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Plan Description

 

KEY BENEFITS

  • Helps pay expenses not covered by medical insurance

  • Covers a wide range of treatments due to an accident

  • Pays money directly to you, not medical providers

  • Pays an extra 25% of total benefits for injuries during youth organized sports


What Is Accident Insurance?

Accident insurance can help keep your finances on track when an accident happens.

Your medical insurance will cover some of the expenses, but you'll be left to foot the bills for your copays and deductible. Those can add up fast, especially if you're unable to work while you recover. That's where Group Accident insurance comes in: It helps protect your bank account from the out-of-pocket expenses that can come with an injury — whether you're coping with a broken arm or recovering from a serious car accident.

How Does Accident Insurance Work?

In the event of a covered accident, your Accident insurance will pay a benefit directly to you. You can use this money wherever you need it most — whether that's to help with your deductible, copay and other medical bills, or your daily expenses while you recover.


BENEFIT EXAMPLES

Don't Let an Accident Stop Your Financial Plans

Accident insurance is an affordable way to help cover the gap between what your health insurance covers and what you'd owe out of pocket if you or a family member were to get injured. It's protection that's also convenient.


 

Back surgery

Falling Off a Ladder
While cleaning the gutters, Kang lost his footing and fell off the ladder. He felt a lot of pain, but thought that a little ice would fix him up. The next day, he was in worse shape and visited an urgent care facility where it was determined that he had fractured his arm and dislocated his elbow. He then needed some physical therapy to get back to full strength. His Accident Insurance benefits helped protect his savings from the out-of-pocket costs he incurred.

Kang's insurance paid benefits for:

  • Urgent care
  • X-ray
  • Dislocated elbow
  • Arm fracture
  • Physician follow-up
  • Physical therapy (two sessions)

 

*Example is for illustrative purposes. Eligibility for benefits and amounts shown in this example may vary from any policy your employer may offer and may vary based upon your individual circumstances, policy definitions, waiting periods, exclusions and limitations.

 

Asthma

Mountain Bike Accident
Warren was mountain biking with friends in the hills near his home, and an errant rock caught his front tire. He went over the handlebars and landed badly on his hand and shoulder. His friends managed to help him limp back to the trailhead and called 911. An x-ray at the emergency room showed a wrist and collarbone injury, and he had to stay in the hospital for observation. His Accident Insurance benefit helped cover the expenses he incurred from the injury, including the deductible from his medical insurance.

Warren's insurance paid benefits for:

  • Ground ambulance
  • Emergency room
  • X-ray
  • Dislocated collarbone
  • Wrist fracture
  • Hospital admission
  • One-day hospital stay
  • Physician follow-up

 

*Example is for illustrative purposes. Eligibility for benefits and amounts shown in this example may vary from any policy your employer may offer and may vary based upon your individual circumstances, policy definitions, waiting periods, exclusions and limitations.

 

Hospital

Hit By a Car
Dante was visiting a nearby city and taking a walking tour to see the sights. While crossing the road, he was struck by a car. An ambulance took him to the hospital, where they found multiple fractures. Because of the severity of his injuries, he had to stay in the hospital for five days. The benefits from his Accident Insurance coverage helped him cover his copayments and meet the deductible under his medical insurance plan as well as some of the out-of-pocket expenses related to his family's travel to and from the hospital. He even used part of the benefits for his prescribed physical therapy to help him get back on his feet.

Dante's insurance paid benefits for:

  • Ground ambulance
  • Emergency room
  • CAT scan
  • Hospital admission
  • Five-day hospital stay
  • Leg fracture
  • Kneecap fracture
  • Two physician follow-ups
  • Physical therapy (two sessions)

 

*Example is for illustrative purposes. Eligibility for benefits and amounts shown in this example may vary from any policy your employer may offer and may vary based upon your individual circumstances, policy definitions, waiting periods, exclusions and limitations.

 

 

BENEFITS

All three plans include these benefits (View details below on each plan):
  • No limits, no max
  • Hospital pays out anytime hospitalized up to 365 days a year
  • Pays out for every accident
  • No industry exclusions
  • Guaranteed Issue
       
 

Archway Accident Gold

Archway Accident Platinum

Archway Accident Diamond

Eligibility Coverage is available for ages 18 - 74
Employees working 20 hours or more per week are eligible
Available for Spouse ages 18-7 4 and Dependent Children (unmarried) ages 0-25
Enrollment Deadline 18th of month Prior to Effective date
Availability Available in ALL States
Issue Age 18 to 74 18 to 74 18 to 74
INPATIENT
Daily Hospital Confinement
Maximum

$150 / Day
365 Days

$225 / Day
365 Days
$250 / Day
365 Days
Hospital Admission
Per Hospital Confinement
$1,000 $1,500 $2,000
Daily Intensive Care
Maximum

