Provided By
Mutual of Omaha
Provider Website
Customer Service
Accident
This is a voluntary, 100% EMPLOYEE Paid benefit.
You have the option to purchase accident insurance, which helps to protect your finances after an accident. You are paid a lump sum if you have a covered injury and can use the money to help pay out-of-pocket medical costs or everyday expenses.
Plan Highlights |
|
|---|---|
Accidental Death |
|
Employee |
$25,000 |
Spouse |
$10,000 |
Child |
$5,000 |
Dismemberment |
|
Loss of One Hand, One Foot, Entire signt of One Eye, or Loss of hearing in Both ears |
50% |
Loss of Both Hands ,Both Feet, Entire sight of Both Eyes, or any combination of 2 or more of these losses |
100% |
Loss of Thumb and Index Finger-Same Hand |
25% |
Loss of Multiple Fingers or Toes |
10% |
Paralysis |
|
Quadriplegia |
100% |
Paraplegia |
50% |
Initial Care |
|
Emergency Room |
$300 |
Urgent care |
$225 |
Initial Physician Office Visit |
$100 |
Hospitalization |
|
Admission |
$1,000 |
Daily Confinement |
$200/day (up to 1 Year) |
ICU Confinement |
$400/day (up to 30 days) |
Rehabilitation Facility Confinement |
$100/day (up to 60 days) |
Surgical |
|
Cranial, Open Abdominal, Thoracic |
$2,000 |
Repair of Tendon, Ligament, Rotator Cuff (365 days) |
$750 |
Exploratory/Arthroscopic (365 days) |
$400 |
Herniated Disc (365 days) |
$900 |
Torn Knee Cartilage (365 days) |
$750 |
Eye Procedure (90 days) |
$300 |
Blood Products (90 days) |
$250 |
Pain Management (90 days) |
$250 |
Diagnostic |
|
X-Ray |
$50 |
Diagnostic Exam |
$200 |
Brain Injury Diagnosis |
$200 |
Other Injuries |
|
Fractures |
Open Reduction: $400-$9,000 |
Chip Fracture |
25% of closed reduction |
Dislocations |
Open Reduction: $500-$10,000 |
Partial Dislocation |
25% of closed reduction |
Lacerations |
$125-$900 |
Burns |
$300-$20,000 |
Skin Graft (% of burn benefit) |
50% |
Follow-Up Care |
|
Physician Follow-Up Office Visit |
$100 |
Medical Device |
$200 |
Prosthetic Device(s) |
$1,000 |
Therapy Services (Up to 6 per accident) |
$50 |
Dental Care |
|
Crown or Filling Repair |
$300 |
Extractions |
$125 |
Emergency Transportation |
|
Ground Ambulance |
$300 |
Air Ambulance |
$1,500 |
Additional Benefits |
|
Transportation (Up to 3 trips per accident) |
$300 per trip |
Lodging (Up to 30 nights per accident) |
$150 per night |
Childcare (Up to 30 days per accident) |
$25 per day |
Portability |
Included |
Termination |
Upon employee termination |
Child Eligibility |
Birth to 26 years |
Rates Per Pay Period |
|
|---|---|
Employee Only |
$4.17 |
EE + Spouse |
$6.97 |
EE + Children |
$7.34 |
EE + Family |
$10.12 |
Provided By
Mutual of Omaha
Provider Website
Customer Service