BENEFIT DESCRIPTION
VALUE CLASSIC PREFERRED
Repaired Knee Cartilage Payable if treatment is received within 60 days of the covered accident and surgical repair is performed within one year.
$300 - $600
$600 - $1,200
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Repaired Rotator Cuff Payable if surgical repair is performed within one year.
$300 - $600
$600 - $1,200
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Ruptured Disc Payable if treatment is received within 60 days and surgical repair is performed within one year.
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$500
$1,000
Exploratory Surgery Payable if Injury does not require surgical repair. Thoracic, Open Abdominal or Cranial Surgery Excludes hernia
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$200
$400
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$1,500 $3,000
Ambulatory Surgical Center Facility and/or Outpatient Hospital Facility Payable once per covered accident for surgery performed in an Ambulatory Surgical Center Facility or Outpatient Hospital Facility. Anesthesia Administered for a covered surgery where a benefit is being paid.
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$150
$300
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$150
$300
Epidural Pain Management
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$100
$200
Coma Payable if the comatose state lasts more than 30 days and diagnosis indicates that permanent neurological deficit is present. Concussion Payable if diagnosed within 72 hours of the covered accident using medical imaging.
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$10,000 $20,000
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$100
$200
Crown: $150
Crown: $300
Dental Emergency Payable for injury to sound natural teeth.
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Resulting in Extraction: $50 Surgical Repair: $150 Removal of Foreign Body: $50
Resulting in Extraction: $100 Surgical Repair: $300 Removal of Foreign Body: $100
Eye Injury Benefit Pays a benefit for eye injuries requiring surgical repair, for an Injury received as a result of a Covered Accident and the insured injures an eye, doctor repairs the eye through surgery, and the eye surgery occurs within 90 days after the Covered Accident. For eye injuries requiring removal of a foreign body, benefit pays the amount selected if a Doctor removes a foreign body from the eye. Gunshot Wound Payable once per covered accident. Must require treatment by a doctor and surgery.
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$750
$1,500
Occupational HIV Payable once per lifetime.
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$300
$600
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