Plan Comparisons
Benefits are payable only as the result of treatment received for an Injury due to a Covered Accident. Limitations Apply. BENEFIT DESCRIPTION VALUE CLASSIC PREFERRED Urgent Care Payable for initial treatment within 60 days of covered accident. Payable once per covered accident. $200 $150 $200 Emergency Room Care Payable for initial treatment within 30 days of covered accident. Payable once per covered accident. $200 $150 $200 Doctor's Office Care Payable for initial treatment within 60 days of covered accident. Payable once per covered accident. $150 $75 $100 Follow-Up Visits Payable twice per covered accident. $100 $50 $100 Ground Ambulance Payable for transport in an ambulance by ground due to an Injury as a result of a Covered Accident. Maximum of one transport per accident. $500 $150 $300 Air Ambulance Payable for transport to a hospital. $1,500 $500 $1,000 First Hospital Admission Payable once per covered accident, once per Calendar Year. $1,000 $750 $1,500 Hospital Confinement Payable for each day an insured person is confined as an inpatient to a hospital up to 365 days per covered accident. $250 $150 $300 ICU Admission Payable if ICU admission is within 48 hours of hospital admission. $1,000 $750 $1,500 ICU Confinement Payable each day an insured person is confined to a hospital Intensive Care Unit up to 30 days per covered accident. $500 $300 $600
X-Ray: $150 Imaging: $100
X-Ray: $100 Imaging: $75
X-Ray: $150 Imaging: $100
Diagnostic Benefits Payable for x-rays, medical imaging (MRI, CT Scan), or EEG. Not payable if Concussion Benefit is paid.
Medical Appliances Payable once per covered accident. Physical Therapy 10 visits per covered accident. Chiropractic Treatment 3 visits per covered accident. Accidental Death* Payable to the named beneficiary.
$300
$150
$300
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$45
$90
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$45
$90
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$50,000 $75,000
* 50% of employee benefit for spouse and 25% of employee benefit for child(ren)
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