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Chose the plan that’s right for you:
The Essential Plan or The Enhanced Plan



Benefit Schedule
Benefits
Base Policy    
Accidental Death Common Carrier Accidental Death
Dismemberment Dislocation or Fracture
Hospital Confinement Initial Hospital Confinement
Intensive Care Ambulance  
Medical Expenses Outpatient Physicians Treatment
INJURY BENEFIT SCHEDULE
Benefit amounts for coverage per occurrence are shown below.
Coverage type, on and off the job.
Loss of Life or Limb Employee Spouse Child Essential Plan Enhanced Plan
Life $ 50,000 $ 15,000 ☑️ ☑️
Both Eyes $ 50,000 $ 15,000 ☑️ ☑️
One Eye $ 25,000 $ 7,500 ☑️ ☑️
Both Hands or Arms $ 50,000 $ 15,000 ☑️ ☑️
Both Feet or Legs $ 50,000 $ 15,000 ☑️ ☑️
One Hand or Arm and One Foot or Leg $ 50,000 $ 15,000 ☑️ ☑️
One Hand or Arm $ 25,000 $ 7,500 ☑️ ☑️
One Foot or Leg $ 25,000 $ 7,500 ☑️ ☑️
One or More Entire Toes $ 4,000 $ 1,200 ☑️ ☑️
One or More Entire Fingers $ 4,000 $ 1,200 ☑️ ☑️
Complete Dislocation Employee Spouse Child
Hip Joint $ 4,000 $ 4,000 ☑️ ☑️
Knee Joint (except Patella) $ 1,600 $ 1,600 ☑️ ☑️
Bone or Bones of the Foot (except Toes) $ 1,600 $ 1,600 ☑️ ☑️
Ankle Joint $ 1,600 $ 1,600 ☑️ ☑️
Wrist Joint $ 1,400 $ 1,400 ☑️ ☑️
Elbow Joint $ 1,200 $ 1,200 ☑️ ☑️
Shoulder Joint $ 800 $ 800 ☑️ ☑️
Bone or Bones of the Hand (except Fingers) $ 600 $ 600 ☑️ ☑️
Collarbone $ 600 $ 600 ☑️ ☑️
Two or More Fingers $ 280 $ 280 ☑️ ☑️
Two or More Toes $ 280 $ 280 ☑️ ☑️
One Finger or Toe $ 120 $ 120 ☑️ ☑️
Simple or Closed Fracture Employee/Spouse Child Employee Spouse Child
Skull (except Bones of Face or Nose) $ 3,800 $ 3,800 ☑️ ☑️
Hip, Thigh (Femur) $ 4,000 $ 4,000 ☑️ ☑️
Pelvis (except Coccyx) $ 4,000 $ 4,000 ☑️ ☑️
Arm, between Shoulder and Elbow (Shaft) $ 2,200 $ 2,200 ☑️ ☑️
Shoulder Blade (Scapula) $ 2,200 $ 2,200 ☑️ ☑️
Leg (Tibia or Fibula) $ 2,200 $ 2,200 ☑️ ☑️
Ankle $ 1,600 $ 1,600 ☑️ ☑️
Knee Cap (Patella) $ 1,600 $ 1,600 ☑️ ☑️
Collarbone (Clavicle) $ 1,600 $ 1,600 ☑️ ☑️
Forearm (Radius or Ulna) $ 1,600 $ 1,600 ☑️ ☑️
Foot (except Toes) $ 1,400 $ 1,400 ☑️ ☑️
Hand or Wrist (except Fingers) $ 1,400 $ 1,400 ☑️ ☑️
Lower Jaw (except Alveolar Process) $ 800 $ 800 ☑️ ☑️
Two or More Ribs, Fingers or Toes $ 600 $ 600 ☑️ ☑️
Bones of Face or Nose $ 600 $ 600 ☑️ ☑️
One Rib, Finger or Toe $ 280 $ 280 ☑️ ☑️
Coccyx $ 280 $ 280 ☑️ ☑️
ACCIDENT INSURANCE
Economy Plan
Coverage Type On and Off-the-Job   Essential Plan Enhanced Plan
AD&D Employee: $50,000 ☑️ ☑️
  Spouse: $50,000 ☑️ ☑️
  Child: $15,000 ☑️ ☑️
Common Carrier AD Employee: $200,000 ☑️ ☑️
  Spouse: $200,000 ☑️ ☑️
  Child: $50,000 ☑️ ☑️
Dislocation or Fracture Employee: $4,000 ☑️ ☑️
  Spouse: $4,000 ☑️ ☑️
  Child: $4,000 ☑️ ☑️
Initial Hospital Confinement (Pays once) † $1,000   ☑️ ☑️
Hospital Confinement (Pays daily) ‡ $300   ☑️ ☑️
Intensive Care (Pays daily) § $500   ☑️ ☑️
Medical Expenses**     Up to $1000 Up to $2000
Ambulance Ground: $200 Air: $600 ☑️ ☑️
Outpatient Physicians Treatment* $50   ☑️ ☑️
(Pays per visit)    
Bereavement and Trauma Counseling $150 per session for up to 10 sessions ☑️ ☑️
ACCIDENT INSURANCE PLAN PRICING
The Essential Plan  
Mode Employee Employee/Spouse Employee/Child(ren) Family
Weekly $ 5.87 $ 9.72 $ 10.55 $ 12.66
Bi-Weekly $ 12.73 $ 19.43 $ 21.09 $ 25.31
Semi-Monthly $ 12.70 $ 21.04 $ 22.85 $ 27.41
Monthly $ 25.40 $ 42.08 $ 45.69 $ 54.82
Includes $6.00 Monthly Payment Processing Fee ($1.39 - Weekly, $2.77 - Bi-Weekly, $3.00 - Semi-Monthly)
The Enhanced Plan  
Mode Employee Employee/Spouse Employee/Child(ren) Family
Weekly $ 8.39 $ 14.41 $ 15.71 $ 19.00
Bi-Weekly $ 16.77 $ 28.81 $ 31.41 $ 37.99
Semi-Monthly $ 18.16 $ 31.19 $ 34.01 $ 41.14
Monthly $ 36.31 $ 62.38 $ 68.02 $ 82.28
Includes $6.00 Monthly Payment Processing Fee ($1.39 - Weekly, $2.77 - Bi-Weekly, $3.00 - Semi-Monthly)

