BENEFIT DESCRIPTION
ONE-UNIT
TWO-UNITS
Quadriplegia We will pay if any Insured Person’s all four extremities (both arms and both legs) of their body become completely paralyzed and can not be recovered as a result of a Covered Accident. (in WA, within 365 days from time of Covered Accident) Rehabilitation Unit - Admission We will pay the first day an insured person is transferred to a Rehabilitation Unit of a Hospital for treatment of an Injury sustained in a Covered Accident. (in WA, within 365 days from time of Covered Accident) This benefit will not be payable for the same day(s) that the Hospital Confinement Benefit is paid. Rehabilitation Unit Payable when a Covered Person is admitted for a Hospital Confinement and is transferred to a bed in a rehabilitation unit of a hospital for treatment for Injuries sustained in a Covered Accident. (in WA, within 365 days from time of Covered Accident) Ruptured Disc We will pay for any and all ruptured disc(s) in the spine suffered by an Insured Person as the result of a Covered Accident. This amount will be paid once per Covered Accident. Surgery Within 72 hours after a Covered Accident to repair internal injuries caused by the Covered Accident. (in WA, 365 days) Hernia repair not covered.* Once per Covered Accident. Tendon/Ligament/Rotator Cuff We will pay for the surgical repair of any and all torn, ruptured, or severed tendons, ligaments, or rotator cuff which an Insured Person suffered as the result of a Covered Accident. Must be performed by a Physician within 90 days after the Covered Accident. (in IN, 6 months; in WA, 365 days) Transportation Round trip when hospital confined and distance is more than 100 miles round trip from residence. (in WA, within 365 days from time of Covered Accident) Three round trips per Covered Accident. Urgent Care Facility Within 60 days of Covered Accident. (in WA, 365 days) Once per Covered Accident.
$5,000
$10,000
$500
$1,000
$150 per day, limited to 30 days for each Covered Person, per period of Hospital Confinement and limited to a calendar year maximum of 60 days.
$150 per day, limited to 30 days for each Covered Person, per period of Hospital Confinement and limited to a calendar year maximum of 60 days.
$500
$1,000
$1,000 for thoracic, open abdominal $100 for exploratory surgery
$2,000 for thoracic, open abdominal $200 for exploratory surgery
$500 Exploratory: $100
$1,000 Exploratory: $200
$300 round trip
$300 round trip
$225
$225
X-Ray Max 1 per Calendar Year
$50
$100
*Does not apply in VA.
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