211239 - Group Accident Plan Summary

Other Benefits Lodging 6 - Pays for lodging for companion up to 30 nights per calendar year

$200 per night, up to 31 nights

Health Screening Benefit (Wellness) 7 benefit provided if the covered insured

$75 Payable 1x per calendar year

takes one of the covered screening/prevention tests

BENEFIT PAYMENT EXAMPLE

Benefit Amount 8

Covered Event 1

Kathy’s daughter, Molly, plays soccer on the varsity high school team. During a recent game, she collided with an opposing player, was knocked unconscious and taken to the local emergency room by ambulance for treatment. The ER doctor diagnosed a concussion and a broken tooth. He ordered a CT scan to check for facial fractures too, since Molly’s face was very swollen. Molly was released to her primary care physician for follow-up treatment, and her dentist repaired her broken tooth with a crown. Depending on her health insurance, Kathy’s out-of-pocket costs could run into hundreds of dollars to cover expenses like insurance co-payments and deductibles. MetLife Group Accident Insurance payments can be used to help cover these unexpected costs.

Ambulance (ground)

$300

Emergency Care

$250

Physician Follow-Up ($100 x 2)

$200

Medical Testing

$200

Concussion

$400

Broken Tooth (repaired by crown)

$200

Benefits paid by MetLife Group Accident Insurance

$1,550

INSURANCE RATES

MetLife offers competitive group rates and convenient payroll deduction so you don’t have to worry about writing a check or missing a payment! Your employee rates are outlined below.

Accident Insurance

Monthly Cost to You

Coverage Options

Plan $9.68

Employee

Employee & Spouse Employee & Child(ren)

$18.42 $20.04 $24.86

Employee & Spouse/Child(ren)

QUESTIONS & ANSWERS

Who is eligible to enroll for this accident coverage? You are eligible to enroll yourself and your eligible family members! 9 You need to enroll during your Enrollment Period and be actively at work for your coverage to be effective. How do I pay for my accident coverage? Premiums will be conveniently paid through payroll deduction, so you don’t have to worry about writing a check or missing a payment. What happens if my employment status changes? Can I take my coverage with me? Yes, you can take your coverage with you. 10 You will need to continue to pay your premiums to keep your coverage in force. Your coverage will only end if you stop paying your premium or if your employer offers you similar coverage with a different insurance carrier. Who do I call for assistance? Contact a MetLife Customer Service Representative at 1 800- GET-MET8 (1-800-438-6388), Monday through Friday from 8:00 a.m. to 8:00 p.m., EST.

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