Sterling Estates - 2025 Benefits Guide

Accident Insurance

What’s covered MEDICAL SERVICES Diagnostic Exam - Arteriogram, Angiogram, CT, CAT, EKG, EEG, or MRI (1 time per benefit year) Accident Emergency Treatment, non-emergency room (once per covered accident) Physician's Follow-up Treatment office visit (per visit, up to 6 times per covered accident)

$200

$75 $25 $25

Physical Therapy (per visit up to 10 visits per covered accident)

Medical Devices Prosthesis (one)

$125 $500 $200

Blood, Plasma, or Platelet Transfusion HOSPITAL Hospital Admission (once per benefit year)

$1,000

Hospital Confinement (per day up to 365 days per covered accident)

$250

Intensive Care Unit Admission (once per Benefit Year; payable instead of Hospital Admission benefit if Confined immediately to ICU) Intensive Care Unit Confinement (per day up to 30 days, payable in addition to any Hospital Confinement benefit)

$1,500

$500

Ambulance (Ground)

$200

Ambulance (Air)

$1,500

Emergency Room Admission

$150 $100 $600 $150

Family Lodging (per day up to 30 days per benefit year)

Transportation (100 or more miles up to 3 times per covered accident) Rehabilitation Unit (per day up to 365 days per covered accident)

SURGERY Miscellaneous Surgery requiring general anesthesia (not covered by any other benefit)

$300

Open Surgery

$1,250

Exploratory Surgery or Debridement

$300 $300 $625 $625 $625

Laparoscopic Surgery

Tendon/Ligament/Rotator Cuff Tear

Torn Knee Cartilage

Ruptured/Herniated Disc EMERGENCY DENTAL Emergency Dental extraction Emergency Dental crown WELLNESS Wellness Screening Benefit (once per benefit year)

$65

$200

$50

LIFE AND DISMEMBERMENT LOSSES* Accidental Death

$25,000 $100,000

Accidental Death Common Carrier (pays an additional benefit if accidental death occurs while traveling as a fare-paying passenger on a public conveyance) Catastrophic Loss: Both arms or both hands, both legs or both feet, one hand and one foot or one arm and one leg, or irrecoverable loss of sight of both eyes

$15,000

Loss of one hand, foot, leg, or arm

$7,500 $7,500 $1,500

Loss of sight of one eye or loss of one eye

Two or more fingers or toes

One finger or one toe $1,500 *Benefits displayed for life and dismemberment are for the employee only. Spouse benefits are 100% of the employee benefit amount for death and 50% of the employee benefit amount for dismemberment. Dependent children benefits are 20% of the employee benefit amount for death and 50% of the employee benefit amount for dismemberment.

11 Sterling Estates 2025 Benefits Guide |

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