$450 / Day
30 Days

$475 / Day
30 Days
$500 / Day
30 Days
Surgery: Abdominal, Thoracic, Tendon, Ligament, Rotator Cuff $750 / Day $1,000 / Day $1,500 / Day
Anesthesia $187.50 /Day $250 /Day $375 /Day
Continuous Care(1)
Maximum

$90 / Day
30 Days

$135 / Day
30 Days
$150 / Day
30 Days
OUTPATIENT
Physician's Office

$25 / Day
6 Per Calendar Year

$50 / Day
6 Per Calendar Year
$50 / Day
6 Per Calendar Year
Wellness Benefit $25 / Day
1 Per Calendar Year
$25 / Day
1 Per Calendar Year
$50 / Day
1 Per Calendar Year
Emergency Room $75 / Day
3 Per Calendar Year
$100 / Day
3 Per Calendar Year
$125 / Day
3 Per Calendar Year
Lab, EKG and other Diagnostic Tests $20 Per Test Day
1 Per Calendar Year
$20 Per Test Day
1 Per Calendar Year
$25 Per Test Day
1 Per Calendar Year
X-Ray, Echocardiography and Cardiovascular Ultrasound $20 Per Test Day
2 Per Calendar Year
$30 Per Test Day
2 Per Calendar Year
$40 Per Test Day
2 Per Calendar Year
Advanced Studies(2) $100 / Day
1 Per Calendar Year
$150 / Day
1 Per Calendar Year
$200 / Day
1 Per Calendar Year
Ambulatory Surgical Center $25 / Day $25 / Day $50 / Day
Surgery: Abdominal, Thoracic, Tendon, Ligament, Rotator Cuff $750 / Day $1,000 / Day $1,500 / Day
Anesthesia $187.50 /Day $250 /Day $375 /Day
Ambulance Services Ground $120 / Day
1 Per Calendar Year
$200 / Day
1 Per Calendar Year
$200 / Day
1 Per Calendar Year
Ambulance Services Air $1,000 / Day
1 Per calendar Year
$2,000 / Day
1 Per calendar Year
$2,000 / Day
1 Per calendar Year
Lodging Maximum $100 I Day
15 Per calendar Year
$125 / Day
15 Per calendar Year
$150 / Day
15 Per calendar Year
Prosthesis $500 $1,000 $1,500
Transportation $300 / Day
3 Per Calendar Year
$500 / Day
3 Per Calendar Year
$600 / Day
3 Per Calendar Year
Accidental Death $20,000 $20,000 $20,000
Accidental Death on Common earner $40,000 $40,000 $40,000
Dislocation Benefit $1,000 $1,000 $1,000
Fracture Benefit $1,000 $1,000 $1,000
Burn Benefit $7,500 $10,000 $10,000
Coma $10,000 $15,000 $20,000
Dismemberment $10,000 $15,000 $20,000
Paralysis $10,000 $10,000 $10,000
(1) Continuous Care means care received in a Skilled Nursing Facility, Rehabilitation Facility, Rehabilitation Un􀀃 or Home Health Care or Hospice. The Continuous Care must begin within 7 days following discharge from a hospital and be necessary to treat the same condition that caused the hosp􀀃alization. Benefits are payable for a period equal to the length of the preceding hospital stay not to exceed 30 days.

(2) Advanced studies tests consist of the following: Magnetic Resonance Imaging (MRI); Magnetic Resonance Angiography (MRA); Computed Axial Tomography (CAT Scans); Pos􀀃ron Emission Tomography (PET Scans); and Computed Tomography (CT scans).
   
(1) Injury facts. (2014). Itasca, IL: National Safety Council.

(2) Moore, B., Levit, K., & Elixhauser, A. (2014, October). Costs for Hospital Stays in the United States, 2012 #181. Retrieved March 02, 2017, from https://www.hcup-us.ahrq.gov/reports/statbriefs/sb181-Hospital-Costs-United- States-2012.jsp
   
Underwritten by
About Standard Life and Accident Insurance Company

Standard Life and Accident Insurance Company (Standard Life) was founded to provide clients with realistic life and health products that solve their needs for financial security.

Since its inception, more than 70 years ago, the Company's ethic has never changed. "People's needs change from day to day. The shrinking value of the dollar makes insurance protection more important to the individual...We must develop think-ahead programs today which will provide benefits in keeping with the economic changes of tomorrow. While we've grown so fast, it has not been at the expense of the human factor, so vital to this business. Efficiency is emphasized. However, we try never to lose sight of the personal aspects of our relations with policyowners and business clients, as well as our own agents and employees." Leonard H. Savage, President 1948-1973, Standard Life and Accident Insurance Company.

Standard Life and Accident Insurance Company (“Standard Life”) has been evaluated and assigned the following ratings by nationally recognized, independent rating agencies. The ratings are current as of November 2018.

