Group Accident Insurance
by Unum
A cost-effective way to help limit financial risk
Accidents happen in a heartbeat. So it can be difficult for you to save for such unexpected emergencies. Unum’s
accident insurance can help protect your finances with lump sum benefits that are based on the type of injury
and the treatment received. This plan covers minor injuries due to catastrophic accidents.
Why buy Accident Insurance?
• Lump sum benefit for off-job accidents provides freedom to use as you choose; no calendar year maximums.
• $50 annual wellness benefit pays once per calendar year per covered individual. 26 covered wellness tests. A covered
individual may receive a multiple wellness benefit for a covered screening test if participating in both the Accident and
Critical Illness plan.
• Simple phone call to 1-800-635-5597 initiates annual wellness benefit.
• A single claim can trigger the following benefits, if applicable, Critical Illness, Accident and Disability– as long as the
benefit is with Unum.
• Coverage is fully portable - you can take the coverage with you if you terminate your employment. Unum will bill
you directly.
Monthly Premiums
Plan Type
Employee
Employee
& Spouse
Employee
& Child
Employee,
Spouse & Child
Off-Job Coverage
$11.19
$17.74
$20.15
$26.70
* Actual rates may vary due to rounding.
Covered accident means an accident causing injury which:
• occurs after the policy effective date;
• occurs while this policy is inforce;
• is of a coverage type listed on the policy schedule; and
• is not excluded by name or specific description in this policy.
Terminations
The policy will terminate on the earliest of the following:
• written request by the insured individual to terminate the policy;
• failure to pay the premiums for the policy, subject to the grace period allowed;
• death of the insured individual.
The family plan includes all children - age 14 days until their 26th birthday who are dependent
upon the employee for at least half of their support. Issue age may vary by state.
Employees must be a U.S. citizen or legally authorized to work in the U.S. to receive coverage. Spouses and dependents must
live in the U.S. to receive coverage.
Schedule of Benefits
These are the benefit amounts payable for covered injuries and accident-related expenses.
See the actual policy for catastrophic accident and dismemberment benefit amounts.
Covered injuries
Benefit
amount
Fractures
Open
Closed
Chips
Up to $7,500
Up to $3,750
25% of closed amount
Dislocations
Open
Up to $6,000
Closed
Burns
At least 10 square inches, but less than 20 square
inches
At least 20 square inches, but less than 35 square
inches
35 or more square inches of body surface
Emergency and hospitalization benefits
Up to $3,000
2nd degree - $0
rd
3 degree - $2,500
2nd degree - $0
3rd degree - $5,000
2nd degree - $1,000
3rd degree - $10,000
Skin grafts for 2nd and 3rd degree burns
50% of
burn benefit
Skin graft for any other accidental traumatic loss of skin
At least 10 square inches, but less than 20 square
inches
At least 20 square inches, but less than 35 square
inches
35 or more square inches of body surface
Concussion
Coma
Ruptured disc
$150
$250
$500
$150
$10,000
$750
$150
Laceration
$25-$600
Tendon/ligament and rotator cuff
Exploratory only
Eye injury (requires surgery or removal of foreign
body)
THIS IS A LIMITED POLICY.
Hospital confinement (per day up to 365 days)
$100
Intensive care confinement (per day up to 15 days)
$200
Medical imaging test (once per accident)
$100
Outpatient surgery facility service (once per
accident)
$150
Pain management (epidural, one per accident)
Treatment and other services
Doctor's office initial visit
Surgery benefit
Open abdominal, thoracic
Exploratory, Hernia repair
Physician Follow-up visit
(2 visits per accident)
$100
Benefit
amount
$50
$1,500
$150
$50
Chiropractic visit
N/A
$15 per
treatment
$750
$1,500
$100
Blood, plasma and platelets
$800
$1,200
$150
Dental work, emergency
Extraction
Crown
$1,500
Prosthetic device or artificial limb
One
More than one
Appliance
Torn
Repair of more than one
$1,000
Intensive care admission (same as above)
Therapy Services (6 per accident)
(Occupational, Speech & Physical Therapy)
Exploratory
$50
Hospital admission (per admission)
$800
Knee cartilage
Repair of one
Ambulance
Air ambulance
Emergency room treatment
Emergency treatment in physician office/urgent care
facility
Benefit
amount
$400
$1,500
$100
$100
$300
$300
Transportation (50+ miles up to 3 trips)
$400
$0.40/mile
Lodging (per night up to 30 days)
$150
Rehabilitation unit confinement (per day up to 15
days; max 30 per calendar year)
$100
Accidental death and other covered losses
Accidental death*
Employee
Spouse
Child
Benefit
amount
$50,000
$20,000
$10,000
*Accidental death benefit doubles if injury occurs while fare-paying
passenger on a common carrier.
Exclusions
Unum will not pay benefits for losses that are caused by or occur as the result of:
• involvement in war or act of war, whether it is declared or undeclared;
• riding in or driving any motor vehicle in a race, stunt show or speed test;
• operating, learning to operate, serving as a crew member of or jumping, parachuting or falling from any aircraft or hot-air balloon, including those which are not motor-driven.
This does not include flying as a fare-paying passenger;
• engaging in hang-gliding, bungee jumping, parachuting, sailgliding, parasailing, parakiting or any similar activities;
• participating or attempting to participate in an illegal activity; and/or being incarcerated in a penal institution;
• committing or trying to commit suicide or injuring him/herself intentionally, whether he/she is sane or not;
• having any sickness or declining process caused by a sickness, including physical or mental infirmity. We also will not pay benefits to diagnose or treat the sickness. Sickness
means any illness, infection, disease or any other abnormal physical condition which is not caused by an injury.
See your contract for more details.
This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The
policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form GA-1 or contact your
Unum representative.
Underwritten by: Unum Life Insurance Company of America, Portland, Maine
© 2013 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.
CE-13177 (9-13)