Your accident coverage
FEATURES (Cont.)
Concussion Baseline Study
$25
Concussions
$200
Diagnostic Exam (Major)
$300
Dislocations
Schedule up to $10,000
Doctor Follow-Up Visits
$100, up to 6 treatments
Emergency Dental Work
$300/Crown, $75/Extraction
Emergency Room Treatment
$300
EpiduralAnesthesiaPain Management
$100, 2 times per accident
Eye Injury $400 Family Care—Benefit is payable for each child attending a Child Care center while the $20/day, up to 30 days insured is confined to a hospital, ICU or Alternate Care or Rehabilitative facility due to injuries sustainedin a covered accident. Fractures Schedule up to $9,000 Gun Shot Wound $750 Hospital Admission $1,500 Hospital Confinement $300/day - up to 1 year Hospital ICU Admission $3,000 Hospital ICU Confinement $600/day - up to 15 days
$200
Initial Dr. Office/Urgent Care Facility Treatment
Joint Replacement (Hip/Knee/Shoulder)
$2,500/$1,250/$1,250
Knee Cartilage
$500
Laceration
Schedule up to $900
$200/day, up to 30 days for companion hotel stay
Lodging - The hospital stay must be more than 50 miles from the insured's residence. Medical Appliance—Wheelchair, motorized scooter, leg or back brace, cane, crutches, walker, walking boot that extends above the ankle or brace for the neck.
Schedule up to $500
Outpatient Therapies
$75/day, up to 10 days
Post-Traumatic Stress Disorder
$400
1: $500 2 or more: $1,000
Prosthetic Device/Artificial Limb
Rehabilitation Unit Confinement
$200/day, up to 15 days
Ruptured Disc With Surgical Repair
$500
Schedule up to $2,500 Hernia: $500
Surgery (Cranial, Open Abdominal,Thoracic,Hernia)Max
Surgery (Exploratory or Arthroscopic)
$600
1: $500 2 or more: $1,000
Tendon/Ligament/Rotator Cuff
Transportation- Benefitis paid if you have to travel morethan 50 milesoneway to receive special treatment at a hospital or facility due to a covered accident. Traumatic Brain Injury — A nondegenerative, noncongenital Injury to the brain from an external nonbiological force, requiring Hospital Confinement for 48 hours or more and resulting in a permanent neurologicaldeficit with significant loss of muscle function and persistentclinical symptoms.
$0.50 per mile, limited to $500/round trip, up to 3 times per accident
$4,000
X - Ray
$75
25
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