Group Accident Insurance Certificate

1. A Small Burns or Large Burns benefit must be paid before We pay this benefit. 2. The skin graft must be performed within 90 days after the Covered Accident.

Benefit Limitations This benefit is payable only once per Covered Person per Covered Accident.

Small Lacerations Benefit We will pay the benefit shown in the Schedule of Benefits, if a Covered Person is injured and sustains one or more lacerations less than or equal to 6 inches long and requires 2 or more sutures due to a Covered Injury requiring treatment resulting directly and independently of all other causes from a Covered Accident. Benefit Conditions Treatment must be received for the laceration(s) within 90 days from the date of the Covered Accident and provided by a Physician. Benefit Limitations. 1. For multiple lacerations we will pay a maximum of 2 times the benefit shown in the Schedule of Benefits. 2. This benefit is payable only once per Covered Person per Covered Accident. Large Lacerations Benefit We will pay the benefit shown in the Schedule of Benefits, if a Covered Person is injured and sustains one or more lacerations more than 6 inches long and requires 2 or more sutures due to a Covered Injury requiring treatment resulting directly and independently of all other causes from a Covered Accident. Benefit Conditions Treatment must be received for the laceration(s) within 90 days from the date of the Covered Accident and provided by a Physician.

Benefit Limitations. 1.

For multiple lacerations we will pay a maximum of 2 times the benefit. 2. This benefit is payable only once per covered person per Covered Accident.

General Anesthesia Benefit We will pay the benefit shown in the Schedule of Benefits, if a Covered Person requires Anesthesia for surgery due to a Covered Injury resulting directly and independently of all other causes from a Covered Accident.

Benefit Conditions 1.

General anesthesia must be administered by a Nurse anesthetist or Physician. 2. The surgery must be performed by a Physician within 90 days from the date of the Covered Accident.

Benefit Limitations. This benefit is only payable 1 time per covered Accident.

Medicine Benefit We will pay the benefit shown in the Schedule of Benefits, if a Covered Person purchases over-the-counter medications due to a Covered Injury resulting directly and independently of all other causes from a Covered Accident.

Benefit Conditions Medicine must be purchased within 90 days from the date of the Covered Accident.

Benefit Limitations. This benefit is only payable 1 time per Covered Accident.

Medical Supply Benefit We will pay the benefit shown in the Schedule of Benefits, if a Covered Person purchases over-the-counter medical supplies due to a Covered Injury resulting directly and independently of all other causes from a Covered Accident.

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