ACCIDENT INSURANCE. Quick Reference Guide

Transcription

1 ACCIDENT INSURANCE Quick Reference Guide

2 Accident Insurance UnumProvident s supplemental accident insurance provides benefi ts for covered injuries 1 and accidentrelated expenses for an individual or family. This individual policy is designed to help cover expenses that result from accidents occurring on or off the job, depending on the plan design selected. Product Overview Plan design options Base plan covers a wide variety of injuries and accidentrelated expenses such as hospitalization, physical therapy, hospital intensive care, transportation, lodging and more. Three base plan options available: 1. On and off-job accident coverage 2. Off-job accident coverage 3. On and off-job accident coverage without catastrophic accident or accidental death benefits and with reduced hospital benefits Policy ownership individual policy sold at the worksite premiums paid through payroll deduction employees can keep their coverage if they leave their current employer for any reason Family coverage options 2 individual coverage: employee, spouse or child employee and spouse one-parent family (where only one parent is covered) two-parent family Guaranteed renewable Coverage is guaranteed renewable for life (except on disability riders) as long as premiums are paid. Base plan eligibility Employee: issue ages must be actively at work 3 with 20 hours per week minimum

3 Spouse: issue ages must not be disabled Children: issue ages 14 days - 24 years 4 must be dependent child of employee must not be disabled Riders: Refer to the rider descriptions for eligibility Effective date of coverage Coverage becomes effective no earlier than the date the application is signed 5 and no later than the date payroll deductions begin. Riders available The employee must be covered under the accident insurance base plan to apply for riders. sickness hospital confinement rider (on- and off-job coverage) Benefits are paid if the insured is confined to a hospital due to a covered sickness Benefit amounts: up to $100 per day for employee or spouse; up to $75 per day for children Eligibility: employee and spouses ages 17-67; children ages 14 days - 24 years Rider coverage is available to, and must match, those that are covered by the base accident plan Certain health questions will be asked when applying for employee or spouse coverage Includes a 12-month pre-existing condition provision and a nine-month pregnancy exclusion accident only disability income rider (off-job coverage) Benefits are paid for covered accidents resulting in a disability that occur off the job Available monthly benefits: $400 to $1,500, in $100 increments, up to a maximum of 40% of income for employees; spouses are eligible for a flat $500 monthly benefit Eligibility: employee and spouse ages who are actively at work and not disabled Zero day elimination period with a six- or 12-month benefit period Rider coverage is offered on a guaranteed issue basis Coverage terminates at age 72

4 Riders available (cont.) accident/sickness disability income rider (off-job coverage) Benefits are paid for a covered sickness or off-job accident resulting in a disability Available monthly benefits: $400 to $1,500, in $100 increments, up to a maximum of 40% of income for employees; spouses are eligible for a flat $500 monthly benefit Eligibility: employee and spouse ages who are actively at work and not disabled Elimination periods (accident/sickness) combinations: 0/7, 7/7, 0/14, or 14/14 with a six- or 12-month benefit period Certain health questions will be asked when applying for coverage Includes a 12-month pre-existing condition provision and a nine-month pregnancy exclusion Coverage terminates at age 72 Rates 6 Rates are level premium, unisex, uni-age with non-occupational classifications. Issue ages are based on the individual s last birthday. Rates vary by coverage type and coverage plan elected. Underwriting guidelines Minimum case size requirements is 100 eligible lives. For cases with eligible lives, refer to the WorkPack portfolio. A minimum of 25 adult applications is required to establish billing for the account. Guaranteed issue underwriting is available for all base plan types and for the accident only disability income rider. Simplified issue underwriting is required for the accident/ sickness disability income rider and the sickness hospital confinement rider. Terminations This policy will terminate on the earliest of the following: written request by the insured to terminate the policy; failure to pay the premiums for this policy, subject to the grace period allowed; and named insured s death. Exclusions We will not pay benefits on any covered person for losses that are caused by or occur as the result of: war or act of war, whether declared or undeclared; riding in or driving any motor-driven vehicle in a race, stunt show or speed test; operating, learning to operate, serving as a crew member of or jumping, parachuting, or falling from any aircraft or hot air balloon, including those which are not motor-driven. This does not include flying as a fare paying passenger; engaging in hang-gliding, bungee jumping, parachuting, sailgliding, parasailing, parakiting or any similar activities; participating or attempting to participate in an illegal activity and/or being incarcerated in a penal institution; committing or trying to commit suicide or injuring oneself intentionally, whether sane or not; having any sickness or declining process caused by a sickness, including physical or mental infirmity. We also will not pay benefits to diagnose or treat the sickness. Sickness means any illness, infection, disease or any other abnormal physical condition which is not caused by an injury; practicing for or participating in any semi-professional or professional competitive athletic contests for which any type of compensation or remuneration is received; or having a work related injury, unless an on-job accident coverage type is shown on the policy schedule. Weekly Premium Rates Plan 1: On- and off-job accident coverage includes catastrophic accident and accidental death benefits Plan 2: Off-job accident coverage includes catastrophic accident and accidental death benefits Plan 3: On- and off-job accident coverage with reduced hospital benefits Coverage for accidents Accident insurance Accident insurance base plan plus optional occurring off the job base policy only rider for hospitalization due to sickness Plan 1 Plan 2 Plan 3 Plan 1 Plan 2 Plan 3 Employee $3.78 $3.30 $2.61 $4.59 $4.11 $3.42 Employee and Spouse $5.40 $4.71 $3.75 $7.02 $6.33 $5.37 One-parent family $7.20 $6.72 $5.55 $8.58 $8.10 $6.93 Two-parent family $8.82 $8.13 $6.69 $11.01 $10.32 $8.88