A.M. Best1: A
Standard & Poor's2: A-  

Ratings reflect current independent opinions of the financial capacity of an insurance organization to meet the obligations of its insurance policies and contracts in accordance with their terms. They are based on comprehensive quantitative and qualitative evaluations of the company and its management strategy. The rating agencies do not provide ratings as a recommendation to purchase insurance or annuities. The ratings are not a warranty of an insurer’s current or future ability to meet its contractual obligations. 

Ratings may be changed, suspended, or withdrawn at any time.

1A.M. Best’s active company rating scale is: A++ (Superior), A+ (Superior), A (Excellent), A- (Excellent), B++ (Good), B+ (Good), B (Fair), B- (Fair), C++ (Marginal), C+ (Marginal), C (Weak), C- (Weak) and D (Poor).

2Ratings from ‘AA’ to ‘CCC’ may be modified by the addition of a plus (+) or minus (-) sign to show relative standing within the major rating categories. For a list of Standard & Poor's active company rating scale visit www.standardandpoors.com.


Accident or Accidental means an act or event which is unforeseen, unexpected and unanticipated, definite as to time
and place, which:
Causes Injury to one or more Covered Persons; and
Occurs while the insurance is in force for the Covered Person.
Actively At Work or Active Service means an Employee who is present for at least 20 hours per week at his/her usual
place of employment for the Employer or at another location as assigned or directed by the Employer, and is mentally and
physically capable of performing the regular duties of the job for which he or she is employed.
On any day that is not an Employee’s regularly scheduled work day (vacation, personal days, and weekends/holidays) the
Employee will be considered Actively at Work on such day provided he or she is not absent due to any type of leave and
was Actively at Work on his/her last regularly scheduled work day.
An Employee who usually performs the regular duties of his/her job at their home is considered Actively at Work if they
meet all the above requirements and could work at the Employer’s usual place of employment if required to do so.
Age means a Covered Person’s Age as of his/her last birthday.
Ambulatory Surgical Center means a facility, licensed as such, that provides outpatient surgical services. It does not
include a Physician's or dentist's office, a clinic, or any other such location.
Calendar Year means a period of 12 consecutive months starting on January 1 and ending on December 31 of the same
year.
Certificate Effective Date is the date coverage begins for each Covered Person under the Policy. It will be different for a
Covered Person added to the Policy after the original date of issue or when a change in coverage for any Covered
Person occurs. Each Covered Person’s Certificate Effective Date is shown in the Employee’s Certificate of Coverage
Schedule of Benefits.
Common Carrier means a vehicle that is duly licensed by a proper authority to transport passengers for a fee. Common
Carrier vehicles are limited to airplanes, trains, buses, trolleys and boats that operate on a regularly scheduled basis
between predetermined points or cities. A taxi is not a common-carrier vehicle.
Covered Person means an Employee, an Employee’s spouse or Dependent children, listed as a Covered Person in the
Certificate Schedule of Benefits and for whom premium has been paid.
Dependent means an Employee’s family as follows:
The lawful Spouse, if not legally separated or divorced;
Unmarried children (whether natural, adopted or stepchildren) under the limiting age of 26; or
Unmarried children for whom the Employee is required to provide insurance under a medical support order or an
order enforceable by a court.
Emergency Treatment means covered services provided in a Hospital emergency facility, freestanding emergency
medical care facility, or comparable emergency facility to evaluate and stabilize medical conditions of a recent onset and
severity, including severe pain, that would lead a prudent layperson possessing an average knowledge of medicine and
health to believe that the individual's Injury is of such a nature that failure to get immediate medical care could:
Place the individual's health in serious jeopardy;
Result in serious impairment to bodily functions;
Result in serious dysfunction of a bodily organ or part;
Result in serious disfigurement; or
For a pregnant woman, result in serious jeopardy to the health of the fetus.
Employee means the Employee designated in the Enrollment Form who is Actively at Work and listed in an eligible class
of Employees in the Employer’s application. The Employee must be listed as a Covered Person in the Certificate
Schedule of Benefits and appropriate premium paid in order to be covered under the Policy.
Employer means the entity or plan sponsor to whom the Group Policy is issued and shall include any affiliated entities or
subsidiaries approved by the Company.
SL-VERSEC-14-DE 5
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Enrollment Form means the form(s) that You (and Your spouse, if any) signed to apply for coverage under the Policy. It
also includes any other document approved by the Company that You use to change coverage under the Policy.
Home Health Care means a program of professional, paraprofessional or skilled care for medical services provided
through a Home Health Care Agency to a Covered Person in his/her home. This includes any of the following services:
Nursing services provided by a:
(a) registered nurse;
(b) licensed practical nurse;
(c) licensed vocational nurse; or
(d) a licensed public health nurse;
Physical therapy;
Speech therapy;
Respiratory therapy; or
Occupational therapy.
Home Health Care Agency means an agency or organization which provides Home Health Care services, and:
Is licensed or certified, if required by the jurisdiction in which it is located; or accredited by:
(a) the National Home Caring Council, a Division of the Foundation for Hospice and Home Care;
(b) the Joint Commission Accreditation of Health Care Organizations; or
(c) the National League for Nursing;
Is supervised by a qualified professional such as a registered nurse or a licensed social worker;
