$3,000 $3,000 $1,000
$6,000 $6,000 $2,000
Knee Joint
Bones of Foot
Ankle We will not pay for Bones of Foot or Toes
$800 $600 $400 $400 $400 $400 $100
$1,600 $1,200
Wrist Elbow
$800 $800 $800 $800 $200
Shoulder
Hand
Collarbone Lower Jaw
Finger or Toe More than 1 finger or toe pays 2 times the benefit
FOLLOW UP CARE
Benefit Type
Benefit Amount
Follow up Physician (or medical professional) Office Visit Benefit is limited to 10 treatments per Accident
$150
Follow up Physical Therapy Visits Benefit is limited to 10 treatments per Accident
$50
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