OPTIONAL BENEFITS
ENHANCED ACCIDENT BENEFITS RIDER All Employee benefits under this Rider are payable at 100% of the Benefit Amount shown for the Eligible Employee. All Spouse benefits are payable at 100% of the Benefit Amount shown for the Employee. All Dependent Child(ren) benefits are payable at 100% of the Benefit Amount shown for the Employee.
EMPLOYEE BENEFITS
PLAN 1
Benefit Type Small Burns
Benefit Amount
$300
Large Burns (3rd degree pays 10x multiple)
$1,000
50% of the applicable Benefit amount for Small Burns or Large Burns
Skin-Graft Benefit
$100 $600 $100
Small Lacerations Large Lacerations
General Anesthesia Benefit
$10 $10
Medicine Benefit
Medical Supply Benefit
$1,250
Abdominal or Thoracic Surgery
$400 $150
Tendon, Ligament, Rotator Cuff, or Knee Surgery - Repair Tendon, Ligament, Rotator Cuff, or Knee Surgery - Exploratory
$750 $400 $200 $150
Ruptured Disc Surgery - repair
Eye Injury Surgery
Eye Injury - Removal of Foreign Object Emergency Dental - Extraction Emergency Dental - Broken Tooth
$75
$150
Concussion
$10,000
Coma
$150 $150
Diagnostic Advanced Exam
Appliance Prosthesis
$1,000 $5,000 $10,000
Paralysis - Paraplegia or Hemiplegia Benefit
Paralysis - Quadriplegia Blood, plasma, platelets
$200 $400
Transportation Family Lodging
$150 per day
WELLNESS TREATMENT, HEALTH SCREENING TEST AND PREVENTIVE CARE BENEFIT RIDER All Employee benefits under this Rider are payable at 100% of the Benefit Amount shown for the Eligible Employee. All Spouse benefits are payable at 100% of the Benefit Amount shown for the Employee. All Dependent Child(ren) benefits are payable at 100% of the Benefit Amount shown for the Employee.
Benefit Waiting Period
0 days
EMPLOYEE BENEFITS
PLAN 1
Benefit Type
Benefit Amount
Wellness Treatment Benefit
6
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