Whose Employees receive appropriate specialized training; and
Keeps clinical records, including Physician’s orders where appropriate, on all patients.
Hospice means a licensed agency, organization, or unit that provides a centrally administered and autonomous
continuum of palliative and supportive care to terminally ill persons and their families. The care must be directed and
coordinated by the Hospice organization and received primarily in the patient's home, or on an outpatient or short-term
inpatient basis in a Hospice unit.
Hospital means an institution licensed to operate as a Hospital pursuant to the law of the state in which it is located that
maintains and uses a laboratory, X-ray equipment and an operating room on its premises or in facilities available to it on a
prearranged, written, contractual basis. The institution must also have permanent and full-time facilities for the care of
overnight-resident bed patients under the supervision of one or more licensed Physicians, provide 24-hour-a-day nursing
service by or under the supervision of a registered professional nurse, and maintain the patients' written histories and
medical records on the premises. The term "Hospital" does not include any institution or part thereof used as a
Rehabilitation Unit or Rehabilitation Facility; a Hospice unit, including any bed designated as a Hospice or a swing bed; a
convalescent home; a rest or nursing facility; an extended-care facility; a Skilled Nursing Facility; or a facility primarily
affording custodial or educational care, care or treatment for persons suffering from mental disease or disorders, care for
the aged, or care for persons addicted to drugs or alcohol.
Immediate Family Member means a person who is related to the Covered Person in any of the following ways: Spouse,
brother-in-law, sister-in-law, son-in-law, daughter-in-law, mother-in-law, father-in-law, parent (includes stepparent),
brother or sister (includes stepbrother or stepsister), or child (includes legally adopted child or stepchild).
Injury or Injuries means Accidental bodily Injury sustained by a Covered Person in an Accident that:
Is the direct cause of the condition for which benefits are provided,
Is independent of disease or bodily infirmity or any other cause, and
Occurs while the insurance is in force.
All Injuries sustained in one Accident, including all related conditions and recurring symptoms of the Injuries will be
considered one Injury.
Inpatient or Confined means confined overnight as a registered bed patient in a Hospital or other medical facility where
at least one day’s room and board is charged. Confined or Inpatient does not include a Covered Person’s treatment in an
Ambulatory Surgical Center, emergency room, or an observation room. The confinement must be Medically Necessary.
Intensive Care Unit (ICU) means a specifically designated unit of the Hospital that provides the highest level of medical
care and that is restricted to those patients who are critically ill or injured. Such facilities must be separate and apart from
the surgical recovery room and from rooms, beds, and wards customarily used for patient confinement. The ICU must be
permanently equipped with special lifesaving equipment for the care of the critically ill or injured, and the patients must be
under constant and continual observation by nursing staffs assigned exclusively to the ICU on a full-time basis. These
units must be listed as Intensive Care Units in the current edition of the American Hospital Association Guide or be
eligible to be listed therein. This guide lists three types of facilities that meet this definition: (1) Intensive Care Units,
(2) Cardiac Intensive Care Units, and (3) Infant (Neonatal) Intensive Care Units.
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Medically Necessary means that, based on generally accepted current medical practice, a service or supply is
necessary and appropriate for the diagnosis or treatment of an Injury. We do not consider a service or supply as
Medically Necessary if:
It is provided only as a convenience to the Covered Person or provider;
It is not appropriate treatment for the Covered Person’s diagnosis or symptoms;
It exceeds (in scope, duration or intensity) that level of care that is needed to provide safe, adequate and appropriate
diagnosis or treatment;
It is experimental or investigational.
The fact that a Doctor may prescribe, order, recommend or approve a service or supply does not, of itself, make the
service or supply Medically Necessary.
Mental or Nervous Disorder means any disorder, regardless of its cause or medical origin, which is classified as a
mental disorder by the International Classification of Diseases.  Diagnoses include, but are not limited to: neurosis,
psychoneurosis, psychopathy, psychosis, mental or emotional disease, bipolar affective disorder or autism. Diagnoses do
not include those that are classified as Substance Abuse, substance dependency or mental disorders induced by
Substance Abuse.
Outpatient means the Covered Person is not confined as Inpatient in a Hospital.
Period of Confinement means a time period of continuous confinement as an Inpatient in a Hospital. If the confinement
follows a previously covered confinement, it will be deemed a continuation of the first confinement unless the later
confinement is the result of an entirely unrelated Injury or the confinements are separated by 180 days.
Physician means a licensed practitioner of the healing arts acting within the scope of his/her license who is not:
The Covered Person; or
An Immediate Family Member.
Rehabilitation Facility means an institution licensed by the state where its primary purpose is to provide restorative
therapy to disabled persons. Such facility must be licensed as such in the state in which it operates. "Rehabilitation
Facility" does not include places for custodial care or places for confinement of drug addicts or alcoholics.
Rehabilitation Unit means a unit of a Hospital providing coordinated multidisciplinary physical restorative services to
inpatients under the direction of a Physician who is knowledgeable and experienced in rehabilitative medicine. Beds must
