Accidentv2

PLAN SUMMARY Accident Insurance Benefits that may help cover costs such as those not covered by your medical plan. Salus Homecare ADF# AI664.14 Accident Insurance Benefits With MetLife, you’ll have a choice a plan (called the “Low Plan” that provide payments in addition to any other insurance payments you may receive1. Here are just some of the covered events/services2. This plan provides protection 24 hours a day—while on or off the job. Benefit Typ0065 Low Plan Benefits Accidental Injury Benefits Fracture Benefit* $100 – $8,000 depending on the fracture and type of repair Dislocation Benefit* $100 – $8,000 depending on the dislocation and type of repair Second or Third Degree Burn Benefit $75 – $10,000 depending on the degree of the burn and the percentage of burnt skin Concussion Benefit $250 Coma Benefit $10,000 Laceration Benefit $50 – $400 depending on the length of the cut and type of repair Puncture Wound Benefit $250 Broken Tooth Benefit Crown: $200 Filling: $25 Extraction: $100 Eye Injury Benefit $300 Accident - Medical Services & Treatment Benefits Ambulance Benefit Ground: $300 Air: $1,000 Emergency Care Benefit $100 – $200 depending on location of care Non-Emergency Initial Care Benefit $100 Physician Follow-Up Visit Benefit $100 Therapy Services Benefit $50 (including physical therapy) Medical Testing Benefit $150 Medical Appliance Benefit $75 – $750 depending on the appliance Transportation Benefit $300 Pain Management Benefit $75 (for epidural anesthesia) Prosthetic Device Benefit One device: $750 More than one device: $1,500