DEPENDENT VOLUNTARY LIFE INSURANCE RATES CARRIER: Sun Life *NOTE: You will see your exact Payroll Deduction when you log into Employee Navigator. 22
VOLUNTARY ACCIDENT INSURANCE CARRIER: Sun Life Accident Insurance supplements your existing medical insurance in case you have an accident; medical insurance alone may not be enough to cover your expenses. This plan pays a cash benefit during the term of your coverage following a covered accident and could help cover: ● Out-of-pocket expenses such as copays and deductibles ● Transportation ● Lodging costs ● Emergency room expenses Accidental Death $25,000 Accidental Death Common Carrier $100,000 Catastrophic Loss: Both arms or both hands, both legs or both feet, one hand and one foot or one are and one leg, or irrecoverable loss of sight of both eyes $15,000 One hand, one foot, one leg, one arm $7,500 Two or more fingers or toes $1,500 One finger or one toe $750 Dislocations Open Closed Hip $4,000 $2,000 Knee, ankle, or bones of the foot $2,000 $1,000 Shoulder $1,000 $500 Fractures Open Closed Hip or thigh $4,000 $2,000 Leg $2,000 $1,000 Rib, Finger, Toe or Coccyx $350 $175 Coma $10,000 Concussion $100 Diagnostic Exam: Arteriogram, Angiogram, CT, CAT, EKG, EEG, or MRI (1 time per benefit year) $200 Diagnostic Exam X-ray (1 time per covered accident) $40 Accident Emergency Treatment, nonemergency room (once per covered accident) $50 Physician's Follow-up Treatment office visit (per visit, up to 6 times per covered accident) $25 Physical Therapy (per visit up to 10 visits per covered accident) $40 Hospital Admission (Once per benefit year) $1,000 Ambulance Ground/Air $200/$1,500 Wellness Screening Benefit (Once per benefit year) $50 ACCIDENT SEMI-MONTHLY RATES PAYROLL DEDUCTIONS Employee Only $4.63 Employee & Spouse $8.00 Employee & Child(ren) $9.05 Employee & Family $12.42 23