Accident Insurance (Non-NY)
Offering Vital Protection When Accidents Happen
Unfortunately, accidents are a fact of life. They come in many forms, ranging from falls, burns or unintentional poisoning to motor vehicle or gun-related accidents. They cause a wide range of injuries which, in turn, can create a tremendous financial burden for men and women who are unprepared. Amalgamated Life offers a robust Accident Insurance policy designed to provide vital protection when an accident-related injury occurs.
| BENEFIT | AMOUNT |
|---|---|
Primary Insured |
|
| Non-Common Carrier Accident | $25,000 |
| Common Carrier Accident | $100,000 |
| Catastrophic Accident | $20,000* |
| Loss of Fingers, Toes, Hands, Feet, Arms, Legs or Sight of Eyes Loss of one hand, or one foot, or one arm, or one leg, or sight of one eye |
$10,000 |
| Loss of one finger or toe | $2,000 |
Spouse |
|
| Non-Common Carrier Accident | $25,000 |
| Common Carrier Accident | $100,000 |
| Catastrophic Accident | $10,000* |
| Loss of Fingers, Toes, Hands, Feet, Arms, Legs or Sight of Eyes Loss of one hand, or one foot, or one arm, or one leg, or sight of one eye |
$5,000 |
| Loss of one finger or toe | $1,000 |
Children |
|
| Non-Common Carrier Accident | $5,000 |
| Common Carrier Accident | $10,000 |
| Catastrophic Accident | $10,000* |
| Loss of Fingers, Toes, Hands, Feet, Arms, Legs or Sight of Eyes Loss of one hand, or one foot, or one arm, or one leg, or sight of one eye |
$5,000 |
| Loss of one finger or toe | $1,000 |
| Accident Follow-Up | $25 |
| Air Ambulance | $500 |
| Ambulance | $150 |
| Blood, Plasma, Platelets | $200 |
| Burns | |
| Flat amount for: | |
| 2nd degree for 36% or more of body surface | $500 |
| 3rd degree 9-34 sq. in. of body surface | $1,000 |
| 3rd degree 35 or more sq. in. of body surface | $10,000 |
| Coma | $7,500 |
| Concussion | $50 |
| Dislocation (based on joint involved) | |
| Open Reduction | $100 to $2,000 |
| Closed Reduction | $50 to $1,000 |
| Emergency Dental Work | |
| Broken teeth repaired with crown(s) | $300 |
| Broken teeth resulting in extraction(s) | $100 |
| Emergency Room Treatment | $150 |
| Eye Injury | |
| Surgical Repair | $200 |
| Removal of Foreign Object | $50 |
| Fracture (based on bone involved) | |
| Open Reduction | $200 to $1,500 |
| Closed Reduction | $100 to $1,500 |
| Hospital Admission | $1,000 |
| Hospital Confinement Per Day | $200 |
| Hospital ICU Admission | $1,500 |
| Hospital ICU Confinement Per Day | $400 |
| Initial Office Visit | $25 |
| Knee Cartilage (Torn) | |
| With Surgical Repair | $500 |
| Exploratory Surgery or Debridement | $150 |
| Laceration | |
| Treated without stitches, staples, glue | $25 |
| Total not more than 3 inches long (less than 7.6 centimeters) and repaired by stitches |
$50 |
| Total is greater than 3 and not more than 5 inches long (7.6 to 12.5 centimeters) and repaired by stitches |
$200 |
| Total is over 5 inches long (12.5 centimeters) and repaired by stitches | $400 |
| Lodging Per Day | $100 |
| Major Diagnostic Exam | $150 |
| Medical Appliances | $100 |
| Pain Management/Epidural | $75 |
| Paralysis | |
| Hemiplegia | $4,000 |
| Paraplegia | $5,000 |
| Quadriplegia | $10,000 |
| Physical Therapy Per Day | $25 |
| Prosthetic Device/Artificial Limb | |
| One prosthetic device or artificial limb | $500 |
| More than one device or artificial limb | $750 |
| Rehabilitation Unit Per Day | $100 |
| Ruptured Disc with Surgical Repair | $500 |
| Skin Graft | 50% of Burn Benefit |
| Surgery | |
| Cranial | $1,000 |
| Hernia with Surgical Repair | $1,000 |
| Abdominal/Thoracic With Surgical Repair | $1,000 |
| Abdominal/Thoracic Exploratory Surgery | $150 |
| Miscellaneous Surgery with general anesthesia | $250 |
| Miscellaneous Surgery with conscious sedation | $100 |
| Tendon/ Ligament/ Rotator Cuff | |
| Surgical repair of one or more tendon, ligament or rotator cuff | $500 |
| If exploratory arthroscopic surgery is performed and no repair is done | $150 |
| Transportation | $350 |
| X-Ray | $50 |
YOU Decide How to Use the Cash Benefits
Our cash benefits provide you with greater coverage options because you get to decide how to use them.
Finances
Can help protect your HSAs, savings, retirement plans and 401ks from being depleted
Travel
You can use your cash benefits to help pay for expenses while
receiving treatment in another city
Home
You can use your cash benefits to help pay the mortgage, rental
payments, or perform needed home repairs for your after care
Expenses
The cash benefit can be used to help pay your family’s living
expenses such as bills, electricity and gas
Accident Plan Features
- Guaranteed Issue—No medical questions asked
- Guaranteed Renewable—Coverage remains in force for life as long as premiums are paid
- Coverage for Family—Insured, spouse and dependent children
- Portability—Insured can keep benefits even with a change of jobs or retirement
- Level Premium—Rates do not increase with age
Here’s How it Works
Imagine while cleaning the gutters, you fall from the ladder and break your leg.
These are out-of-pocket expenses you may encounter:
| $100 | Emergency room copay |
| $250 | Deductible (copays do not count toward deductible) |
| $35 | Specialist visit copay—orthopedic surgeon |
| $350 | Specialist visit copay—occupational/physical therapy for 10 days |
| $735 | Out-of-pocket expenses |
And here is a sample of benefits you may be eligible for with Amalgamated Life’s Accident Insurance:
| $150 | Accident Emergency Treatment |
| $50 | X-Ray (for diagnosis of broken leg) |
| $150 | MRI |
| $675 | Fracture (broken leg) |
| $100 | Appliance (crutches) |
| $25 | Accident Follow-up Doctor ($25 per visit, up to 1 per accident) |
| $150 | Physical Therapy ($25/day for 6 days) |
| $1,150 of benefits paid to you in additional to other coverage you may have with other insurance companies | |
Accident Claims Checklist
Have this information handy to identify your policy:
- Policy number
- Policyholder’s name
- Policyholder’s date of birth
- Policyholder’s address
Here’s a list of common items you will need to file a claim:
- Patient’s name and date of birth
- Patient’s relationship to policyholder
- Date and description of injury
- Location of accident
- Copy of police report (motor vehicle accidents)
- Authorization to obtain information: To allow Amalgamated Life to contact your provider on your behalf, please include the provider’s name, address and fax number (if available)
- For hospital confinement: Ask your hospital to provide a completed UB04 document or ask your physician to provide a completed HCFA 1500 document
- For surgery: Include the operative report, and both the surgeon’s and anesthesia’s bills
- Include all ambulance, mobility aids, lodging and transportation invoices
