Accident Insurance Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 L0924043620[exp0926][All States][DC,GU,MP,PR,VI] © 2024 MetLife Services and Solutions, LLC Modification Benefit $1,000 Blood/Plasma/Platelets Benefit $400 Surgical Repair Benefit $150 – $1,500 depending on the type of surgery Exploratory Surgery Benefit $150 Other Outpatient Surgery Benefit $300 Hospital Benefits Admission Benefit $1,000 for the day of admission ICU Supplemental Admission Benefit $1,000 for the day of admission Confinement Benefit $200 per day (paid for up to 180 days per accident) ICU Supplemental Confinement Benefit $200 per day (paid for up to 180 days per accident) Inpatient Rehabilitation Benefit $150 per day (paid for up to 15 days per accident) Accidental Death Benefit Accidental Death Benefit* $25,000 $75,000 for accidental death on common carrier Accidental Dismemberment, Functional Loss & Paralysis Benefits Dismemberment/Functional Loss $750 – $20,000 depending on the injury Paralysis $10,000 – $20,000 depending on the number of limbs Other Benefits Health Screening Benefit* - $50 benefit provided for certain screening/prevention tests Paid 1 time per calendar year Lodging Benefit* - for a companion of a covered person who is hospitalized $100 per day Organized Sports Activity Injury Benefit Rider This coverage includes an Organized Sports Activity Benefit Rider. The rider increases the amount payable under the Certificate for certain benefits by 25% for injuries resulting from an accident that occurred while participating as a player in an organized sports activity. The rider sets forth terms, conditions and limitations, including the covered persons to whom the rider applies. * Notes Regarding Certain Benefits • Fracture and Dislocation benefits – Chip fractures are paid at 25% of Fracture Benefit and partial dislocations are paid at 25% of Dislocation Benefit • Hospital Benefits – Hospital does not include certain facilities such as nursing homes, convalescent care or extended care facilities. See MetLife’s Disclosure Statement or Outline of Coverage/Disclosure Document for full details. The Admission Benefit is not payable for Emergency Room treatment or outpatient treatment. The payment of the admission benefit requires a Confinement. Hospital Confinement requires the assignment to a bed as a resident inpatient in a Hospital (including an Intensive Care Unit of a Hospital) on the advice of a Physician or confinement in an observation area within a Hospital for a period of no less than 20 continuous hours on the advice of a Physician. Please consult your certificate for details. • Accidental Death Benefit – The benefit amount will be reduced by the amount of any accidental dismemberment/functional loss/paralysis benefits and modification benefit paid for injuries sustained by the covered person in the same accident for which the accidental death benefit is being paid.