be set up and staffed in a unit specifically designated for this service.
Skilled Nursing Facility means a lawfully operating institution or a distinct part thereof. Such facility must be engaged
mainly in providing skilled nursing care and treatment for people convalescing from an Injury. It must: 1) have organized
facilities for medical services; 2) provide 24 hour a day nursing services under the full-time supervision of a Physician or a
registered nurse; 3) have available the services of a Physician at all times; 4) maintain daily clinical records on each
patient; and 5) provide appropriate methods for dispensing and administering drugs and medicines.
A Skilled Nursing Facility will include the following facilities that are operating within the scope of their lawful licenses:
1) a rehabilitation center; 2) a transitional care unit; 3) an intermediate nursing facility; 4) an extended care facility; and
5) a nursing home.
A Skilled Nursing Facility does not mean a home or facility, or part of home or facility, that is used primarily for: 1) rest;
2) the aged; 3) alcoholics or drug addicts; 4) mental illness or disorders; 5) custodial care; or 6) educational care.
Substance Abuse means psychological or physical dependence on, or addiction to, alcohol, drugs or any other controlled
substances characterized by:
Impairments in social and/or occupational functioning;
Debilitating physical condition;
Inability to abstain from or reduce consumption of the substance; or
The need for daily substance use to maintain adequate functioning.
Substance abuse includes alcohol and drugs but excludes caffeine and tobacco.
You, Your or Yours means the Employee named on the Certificate Schedule of Benefits.
SL-VERSEC-14-DE 7
DEFINITIONS - MEDICAL TERMS
Ankle means the distal fibula, tibia, navicular, and calcaneus bones.
Bone Degeneration Disease means any disease causing bone loss or deterioration of bone structure including but not
limited to the following diagnosis: Osteoporosis, Paget’s disease, osteogenesis imperfecta, bone malignancies,
osteonecrosis, and metabolic bone disease.
Collarbone means the clavicle bones.
Coccyx means four fused vertebrae at the bottom of the spine.
Coma -- means a profound state of unconsciousness that lasts for a period of at least 96 hours and from which the
Covered Person cannot be aroused to consciousness, even by powerful stimulation, as determined by a Physician. This
does not include medically induced comas.
Dislocation means displacement or disarrangement of the normal anatomical relation of the bones in a joint in which
there is loss of contact between articular surfaces.
Finger means the digits of the hand consisting of the proximal, middle and distal phalangeal bones that comprise the four
fingers and the thumb.
Feet or Foot means the part of the lower extremity consisting of the calcaneus bone, cuboid bone, cuneiform bones,
metatarsal bones, navicular bones, phalanges, and the bones which form the ankle. For Fracture or Dislocation
purposes, the Toes are not covered.
Fracture means a break or rupture in the continuity of the bone or cartilage and includes, but is not limited to: complete
fractures; compound fractures; compression fractures; depressed fractures; open fractures; simple fractures.
Green Stick Fracture means a fracture in a soft bone in which the bone bends and partially breaks.
Hairline Fracture means a break that appears as a narrow crack along the surface of the bone.
Hand means a portion of the upper Limb consisting of the wrist, palm, four fingers and thumb. For Fracture or
Dislocation purposes, the Fingers are not covered.
Hip means the femoral neck.
Kneecap means the patella.
Leg means the tibia and fibula and femur/thigh.
Limb means entire arm or entire leg.
Loss of finger or toe means complete severance through or above the metacarpophalangeal joint of a Finger or
metatarsophalangeal joint of a Toe.
Loss of hand or foot means permanent severance of an arm distal to the ulna and radius; or distal to the tibia and fibula
of the leg respectively.
Loss of hearing means total and irrecoverable loss of the ability to perceive sound.
Loss of sight means a total, permanent and irrecoverable loss of perception to light.
Loss of speech means total and irrecoverable loss of the ability to speak.
Lower Arm means the radius and ulna.
Lower Jaw means the mandible.
Lower Leg means the tibia or fibula.
Neck means the seven cervical vertebrae.
SL-VERSEC-14-DE 8
Osteoporosis means a reduction in bone mass and loss of normal bone leading to increased susceptibility to fractures.
Paralysis/Paralyzed means Quadriplegia, Paraplegia, Hemiplegia or Uniplegia that is expected to last for a continuous
period of 12 months or more from the earlier of the date of the Accident causing Paralysis or the date of the diagnosis.
“Quadriplegia” means the complete and irreversible Paralysis of both upper and lower Limbs. “Paraplegia” means the
complete and irreversible Paralysis of both lower Limbs. “Hemiplegia” means the complete and irreversible Paralysis of
the upper and lower Limbs of the same side of the body. “Uniplegia” means the complete and irreversible paralysis of one
Limb.
Pathological Fracture means any Fracture in an area where pre-existing disease has caused weakening of the bone.
Pelvis means the area formed by the pubic bone, ilium, and ischium.
Reduction means manipulative or surgical restoration procedures of a dislocated body part to its normal anatomical
relation.
Second Degree Burn means a burn marked by pain, blistering and superficial destruction of the dermis.
Shoulder Blade means scapula.
Skull means the bones of the head collectively.
Spine/Vertebral Column means 7 cervical, 12 thoracic, 5 sacral, and 4 coccygeal bones.
Sternum means the breastbone located in the center of the chest. This does not include ribs.
Tailbone means the four coccygeal vertebrae.
Third Degree Burn means a burn that causes damage to subcutaneous tissue.
Toe means the digits of the foot consisting of the phalangeal bones that comprise the 5 toes.
Upper Arm means the humerus.
Upper Jaw means the maxilla.
Upper Leg means the femur/thigh.
Wrist means the proximal segment of the hand consisting of the carpal bones.


