Accident Insurance
Accident-only benefits
Just consider that nearly 4 out of 10 people
are treated in hospital emergency rooms annually.1
The costs associated with
Ask yourself…
treatment and recovery from
an accident can be more than
If you, or a family member, suffered an accident,
do you have an emergency cash fund to help
pay for unexpected expenses?
the average family earns
in a month.
Major medical insurance
pays many of the doctor
Are you prepared?
and hospital bills. However,
When an accident strikes will you be able to afford:
there are likely to be both
• High deductibles and copayments on your medical
medical and non-medical
­insurance?
expenses that you must
• Keeping up with monthly expenses such as mortgage or
pay out-of-pocket.
rent, car payments, utility bills—even groceries?
• Help with everyday expenses such as child care, home
maintenance and transportation?
• Lost income because of time off work?
If you said “no” to any of these, you could be at risk.
EXCLUSIONS AND LIMITATIONS
This is an Accident Only policy. Benefits will not be payable if a loss is directly caused by or
results from any sickness or disease or a covered person’s: voluntarily participating in illegal
activity or a felony; self inflicted intentional injuries; suicide or attempted suicide; dental
treatment, except for treatment due to injury of sound natural teeth; war or any act of war,
declared or undeclared, or serving in the armed forces or units auxiliary thereto.
1. N
ational Safety Council,
Injury Facts, 2014 Edition.
Accident Policy Form No. 14150R-NV.
SUPPLEMENTAL INSURANCE
combinedinsurance.com
Health
Accident
Disability
Life
Accident Insurance – Benefit Overview
BENEFITS
Hospital Admission
Hospital Confinement
ICU Admission
ICU Confinement
Rehab Admission Rehab Confinement
Outpatient Surgical Facility
Recovery Benefit
Emergency Room
Initial Doctor Visit
Follow up, PT, OT
Urgent Care
X-Ray
Diagnostic exams (CT, MRI, etc)
Air Ambulance
Ground Ambulance
Appliances
Blood/Plasma
Burns
Coma
Concussion
Emergency Dental Work
Eye Injury
Herniated Disc
Internal Organ Loss
Knee Cartilage Torn (Repair)
Lacerations
Lodging (per night)
Loss of Finger, Toe, Hand, Foot, or Sight
Prosthesis
Skin Graft
Surgery (abdomen/thoracic only)
Tendon, Ligament, Rotator Cuff
Tendon, Ligament, Rotator Cuff
Transportation
Fractures & Dislocations
Sports Package
AD&D (primary, spouse, child)
Monthly Premiums
STANDARD
CHOICE
PREFERRED
$1,000
$1,000
$1,250
$200
$275
$375
$2,000
$2,000
$2,500
$400
$550
$750
$1,000
$1,000
$1,250
$120
$165
$225
$200
$200
$300
$35
$50
$100
$75
$100
$150
$50
$75
$125
$20
$25
$50
$50
$75
$125
$15$20 $40
$75
$100
$200
$750
$1,000
$2,000
$100
$120
$200
$50$75 $100
$150$200 $300
$600-$6,000$750-$7,500 $1,000-$10,000
$6,000$7,500 $12,500
$50$60 $100
$40-$160
$50-$200
$100-$400
$150
$200
$300
$300
$400
$750
$2,000
$2,500
$2,500
$300
$400
$750
$15-$250$20-$300 $30-$500
$75
$100
$150
$450-$7,500
$600-$10,000
$1,000-$20,000
$250$500 $1,500
25%*Burn
25%*Burn
25%*Burn
$550
$750
$1,500
$250
$400
$750
$450
$600
$1,125
$200$300 $600
$200-$750
$300-$1,000
$800-$2,000
125%
125%
125%
$20,000
$30,000
$50,000
BENEFITS LIMITS
Per day/365 day maximum
Per day/30 day maximum
Per day/30 day maximum
Per day/7 day maximum
Per day/3 day maximum
Maximum 30 nights
One repair
Multiple repairs
Up to $1,000 per year
Per person
Standard
Choice
Preferred
Primary
$14.22
$18.02
$28.00
Primary + Spouse
$24.00
$30.45
$47.36
Primary + Children
$26.76
$34.02
$51.96
Primary + Family
$36.54
$46.45
$71.32
IMPORTANT NOTICE:
This is a supplement to health insurance and is not a substitute for Major Medical Coverage. Lack of Major Medical coverage (or other
minimum essential coverage) may result in an additional payment with your taxes.
The information contained within this document is only a brief description. See the actual policy for complete details of the policy plans,
features, benefits, options, rates, definitions, limitations and exclusions.
Combined Insurance Company of America
111 E. Wacker, Suite 700, Chicago, IL 60601 | Toll-free: 800-225-4500
®
Policy Form No. 14150R-NV | EVG-WRTS-APAT-NV (8-15)