Accident Summary.docx

It pays to be healthy. It’s easier to prevent a medical condition than to cure it. That’s why healthcare professionals recommend regular health screenings that can detect potential medical conditions early on. But if you’re enrolled in Lincoln Financial Group Accident Insurance, you have another inc...

It pays to be healthy. It’s easier to prevent a medical condition than to cure it. That’s why healthcare professionals recommend regular health screenings that can detect potential medical conditions early on. But if you’re enrolled in Lincoln Financial Group Accident Insurance, you have another incentive as well: We’ll pay you for keeping up with important screenings. As you can see below, a wide range of screenings and exams are covered. It’s easy to take advantage of this benefit: ■ Each plan year, you’ll receive cash back for one covered screening — no waiting period. ■ Claims may be submitted by fax, mail, online through the employee self-service portal or email, and will be processed within 24 hours of receipt. Telephonic submissions are processed while the claimant is on the phone. ■ Your health assessment benefit will be paid within 24 hours of receiving a completed claim form. Get money back for keeping up with your health screenings. All covered persons Adults only Children only ■ Routine dental examination ■ Annual physical ■ Eye exam ■ Hearing exam ■ Depression screening ■ Substance abuse screening/counseling ■ Tetanus immunization ■ Osteoporosis screening (bone mineral density) ■ Accident/fall prevention counseling ■ Sports/school physicals ■ Concussion screening ■ Immunizations: DTP, MMR, rotavirus, chicken pox, meningitis Health assessments are not available in Connecticut, Indiana, Michigan, Minnesota, Missouri, North Dakota, New Hampshire, New Jersey, New York, New Mexico, Vermont and Washington. Emergency Treatment Your Cash Benefit Ambulance $225 Air ambulance $1,125 Emergency care $150 X-ray (within 60 days of the accident) $30 at initial visit Initial care visit $75 Major diagnostic exam $150 Fractures* Your Cash Benefit Fingers, toes $100 Ankle, arm (elbow to wrist), elbow, foot (except toes), hand (except fingers), kneecap, rib, shoulder blade, vertebral process, wrist $450 Coccyx, collarbone, lower jaw, sternum $525 Arm (shoulder to elbow), bones of the face, nose, upper jaw $875 Leg (knee to ankle), pelvis, skull non-depressed, vertebral body $1,750 Hip, leg (hip to knee) $2,625 Skull depressed $3,500 Surgical treatment 2x nonsurgical benefit Chip fracture 25% of fracture benefit *Fracture benefits listed are nonsurgical. Treatment for the fracture must occur within 90 days of the accident. The combined maximum of all fractures is two times the highest fracture payable. No money is due at enrollment. Your premium simply comes out of your paycheck. Dislocations* Your Cash Benefit Fingers, toes $100 Collarbone (acromio and separation), elbow, hand (except fingers), lower jaw, shoulder, wrist $450 Ankle, collarbone (sternoclavicular), foot (except toes) $875 Knee (except kneecap) $1,750 Hip $2,625 Surgical treatment 2x nonsurgical benefit Partial dislocation 25% of dislocation benefit *Dislocation benefits listed are nonsurgical. Treatment for the dislocation must occur within 90 days of the accident. The combined maximum of all dislocations is two times the highest dislocation payable. Specific Injuries Your Cash Benefit Blood, plasma, platelets $375 2nd or 3rd degree burns: based upon surface area burned $100-$10,000 Skin grafts 25% of burn benefit Concussion $150 Dental crown $150 Dental extraction $75 Eye (surgical repair) $300 Eye (removal of foreign object) $150 Laceration: based upon the need for and length of sutures $35-$400 Traumatic brain injury $5,000 Surgical benefits:* Arthroscopic Cranial Hernia Thoracic/open abdominal Ligaments, tendons, rotator cuff Knee cartilage Ruptured disc Surgical repair under general anesthesia Surgical repair under conscious sedation $150 $1,125 $150 $1,500 $750 $750 $750 $225 $125 *Benefits will be paid up to two times the highest surgical benefit payable for all surgeries. Group Accident Insurance | Benefits At-A-Glance Hospitalization and ongoing care Your Cash Benefit Accident hospital admission $1,000 Accident intensive care admission $1,500 Accident hospital daily confinement $200 Accident intensive care daily confinement $400 Alternative care/rehab facility daily confinement $150 Physician follow-up visits (up to 2 visits) $75 Physical, occupational and chiropractic therapy (up to 6 sessions) $35 Epidural/cortisone pain management (up to 1 injection) $75 Medical mobility devices $75 Wheelchair (expected use less than one year) $150 Wheelchair (expected use one year or more) $300 Prosthesis (per limb) $750 Recovery assistance Your Cash Benefit Family care $50 Companion lodging (100+ miles from home) $100 per night up to 30 nights Transportation (100+ miles from home) $200 per trip up to three trips Moving Vehicle Benefits Your Cash Benefit Moving vehicle injury $100 Moving vehicle death $2,500 Safe driver injury/death: seat belt Additional 25% of motor vehicle injury or death benefit Safe driver injury/death: air bag Additional 25% of motor