% or more $10,000 AG70075ITM-LT R1 Underwritten by Continental American Insurance Company (CAIC) A proud member of the Aflac family of insurers
IV (1/20)
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