5 Schedule of Benefits Accident/Injury Benefi t Amount Accidental death (Plans 1 & 2 only) employee $25,000 spouse $10,000 child $5,000 The accidental death benefit doubles if the insured is injured as a farepaying passenger on a common carrier. Employee $50,000; Spouse $20,000; Child $10,000 Ambulance $100 air $500 Appliance $100 Blood, plasma and platelets $300 Burns Flat amount for 2nd degree for 36% or more of body $750 3rd degree for 36% or more of body, 9-34 sq. in. $1, or more sq. in. $10,000 skin grafts 25% of burn benefit Catastrophic accident (loss of use of sight, hearing, speech, arms or legs Plans 1 & 2 only)* employee <65 years $100,000 spouse or child <65 years $50,000 age Amount reduced 50% age 70+ Amount reduced 75% Concussion $100 Dental work, emergency extraction $50 crown $150 Dislocations open up to $4,000 closed up to $2,000 Doctor s office initial visit $50 Emergency room treatment (includes X-rays) $150 Eye injury requires surgery or removal of foreign body $200 Follow-up treatment for accident initial follow-up visit $50 Accident/Injury * Catastrophic accident benefits are payable after fulfilling a 365-day elimination period. See policy for details. ** Outline of Coverage is required at time of solicitation for the following states: CA, GA, ME, MT, NV, NH, OR, TX, WI and WV. Special Forms required at time of solicitation for the following states: MN, OR, SC and WI. Benefit amounts may vary by state. Benefi t Amount Fractures open up to $5,000 closed up to $2,500 chips 25% of closed amount Hospital admission (per admission) $750 (Plan 3 $250) Hospital confinement (per day up to 365 days) $200 (Plan 3 $100) Hospital intensive care unit (per day up to 15 days) $400 (Plan 3 $200) Knee cartilage (torn) $500 exploratory $100 Laceration $25-$400 Lodging (per night up to 30 days) $100 Loss of finger, toe, hand, foot or sight of an eye Loss of both hands, feet, sight of both eyes, or any combination of two or more losses $15,000 Loss of one hand, foot or sight in one eye $7,500 Loss of two or more fingers, toes or any combination of two or more losses $1,500 Loss of one finger or toe $750 Physical therapy (6 treatments) $25 per treatment Prosthetic device or artificial limb one $500 more than one $1,000 Ruptured disc $400 Surgery benefit (open abdominal, thoracic) $1,000 exploratory $100 Tendon/ligament and rotator cuff repair of one $400 repair of more than one $600 exploratory only $100 Transportation (100+ miles up to 3 trips) $300

6 Significant Exceptions UnumProvident s Accident Coverage Insurance Policy and its provisions may vary by state. Below is a list of those states which have significant exceptions. Please contact your UnumProvident representative for complete details for your state. State exceptions are subject to change. State California Colorado Florida Massachusetts Exception Maximum policy issue age is 64. Premium rates vary for the disability riders. Higher Benefit Schedule. Reduced 1 st year compensation. Higher Benefit Schedule. Policy is non-cancelable New Hampshire Higher Benefit Schedule. Reduced 1 st year compensation. New Jersey Pennsylvania Washington CAT benefit paid immediately upon written proof of loss. Loss of Sight, Hearing and Speech are not covered. Off-job only (Plan 2) is NOT available. CAT benefit paid immediately upon written proof of loss. Loss of Sight, Hearing and Speech are not covered. Lower Benefit Schedule. All benefits include a 365 day time frame to file a claim. The policy or its provisions may vary or be unavailable in some states. See the actual policy or your UnumProvident representative for specific provisions and details of availability. UnumProvident Corporation s insuring subsidiaries comply with Act 91, the Vermont Civil Union Endorsement Law. 1 Covered accident means an accident that occurs after the policy effective date; occurs while the policy is in force; is of a coverage type listed on the policy schedule; and is not excluded by name or specific description in this policy. Injury or injuries means accidental bodily injury that is the direct result of a covered accident. Injuries must be independent of sickness, disease, bodily infirmity and other causes. Carpal tunnel syndrome is considered to be a sickness. 2 One or two-parent family plans include all unmarried children ages 14 days to 25 years old and is dependent upon the employee for at least 50% support. 3 Being actively at work means that on the day the employee applies for coverage, he/she is working at one of his/ her company s business locations, or is working at a location where he/she is required to represent his/her company. If he/she is applying for coverage on a day that is not a scheduled workday, then he/she will be considered actively at work if he/she meets this definition as of the last scheduled workday. Employees are not considered actively at work if their normal duties are limited or altered due to health, or if they are on a leave of absence. 4 Children covered at birth for the following states: AZ, CO, FL, GA, ID, IN, KS, LA, MN, MT, NC, NM, OK, OR, SC, SD, TX, UT, WA, and WI. In the following states, children are covered until age 26: ND and UT 5 The employee will receive the plan and coverage amount applied for on the application, unless it is determined to be unacceptable under UnumProvident s rules, limits or standards. In such event, the plan and coverage amount may be modified or declined. 6 The premium rate for this policy can be changed only if UnumProvident changes it on all similar inforce policies. Base plan is an accident-only policy. THIS IS A LIMITED POLICY. Underwritten by the following subsidiary of UnumProvident Corporation: Provident Life and Accident Insurance Company 1 Fountain Square, Chattanooga, TN UnumProvident Corporation. UnumProvident represents the marketing brand of UnumProvident Corporation s insuring subsidiaries. All rights reserved. VB-596 (Rev. 6-04)