Accident Insurance
The following information and benefits chart have been supplied by MetLife to describe their Accident Insurance Plan.
An accident can happen to anyone in the family — and with it can come unexpected expenses not covered by medical insurance. You may want to consider accident insurance if:
- You and your family have an active lifestyle
- Your children play sports
- Your medical plan has high deductibles or copays
Accident insurance:
- Covers your family for a wide variety of accidental injuries, including broken bones, concussions, dislocations, and second- and third-degree burns
- Provides a lump-sum payment when a covered person has medical services and treatments related to accidental injuries, such as certain doctor visits, ambulance transportation, medical testing and physical therapy
- Is a valuable complement to your medical insurance
- Can help protect your savings from unexpected expenses, which could be substantial
- Provides payment directly to you, which you can use any way you see fit
- Covered services/treatments must be the result of an accident or sickness as defined in the group policy/certificate
You must be actively at work on the effective date of insurance. If you are not, your insurance coverage will not take effect until you return to work. If you cover a dependent, your dependent must not be confined at home under a physician’s care, receiving or applying for disablity benefits from any source, or hospitalized in order for the insurance to take effect. You may cancel this coverage at any time during the year by emailing benefits@choc.org. Upon termination of employment, this coverage ends on the date of termination.
| Benefit Type1 | Insurance Pays |
|---|---|
| Injuries | |
| Fractures2 | $100 – $6,000 |
| Dislocations2 | $100 – $6,000 |
| Second and Third Degree Burns | $100 – $10,000 |
| Concussions | $400 |
| Cuts/Lacerations | $50 – $400 |
| Eye Injuries | $300 |
| Medical Services & Treatment | |
| Ambulance | $300 – $2,000 |
| Emergency Care | $50 – $225 |
| Non-Emergency Care | $50 |
| Physician Follow-Up | $100 |
| Therapy Services (including physical therapy) | $35 |
| Medical Testing Benefit | $200 |
| Medical Appliances | $100 – $1,000 |
| Inpatient Surgery | $200 – $2,000 |
| Hospital3 Coverage (Accident) | |
| Admission | $2,000 (non-ICU) – $2,000 (ICU) per accident |
| Confinement | $225 a day (non-ICU) – up to 31 days $450 a day (ICU) – up to 31 days |
| Inpatient Rehab (paid per accident) | $200 a day, up to 15 days |
| Accidental Death | |
| Employee receives 100% of amount shown, spouse receives 50% and children receive 20% of amount shown. | $50,000 $150,000 for common carrier5 |
| Dismemberment, Loss & Paralysis | |
| Dismemberment, Loss & Paralysis | $500 – $50,000 per injury |
| Other Benefits | |
| Lodging6 – Pays for lodging for companion up to 30 nights per calendar year.
Health Screening Benefit (Wellness) benefit provided if the covered insured takes one of the covered screening/ prevention tests. | $200 per night, up to 30 nights; up to $6,000 in total lodging benefits available per calendar year
$60 – Payable 1x per calendar year |
1 Covered services/treatments must be the result of a covered accident as defined in the group policy/certificate. See your Disclosure Statement or Outline of Coverage/Disclosure Document for full details.
2 Chip fractures are paid at 25% of Fracture Benefit and partial dislocations are paid at 25% of Dislocation Benefit.
3Hospital 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.
5Common Carrier refers to airplanes, trains, buses, trolleys, subways and boats. Certain conditions apply. See your Disclosure Statement or Outline of Coverage/Disclosure Document for specific details.
6It provides a benefit for a companion accompanying a covered insured while hospitalized, provided that lodging is at least 50 miles from insured’s primary residence.
METLIFE’S ACCIDENT INSURANCE IS A LIMITED BENEFIT GROUP INSURANCE POLICY. The policy is not intended to be a substitute for medical coverage. MetLife’s Accident Insurance may be subject to benefit reductions that begin at age 65. And, like most group accident and health insurance policies, policies offered by MetLife may include waiting periods and contain certain exclusions, limitations and terms for keeping them in force. For complete details of coverage and availability, please contact MetLife.
