eyes due to a Covered Injury resulting directly and independently of all other causes from a Covered Accident.
Benefit Conditions 1.
This surgery must be performed by a Physician. 2. This surgery must occur within 90 days from the date of the Covered Accident.
Benefit Limitations This benefit is only payable 1 time per Covered Accident.
Eye Injury - Removal of Foreign Object Benefit We will pay the benefit shown in the Schedule of Benefits, if a Covered Person requires non-surgical removal of a foreign object to one eye or both eyes due to a Covered Injury resulting directly and independently of all other causes from a Covered Accident.
Benefit Conditions 1.
This non-surgical removal must be performed by a Physician. 2. This non-surgical removal must occur within 90 days from the date of the Covered Accident.
Benefit Limitations 1.
This benefit is only payable 1 time per Covered Accident. 2. If the Eye Injury Surgery Benefit is paid this benefit will not be paid for or during the same procedure.
Emergency Dental - Extraction Benefit We will pay the benefit shown in the Schedule of Benefits, if a Covered Person requires an extraction of one or more teeth due to a Covered Injury resulting directly and independently of all other causes from a Covered Accident.
Benefit Conditions 1.
The extraction must be performed by a licensed dentist. 2. The extraction must occur within 90 days from the date of the Covered Accident.
Benefit Limitations For more than one tooth, We will pay 2 times the benefit shown in the Schedule of Benefits.
Emergency Dental - Broken Tooth Benefit We will pay the benefit shown in the Schedule of Benefits if the Covered Person requires a crown for one or more teeth due to a Covered Injury resulting directly and independently of all other causes from a Covered Accident.
Benefit Conditions 1.
This procedure must be performed by a licensed dentist. 2. The procedure crown must occur within 90 days from the date of the Covered Accident.
Benefit Limitations 1. If the Dental Extraction benefit is paid we will not pay this benefit for the same tooth, for and during the same procedure. 2. If more than one tooth requires a crown We will pay 2 times the benefit shown in the Schedule of Benefits. Concussion Benefit We will pay the benefit shown in the Schedule of Benefits, if a Covered Person requires treatment for a concussion due to a Covered Injury resulting directly and independently of all other causes from a Covered Accident.
Benefit Conditions The Concussion must be diagnosed by a Physician within 90 days from the date of the Covered Accident.
Benefit Limitations 1.
This benefit is payable 1 time per Covered Accident.
Coma Benefit
31
Made with FlippingBook flipbook maker