Presentation Date: 11/16/2022
Expires on 01/01/2023
Accident Insurance (Aflac)
Group Accident Insurance
Plan Benefits (Benefit provisions may vary by situs state)
Initial Accident Treatment Category - Mid
Employee Spouse Child Continental American Insurance Company (CAIC) A proud member of the Aflac family of insurers. Policy Form Series C70000
Initial Treatment - once per accident, within 7 days of the accident ER/Urgent Care
$150 $200 $75 $100
$150 $200 $75 $100
$150 $200 $75 $100
ER/Urgent Care with X-Ray
Doctor's Office
GP-39730.PLAN-255321
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Doctor's Office with X-Ray
Ambulance - once per day, within 90 days of the accident Maximum number of payments per covered accident: No Maximum Ground Major Diagnostic Testing - within six months of the accident Maximum number of diagnostic tests per covered accident: 1 Emergency Room Observation - within 7 days of the accident Maximum number of 24-hour periods of observation per covered accident: No Maximum Short Observation Period (4-24 Hours) Air Prescriptions - within six months of the accident Maximum number of filled prescriptions per covered accident: 2 Pain Management - within six months of the accident Maximum number of payments per covered accident: 1 Blood/Plasma/Platelets - within six months of the accident Maximum number of days per covered accident: 3 Concussion - once per accident, within six months of the accident Long Observation Period (24+ Hours) Traumatic Brain Injury - once per accident, within six months of the accident Coma - once per accident We will pay the amount shown if the insured is in a coma lasting 30 days or more as a result of a covered accident
$300 $900 $150
$300 $900 $150
$300 $900 $150
$35 $70
$35 $70
$35 $70
$5
$5
$5
$75
$75
$75
$200 $350
$200 $350
$200 $350
$3,500
$3,500
$3,500
$7,500
$7,500
$7,500
Burns - once per accident, within six months of the accident Second Degree Burns Less than 10%
$75 $150 $375 $750
$75 $150 $375 $750
$75 $150 $375 $750
At least 10%, but less than 25% At least 25%, but less than 35%
35% or more
Third Degree Burns Less than 10%
$750 $3,750 $7,500 $15,000
$750 $3,750 $7,500 $15,000
$750 $3,750 $7,500 $15,000
At least 10%, but less than 25% At least 25%, but less than 35%
35% or more
Emergency Dental Work - once per accident, within six months of the accident Repair with Crown
$120 $30 $175
$120 $30 $175
$120 $30 $175
Extraction
Eye Injury - removal of a foreign body
Dislocations - once per accident, within 90 days of the accident Dislocation
Open Reduction
Closed Reduction
Employee Spouse
Child Employee Spouse Child
Schedule
Hip
$4,500 $2,925 $2,250 $1,800 $1,575 $1,350 $1,125 $900 $360
$4,500 $2,925 $2,250 $1,800 $1,575 $1,350 $1,125 $900 $360
$4,500
$2,250
$2,250
$2,250
Knee
$2,925 $1,462.50 $1,462.50 $1,462.50
Shoulder Foot/Ankle
$2,250 $1,800 $1,575 $1,350 $1,125 $900 $360
$1,125 $900
$1,125 $900
$1,125 $900
Hand
$787.50 $787.50 $787.50
Lower Jaw
$675
$675
$675
Wrist Elbow
$562.50 $562.50 $562.50
$450 $180
$450 $180
$450 $180
Finger/Toe
Lacerations - once per accident, within 7 days of the accident Lacerations requiring stitches Under 5 centimeters
$75 $300 $600
$75 $300 $600
$75 $300 $600
5 to 15 centimeters Over 15 centimeters
Lacerations not requiring stitches
$37.50
$37.50
$37.50
12 THRUSH AIRCRAFT 2023 BENEFITS GUIDE GP-39730.PLAN-255321
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