What benefits are payable for covered accidents? Accident Insurance Schedule Initial Emergency Treatment: Pays a benefit for accident emergency treatment, ambulance transportation for medical treatment of a covered accident and certain other services. Ambulance* $200 – Ground ambulance $1,500 – Air ambulance Accident Emergency Treatment* $150 - Emergency Room $75 - Non-Emergency Room Limited to once each accident and once in any 24-hour period. Major Diagnostic Exams $200 per benefit year. Initial treatment must be provided within 6 days of the accident. Blood/Plasma/Platelets $200 payable once for any accident Hospital Care: Traditional health insurance policies may have deductibles and co-payments associated with hospital stays. Accident benefits can help cover your out-of-pocket costs resulting from a hospital admission due to a covered accident.
$1,000 limited to once per benefit year. Increases to $1,500 if immediately admitted to the ICU.
Initial Accident Hospitalization
$250 not to exceed 365 days
Daily Hospital Confinement Daily Intensive Care Unit Confinement
$500 not to exceed 15 days per Accident. Paid in addition to the daily Hospital Confinement Benefit.
Accidental Injuries: Benefits are payable for many injuries.
Up to $4,000 for Open Reduction (Surgical). Up to $1,000 for Closed Reduction (repair by manipulation). Limited to 2 dislocations per accident. If reduction is administered without general anesthesia, 25% of the Closed Reduction benefit is payable. Up to $5,000 for Open Reduction (Surgical). Up to $2,500 for Closed Reduction (repair by manipulation). Limited to 2 fractures per accident. Chip fractures and other fractures not reduced by Open or Closed Reduction will be payable at 25% of the amount otherwise payable for the Closed Reduction.
Dislocation (Separated Joint)*
Fractures (Broken Bones)
$200 – Broken teeth repaired with crowns $65 – Broken teeth resulting in extractions Limited to 1 benefit per accident.
Emergency Dental Work*
Concussion*
$100
$300 – Surgical repair $65 – Removal of foreign body by a doctor
Eye Injury
$35 to $500
Lacerations*
Third Degree Burns – $1,000 to $20,000** Second Degree Burns – $400 to $2,000** Skin Grafts – 50% of the total burn benefit* payable * *Burn benefit is a fixed amount determined by the surface area burned.
Burns*
Surgical Care: Provides a benefit for covered surgical procedures performed within 90 days of the accident. $1,250 Open abdominal (including exploratory laparotomy), cranial (head), hernia, or thoracic (chest) surgery. $625 Repair of tendons and/or ligaments, torn rotator cuffs, ruptured discs, or torn knee cartilages.
Arthroscopy without surgical repair, or miscellaneous surgery requiring general anesthesia that is not covered by any other specific-sum injury benefit. Miscellaneous surgery limited to one surgery per 24-hour period.
$300
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