EXCLUSIONS:
No coverage shall be provided and no benefits will be paid for any loss resulting in whole or in part from, or contributed to,
or as a natural and probable consequence of any of the following:
Suicide or any attempt at suicide or intentionally self-inflicted Injury or any attempt at intentionally self-inflicted Injury
or any act of auto-eroticism, while sane or insane;
Travel or flight in or on (including getting in or out of, or on or off of) any vehicle used for aerial navigation, if the
Covered Person is:
riding as a passenger in any aircraft not intended or licensed for the transportation of passengers;
performing, learning to perform or instructing others to perform as a pilot or crew member of any aircraft; or
riding as a passenger in an aircraft owned, leased or operated by the Covered Person's employer;
Declared or undeclared war, or any act of declared or undeclared war;
Full-time active duty in the armed forces, National Guard or organized reserve corps of any country or international
authority. (Unearned premium for any period for which the Covered Person is not covered due to his/her active duty
status will be refunded. Loss caused while on short-term National Guard or reserve duty for regularly scheduled
training purposes is not excluded.);
The Covered Person’s being intoxicated (defined as blood alcohol concentration equal to or in excess of .08 gms/dl
blood alcohol). This applies whether or not the Covered Person is charged with any violation in connection with a loss
and there is no need to prove a loss was caused, contributed to, or resulted from the excessive blood alcohol
concentration;
The Covered Person’s: a) voluntary use of illegal drugs; b) the intentional taking of over the counter medication not in
accordance with recommended dosage and warning instructions; and c) intentional misuse of prescription drugs;
The Covered Person’s commission of or attempt to commit a felony;
The Covered Person being engaged in an illegal occupation;
Services and supplies which are not Medically Necessary to treat a covered loss (other than as stated in the Wellness
and Preventive Care Benefit);
Services and supplies which are received without charge or legal obligation to pay or would not normally be paid in
the absence of insurance;
Services and supplies which are received outside of the United States of America, its possessions and territories;
Dental care or treatment unless due to an Injury to a sound and natural tooth;
Cosmetic surgery or reconstructive surgery, including breast reduction and surgery to repair, replace, or remove
breast implants; however, this Exception does not apply when surgery is required:
To repair a birth defect of a child born to the Employee and continuously covered under the Policy from birth; or
For reconstructive surgery following a covered mastectomy;
Any covered loss that is covered under any state or federal Workers’ Compensation, Employer’s Liability law or
similar law;
Any Mental or Nervous Disorder or Substance Abuse unless such coverage is expressly provided herein;
Any procedure for refractive correction, eye refraction or the purchase or fitting of vision or hearing aids, Cochlear
Implants and related devices;
Pregnancy or maternity.
SL-VERSEC-14-DE 20
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Participating in hazardous occupations or other activity including participating, instructing, demonstrating, guiding or
accompany others in the following: professional or semi-professional sports, extreme sports, organized body contact
sports, parachute jumping, hot-air ballooning, hang-gliding, base jumping, mountain climbing, bungee jumping, scuba
diving, sail gliding, parasailing, parakiting, rock or mountain climbing, cave exploration, parkour, racing including stunt
show or speed test of any motorized or non-motorized vehicle, rodeo activities, or similar hazardous activities. Also
excluded is Injury received while practicing, exercising, undergoing conditional or physical preparation for such
activity;
A custodial institution, domiciliary care or rest cures;
Weight reduction or treatment of obesity, including exogenous, endogenous or morbid obesity; or
Diagnosis or treatment (including surgery) of sexual dysfunctional disorders or inadequacy, or transsexual surgery.


