SUPPLEMENTAL BENEFITS
Group Accident Insurance - Continued
Eye injury - With surgical repair or removal of a foreign object
$300
Hospital admission - Per covered person per covered accident
$1,000
Hospital confinement - Up to 365 days per covered person per covered accident
$250 per day
Hospital Intensive care unit admission - Per covered person per accident
$1,750
Hospital Intensive care unit confinement - Up to 15 days per covered person per covered accident
$400 per day
Knee cartilage – Torn
$750
Laceration - No repair, without stitches
$50
Laceration - Repaired by stitches Less than 2 inches 2 – 5 inches 6 inches or longer
$150 $300 $600
Lodging - Up to 30 days per covered person per accident
$200 per day
Medical Imaging (CT, CAT, EEG, MRI, MR) - One benefit per covered person per covered accident per calendar year
$200
Occupational or physical therapy - Up to 10 days per covered person per covered accident
$45 per day
Pain management for epidural anesthesia
$150
Prosthetic device / artificial limb - One benefit per covered person per accident One Two or more Rehabilitation unit confinement - Immediately after a period of hospital confinement due to a covered accident; up to 15 days per covered person per accident, not to exceed 30 days per covered person per calendar year
$1,250 $2,500
$150 per day
Ruptured disc with surgical repair
$900
Surgery Cranial, open abdominal and thoracic Hernia with surgical repair
$1,500 $300
Surgery - Exploratory and arthroscopic
$225
Tendon/ligament/rotator cuff One with surgical repair Two or more with surgical repair
$900 $1,800
Transportation for hospital confinement - Up to 3 round trips from more than 50 miles from home per covered person per covered accident
$600 per round trip
X-ray
$60
Accidental Death
Employee Spouse Child(ren)
Per Covered Person
$50,000
$50,000 $10,000
Catastrophic Accident
Employee Spouse Child(ren)
Total and irrecoverable loss or loss of use of both hands, arms, feet, legs or the sight of both eyes, loss of hearing in both ears or loss of ability to speak Subject to a 365-day elimination period; payable once per lifetime per covered person
$50,000
$50,000 $25,000
CONMB Employee Benefit Guide 2025
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