vehicle injury or death benefit Safe driver injury/death: motor vehicle helmet Additional 25% of motor vehicle injury or death benefit Safe rider: other helmet (bicycle, scooter, skateboard, etc.) $100 Accidental Death & Dismemberment Benefit Your Cash Benefit Accidental death Your death Your spouse or life partner Your child $25,000 $10,000 $5,000 Common carrier death Your death Your spouse or life partner Your child A common carrier is any land, air or water conveyance licensed to transport passengers for hire. $50,000 $20,000 $10,000 Transportation of remains (100+ miles) $5,000 Loss of hand, foot, arm, leg, eye or hearing in one ear $5,000 Loss of finger, thumb, toe $250 Severe loss (loss of sight in both eyes, loss of hearing in both ears, loss of speech, loss of both arms, loss of both legs, loss of arm and leg, paraplegia, hemiplegia, loss of both arms and both legs, quadriplegia) $10,000 Education: This benefit is paid if an insured person dies within 365 days of a covered accident and is survived by one or more full-time students. The education benefit is payable for each full-time student. 10% of Accidental death benefit Spouse training: This benefit is paid if a covered employee or dependent spouse dies within 365 days of a covered accident and the surviving spouse is enrolled as a student. The spouse training benefit covers students enrolled in any school that retrains or refreshes skills needed for employment within 365 days from the date of death. 10% of Accidental death benefit Modification to home/auto: This benefit is payable for modifications to make the principal residence accessible or the vehicle ridable if the insured suffers a severe loss. This benefit is payable once per person within 365 days of the accident. $1,000 Health Assessment Benefit You receive a cash benefit every year you and any of your covered family members complete a single covered assessment test $50 Additional Plan Benefits Portability Included Child Sports Injury Benefit Included Benefit Exclusions Accident insurance covers many injuries that result from a covered event; though, the policy does have some exclusions. These are: 1. disease, physical or mental infirmity, sickness, or medical or surgical treatment of these; 2. suicide, attempted suicide or any intentionally self-inflicted injury, while sane or insane; 3. voluntary intake or use by any means of any drugs, poison, gas, or fumes, except when: a. prescribed or administered by a physician, and b. taken in accordance with the physician’s instructions; 4. committing or attempting to commit a felony; 5. war or any act of war, declared or undeclared; 6. participation in a riot, insurrection or rebellion of any kind; 7. military duty, including the Reserves or National Guard; 8. travel or flight in or on any aircraft, except: a. as a fare-paying passenger on a regularly scheduled commercial flight; or b. as a passenger, pilot or crew member in the group policyholder’s aircraft while flying for the group policyholder’s business, provided: i. the aircraft has a valid U.S. airworthiness certificate (or foreign equivalent); and ii. the pilot has a valid pilot’s certificate with a nonstudent rating authorizing him to fly the aircraft; 9. driving a vehicle while intoxicated, as defined by the jurisdiction where the accident occurred; 10. cosmetic or elective surgery; 11. being incarcerated in any type of penal or detention facility; 12. participating in, practicing for, or officiating any semi-professional or professional sport; 13. riding in or driving in any motor driven vehicle for race, stunt show or speed test; 14. an injury sustained while residing outside the U.S., U.S. territories, Canada or Mexico for more than 12 months; 15. bungee cord jumping, mountaineering or base jumping; 16. skydiving, parachuting or jumping from any aircraft for recreational purposes; It pays to be healthy. It’s easier to prevent a medical condition than to cure it. That’s why healthcare professionals recommend regular health screenings that can detect potential medical conditions early on. But if you’re enrolled in Lincoln Financial Group Accident Insurance, you have another incentive as well: We’ll pay you for keeping up with important screenings. As you can see below, a wide range of screenings and exams are covered. It’s easy to take advantage of this benefit: ■ Each plan year, you’ll receive cash back for one covered screening — no waiting period. ■ Claims may be submitted by fax, mail, online through the employee self-service portal or email, and will be processed within 24 hours of receipt. Telephonic submissions are processed while the claimant is on the phone. ■ Your health assessment benefit will be paid within 24 hours of receiving a completed claim form. Get money back for keeping up with your health screenings. All covered persons Adults only Children only ■ Routine dental examination ■ Annual physical ■ Eye exam ■ Hearing exam ■ Depression screening ■ Substance abuse screening/counseling ■ Tetanus immunization ■ Osteoporosis screening (bone mineral density) ■ Accident/fall prevention counseling ■ Sports/school physicals ■ Concussion screening ■ Immunizations: DTP, MMR, rotavirus, chicken pox, meningitis