‡ 70 Day Limit / § 90 Day Limit
† This benefit is payable only once per Hospital Confinement and only once per Covered Person per Accident
* Pays up to 2 times for employee. If spouse or children are covered the maximum benefit of 2 per person, 4 maximum per calendar year.
**Any expense associated with a covered accident

CERTIFICATE/RIDER SPECIFICATIONS

Conditions and Limits - When an injury results in a covered loss within 90 days (180 days for dismemberment or death) from the date of an accident, certain underwriters at Lloyd’s of London will pay benefits as stated. 

Your Eligibility - Your employer decides who is eligible for your group (such as length of service and hours worked each week). Issue ages are 18 and over.

Dependent Eligibility/Termination - (a) Coverage may include you, your spouse and unmarried children. (b) Coverage for dependent children terminates on the certificate anniversary after the child reaches age 26. (c) Spouse coverage ends upon valid decree of divorce or your death.

Termination of Coverage - Coverage under the policy ends on the earliest of: the date the policy is canceled; or the last day of the period for which you made any required contributions; or the last day you are in active employment, except as provided under the “Temporarily Not Working” provision; or the date you are no longer in an eligible class; or the date your class is no longer eligible.

Portability Privilege - Coverage may be continued under the Portability Provision when coverage under the policy ends.

Certificate Limitations and Exclusions - We will not pay benefits for a Covered Person’s Accident that is caused by or occurs as a result of one of the following events:

(a) Driving any taxi for wage, compensation, or profit; (b) Mountaineering, parachuting, or hang gliding; (c) Intentionally taking, administering, absorbing, or inhaling poison, gas, or fumes; (d) Alcoholism or drug addiction; (e) Participating in any sport or sporting activity for wage, compensation, profit,
or racing any type vehicle in an organized event; (f) War, or any act of war, whether declared or undeclared; (g) Participating in any activity or event, including the operation of a vehicle, while intoxicated or under the influence according to the laws of the jurisdiction in which the Accident occurred; (h) Participating in a riot, civil commotion, civil disobedience, or unlawful assembly; (i) Committing, attempting to commit, or taking part in a felony or assault, or engaging in an illegal occupation; (j) Intentionally self-inflicting a bodily injury or attempting suicide, while sane or insane; (k) Any loss incurred while on active duty status in the armed forces. If you notify us of such active duty, we will refund any premiums paid for any period for which no coverage is provided as a result of this exception.