Voluntary Accident We provide cash for accidental injuries, and you decide the best way to spend it. And because your employer offers this coverage at a group rate, it’s protection you can afford. Accident Insurance » Pays cash for accidental injuries » Includes travel assistance » Covers multiple injuries from the same accident » Includes on the job accidents » Is available for spouses and children » Is available at an affordable rate VOLUNTARY ACCIDENT INSURANCE POLICY HIGHLIGHTS BENEFITS BENEFITS EMERGENCY CARE RECOVERY BENEFITS AMBULANCE $225 FAMILY CARE $50 INITIAL CARE $75 COMPANION LODGING $100 EMERGENCY CARE TREATMENT $150 TRANSPORTATION $200 FRACTURE BENEFIT (NON-SURGICAL) CHILD SPORTS INJURY BENEFITS PER FRACTURE $100 -– $3,500 CHILD INJURY Additional 25% SURGICAL TREATMENT 2x non-surgical bene昀椀t ACCIDENTAL DEATH & DISMEMBERMENT CHIP FRACTURES 25% TEAM MEMBER $25,000 SPOUSE $10,000 DISLOCATION BENEFITS (NON-SURGICAL) PER INJURY $100 – $2,625 CHILD $5,000 SURGICAL TREATMENT 2x non-surgical bene昀椀t TRANSPORTATION OF REMAINS $5,000 LOSS OF OR LOSS OF USE OF: HAND, PARTIAL DISLOCATION 25% FOOT, ARM, LEG, EYE, HEARING $5,000 – $10,000 SPECIFIC INJURY BENEFITS MOTOR VEHICLE BENEFITS BLOOD TRANSFUSION $375 MOTOR VEHICLE INJURY $100 BURNS, 2ND OR 3RD DEGREE $100 – 10,000 MOTOR VEHICLE DEATH $2,500 SEVERE TRAUMATIC BRAIN INJURY $5,000 SEATBELT Additional 25% of motor vehicle injury or death bene昀椀t CONCUSSION $150 AIRBAG Additional 25% of motor vehicle DENTAL CROWN $150 injury or death bene昀椀t DENTAL EXTRACT $75 HELMET Additional 25% of motor vehicle injury or death bene昀椀t EYE (REMOVAL OF FOREIGN BODY) $150 SAFE RIDER (BICYCLE, SCOOTER, EYE (SURGICAL REPAIR) $300 SKATEBOARD, ETC.) $100 LACERATION $35-400 HELMET $100 HEALTH ASSESSMENT BENEFIT SURGICAL BENEFITS COVERED BENEFITS: PER SURGERY $150 – $1,500 REPAIR OF LIGAMENTS, TENDONS, Dental Preventive Exams, Annual Physical, Eye Exam, Hearing Exam, ROTATOR CUFF, KNEE CARTILAGE, $750 RUPTURED DISC Depression Screening, Substance Abuse Screening/Counseling, and Tetanus Immunization, Additional Adult Tests: HOSPITAL & ONGOING CARE BENEFITS $50 Osteoporosis Screening (Bone Mineral HOSPITAL ADMISSION $1,000 Density). Accident/Fall prevention HOSPITAL CONFINEMENT $200 counseling. Additional Child Tests: Sports/School Physicals, Concussion PHYSICIAN FOLLOW-UP $75 Screening, Immunizations (DTP, MMR, ALTERNATE CARE AND Rotavirus, Chickenpox, Meningitis) REHABILITATIVE CONFINEMENT $150 OCCUPATIONAL, PHYSICAL, SEMI-MONTHLY (24 DEDUCTIONS) CHIROPRACTIC THERAPY $35 TEAM MEMBER ONLY $3.96 PAIN MANAGEMENT $75 TEAM MEMBER + SPOUSE $5.77 MEDICAL MOBILITY DEVICES (CANE, KNEE WALKER, WALKER, CRUTCHES, $75 TEAM MEMBER + CHILD(REN) $6.97 WALKING BOOT) TEAM MEMBER + FAMILY $9.24 WHEELCHAIR $150/$300 PROSTHESIS $750 50