Benefits described below are payable as stated in the Employee’s Certificate Schedule of Benefits when a Covered
Person receives Medically Necessary treatment while coverage is in force, subject to any applicable terms, exclusions or
limitations.
HOSPITAL BENEFITS
Hospital Admission Benefit:
For the day that a Covered Person is admitted as an Inpatient in a Hospital for treatment of an Injury, the Company will
pay the Hospital Admission Benefit shown in the Certificate Schedule of Benefits.
The Hospital Admission Benefit is payable once during each Period of Confinement.
Hospital Confinement Benefit:
When a Covered Person is Confined to a Hospital for treatment of an Injury in a room for which the Intensive Care Unit
Benefit is not payable, the Company will pay the Daily Hospital Confinement Benefit shown in the Certificate Schedule of
Benefits for each day that a Covered Person is Confined.
The Daily Hospital Confinement Benefit is payable subject to the Maximum Hospital Confinement Benefit Period shown in
the Certificate Schedule of Benefits for each Period of Confinement.
This benefit is not payable if the Covered Person is receiving Intensive Care Unit Benefits under the Policy.
This benefit is not payable if the Covered Person is Confined for the treatment of a Mental or Nervous Disorder or
Substance Abuse.
No benefits are payable for treatment received in an emergency room, any Outpatient setting, skilled nursing facility,
rehabilitation facility, rehabilitation Unit, hospice or any other facility other than a Hospital.
Intensive Care Unit Benefit:
When a Covered Person is confined in and charged for an Intensive Care Unit for treatment of an Injury, the Company will
pay the Daily Intensive Care Unit Benefit shown in the Certificate Schedule of Benefits for each day a Covered Person is
confined in and charged for an Intensive Care Unit.
This benefit is paid in lieu of and not in addition to the Daily Hospital Confinement Benefit under the Policy.
The Daily Intensive Care Unit Benefit is payable subject to the Maximum Intensive Care Unit Benefit Period shown in the
Certificate Schedule of Benefits for each Period of Confinement.
AMBULATORY SURGICAL CENTER BENEFIT
For each day that a Covered Person receives surgery for the treatment of an Injury in an Ambulatory Surgical Center, We
will pay the Ambulatory Surgical Center Benefit listed in the Certificate Schedule of Benefits.
AMBULANCE BENEFIT
For each day that a Covered Person requires ground or air ambulance transportation to a Hospital or other medical facility
for Emergency Treatment of an Injury, the Company will pay the Ground Ambulance Benefit or the Air Ambulance
Benefit, subject to the Maximum Number of Days shown in the Certificate Schedule of Benefits.
A licensed professional ambulance company must provide the ambulance service.
EMERGENCY ROOM BENEFIT
For each day that a Covered Person receives Emergency Treatment in the emergency room of a Hospital or freestanding
emergency medical care facility due to an Injury resulting from a covered Accident, the Company will pay the Emergency
Room Benefit, subject to the Maximum Number of Days shown in the Certificate Schedule of Benefits. To receive
benefits due to an Injury, the Covered Person must seek Emergency Room Treatment within 72 hours of the covered
Accident.
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CONTINUOUS CARE BENEFIT
If a Covered Person is Confined to a Hospital for treatment of an Injury and upon discharge requires Continuous Care,
We will pay the Daily Benefit for each day subject to the Maximum Continuous Care Benefit Period shown in the
Certificate Schedule of Benefits.
Continuous Care means care received in a Skilled Nursing Facility, Rehabilitation Facility, Rehabilitation Unit or Home
Health Care or Hospice care in connection with the condition for which he or she was hospitalized.
The following conditions must be met before Continuous Care benefits are payable:
Continuous Care must begin within 7 days following discharge from Inpatient care in a Hospital;
Continuous Care must be for the same Injury for which the Covered Person was hospitalized;
The Continuous Care must be prescribed by a Physician and must be Medically Necessary for the care and treatment
of the Covered Person’s condition;
Home Health Care services must be performed by a Home Health Care Agency. Home Health Care services cannot
be performed by a person who lives with the Covered Person or by the Covered Person’s Immediate Family Member;
Hospice care services require: (a) a written statement from the attending Physician that the Covered Person has a life
expectancy of six (6) months or less, and (b) a written statement from the Hospice certifying the days that services
were provided.
The Daily Benefit is payable once per day regardless of how many Continuous Care services are provided on that day.
No benefits are payable if the Covered Person is Hospital Confined.
SURGICAL AND ANESTHESIA BENEFITS
Surgery Benefit:
For each day that a Covered Person undergoes a surgical procedure performed by a Physician in the operating room of a
Hospital or an Ambulatory Surgical Center for treatment of an Injury, the Company will pay the Surgery Benefit shown in
the Certificate Schedule of Benefits.
Procedures that are performed or can otherwise be performed in another setting are not covered under this benefit. We
