Providence Engineering - 2023 Benefits Guide

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
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