Member Eligibility Definition |
Active
Members under the age of 65. |
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Minimum Hours Requirement |
Does not apply |
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Definition of Dependents |
Spouse/Domestic Partner under the age of 65. Children from Live Birth to Age 26. |
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Dependent Eligibility Rules |
Eligibility may be subject to state laws and regulations |
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Benefit Waiting Period |
None |
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Coverage Type |
24 Hour |
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Accident Day Limit |
90 days |
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Guaranteed Issue |
All Amounts |
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Age Reduction Schedule |
Does not apply |
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Accidental Death Benefit |
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Common Carrier Benefit |
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Accidental Dismemberment Benefit |
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Catastrophic Loss Benefit |
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Fracture Benefit |
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Dislocation Benefit |
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Burn Benefit |
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Eye Injury Benefit |
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Laceration Benefit |
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Torn Knee Cartilage Benefit |
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Torn, Ruptured or Severed Tendon/Ligament/Rotator Cuff Benefit |
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Broken Tooth Benefit |
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Additional Injuries Benefit |
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Ambulance Benefit |
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Emergency Care Benefit |
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Medical Testing Benefit |
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Therapy Services Benefit |
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Pain Management Benefit |
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Medical Appliance Benefit |
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Prosthetic Device Benefit |
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Inpatient Surgery Benefit |
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Hospital Benefit |
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Paralysis Benefit |
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Transportation Benefit |
Pays a benefit per Round trip, if the hospital/facility is more than 50 miles from primary residence. Limit to 3 per year. |
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Lodging Benefit |
Pays a benefit per day if a Covered Person is confined in a Hospital for treatment of an accidental injury, and a companion who accompanies the Covered Person while the Covered Person is Confined, stays in a Lodging for which a charge is made. The lodging facility must be more than 50 miles one way from the primary residence and proof must be submitted that the companion incurred an expense for staying at the Lodging for each day of the Stay. This benefit is limited to 30 days per calendar year. |
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Limits for Specific Accidental Losses |
(1) Coma Limit: A benefit is not payable for a medically induced Coma. (2) Accident Day Limit: A person must seek treatment within 90 days of the accident. (3) Dislocation Limits: (a) A benefit is payable only once for the Dislocation of a joint after the coverage effective date. No benefit is payable for subsequent Dislocations of the same joint after the coverage effective date. (b) If the person suffers more than one Dislocation as a result of the same Accident, the total benefit payable for all such Dislocations is limited to two times the benefit amount payable for the joint involved which has the highest benefit amount. (4) Fracture Limits: (a) If the person suffers more than one Fracture to the same bone as a result of the same Accident, only one Fracture benefit is payable. (b) If the person suffers more than one Fracture as a result of the same Accident, the total benefit payable for all such Fractures is limited to two times the benefit amount payable for the Fracture involved which has the highest benefit amount. (5) Lodging: Limited to 30 days per calendar year. (6) Inpatient Rehabilitation Benefit: Limited to 15 days per accident, max of 30 days per year. (7) Non-ICU Hospital Confinement: 365 per accident, max 3 per year. (8) ICU Confinement: 30 per accident, max 3 per year. (9) Therapy Services: Limited to 10 per accident and to 10 per calendar year. |
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This product may not be available in all states. |
An Accidental Loss is not covered if it results from any of these:
(1) Suicide or attempted suicide, while sane or insane.
(2) Intentionally self-inflicted Injuries, or any attempt to inflict such Injuries.
(3) Sickness, whether the claim results directly or indirectly from the Sickness.
(4) Medical or surgical treatment, whether the claim results directly or indirectly from the treatment.
(5) Taking part in any riot or insurrection.
(6) War, or any act of war. War means declared or undeclared war and includes resistance to armed
aggression. Terrorism is not considered an act of war. Terrorism means the deliberate use of violence or the threat of violence against civilians to create an emotional response through the suffering of victims or to achieve military, political, religious or social objectives.
(7) An Accident that occurs while the person is serving on full-time active duty for more than 90 days in any armed forces. But this does not include Reserve or National Guard active duty for training.
(8) Travel or flight in any vehicle used for aerial navigation, if:
(a) the person is riding as a passenger in any aircraft not intended or licensed for the transportation of passengers;
(b) the person is performing as a pilot or a crew member of any aircraft; or
(c) the person is riding as a passenger in an aircraft owned, operated, controlled or leased by or on behalf of the Contract Holder or any of its subsidiaries or affiliates. This includes getting in, out, on or off any such vehicle.
(9) Commission of or attempt to commit an assault or a felony.
(10) Being under the influence of alcohol or alcohol intoxication, including but not limited to having a blood alcohol level above the limit for permissible operation of a motor vehicle in the jurisdiction where the Accident occurred, regardless of whether the person:
(a) was operating a motor vehicle; and
(b) was convicted of an alcohol related offense.
(11) Being under the influence of or taking any non-prescription drug, medication, narcotic, stimulant, hallucinogen, barbiturate, amphetamine, gas, fumes or inhalants, poison or any other controlled substance as defined in Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, as now or hereafter amended, unless prescribed by and administered in accordance with the advice of the person’s Doctor.
(12) Participation in these hazardous sports: scuba diving; bungee jumping; base jumping; skydiving; ziplining; parachuting; hang gliding; paragliding; paramotoring; parascending; or ballooning.