will pay only one daily benefit regardless of the number of surgical procedures occurring in one day, even if caused by
more than one Injury.
Anesthesia Benefit:
For each day that a Covered Person is administered anesthesia during a surgical procedure covered under the Policy, the
Company will pay the Anesthesia Benefit shown in the Certificate Schedule of Benefits.
Services must be administered by a licensed anesthesiologist or certified registered nurse anesthetist (CRNA).
OUTPATIENT PHYSICIAN'S OFFICE VISIT BENEFIT
For each day that a Covered Person visits a Physician’s office, clinic or urgent care facility for treatment of an Injury, the
Company will pay the Physician’s Office Visit Benefit subject to the Maximum Number of Visit Days shown in the
Certificate Schedule of Benefits.
No benefits are payable under this provision for Mental or Nervous Disorders or Substance Abuse.
OUTPATIENT DIAGNOSTIC, X-RAY LAB AND ADVANCED STUDIES BENEFIT
For each day that a Covered Person receives Outpatient Diagnostic X-ray, Lab and Advanced Studies Tests for the
treatment of an Injury, as ordered or performed by a Physician, We will pay the Benefit Amount shown in the Certificate
Schedule of Benefits, subject to the maximum number of test days listed in the Certificate Schedule of Benefits.
“Advanced studies Tests” consist of the following: Magnetic Resonance Imaging (MRI); Magnetic Resonance
Angiography (MRA); Computed Axial Tomography (CAT Scans); Positron Emission Tomography (PET Scans); and
Computed Tomography (CT scans).
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WELLNESS AND PREVENTIVE CARE BENEFIT
For each day that a Covered Person receives Wellness and Preventive Care under the supervision of a Physician, We will
pay the Benefit Amount shown in the Certificate Schedule of Benefits.
Wellness and Preventive Care (care for reasons other than to diagnose or treat a suspected or identified Injury) means
an office visit and related procedures for the following: 1) a routine history and physical examination; 2) cervical
cytological screening (pap test), colorectal cancer screening, prostate cancer screening, routine mammography
screening, or bone density screening; or 3) childhood immunizations as recommended by the Department of Health and
Human Services and Centers for Disease Control and Prevention.
Only one daily benefit will be paid for the combined services listed under Wellness and Preventive Care. The Benefit
Amount is payable subject to the Maximum Number of Days shown in the Certificate Schedule of Benefits.
ACCIDENTAL DEATH BENEFIT
If a Covered Person suffers an Injury that results in the Covered Person’s Death within 90 days of the date of the
Accident that caused the Injury, the Company will pay the Accidental Death Benefit listed in the Certificate Schedule of
Benefits when the Company receives proof that the Covered Person’s death:
Resulted directly and independently of all other causes from the Accident;
Occurs while the coverage is in force.
This benefit is not payable if the Common Carrier Benefit is eligible to be paid.
COMMON CARRIER BENEFIT
If a Covered Person suffers an Injury that results in death and the Accident causing death occurs while riding in or on a
Common Carrier, the Company will pay the Common Carrier Benefit listed in the Certificate Schedule of Benefits. This
benefit is paid in lieu of the Accidental Death Benefit.
This benefit will also apply if the Accident occurs while entering or exiting, getting in or out of, or on or off of, the Common
Carrier. A Taxi is not a Common Carrier.
ACCIDENTAL DISMEMBERMENT BENEFITS
If a Covered Person suffers an Injury that results in a Dismemberment specified in the Certificate Schedule of Benefits
within 90 days of the date of the Accident that caused the Injury, the Company will pay the Benefit Amount listed in the
Certificate Schedule of Benefits.
If a Covered Person suffers one or more losses from the same Accident for which amounts are payable under more than
one benefit category, the amount payable will be limited to only one of the covered losses, the largest to which the
Covered Person is entitled.
PARALYSIS BENEFIT
If a Covered Person is Paralyzed due to an Injury, the Company will pay the applicable Benefit Amount shown in the
Certificate Schedule of Benefits for that type of Paralysis.
If the Covered Person suffers more than one type of Paralysis as a result of the same Accident, only one amount, the
largest, will be paid.
PROSTHESIS BENEFIT
If a Covered Person suffers an Injury that requires initial placement of an external Prosthesis, the Company will pay the
Prosthesis Benefit shown in the Certificate Schedule of Benefits.
Prosthesis means a device which replaces all or part of an external body part or replaces all or part of the function of a
permanently inoperative or malfunctioning external body part. Prosthesis does not mean a device or appliance surgically
inserted into the body and does not include:
dental aids, including false teeth,
eyeglasses,
cosmetic prosthesis such as hair wigs,
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other types of prosthesis devices that are permanently implanted such as artificial hip or tooth,
any experimental prosthesis,
any auditory prosthesis (a device that substitute for or enhances ability to hear).
No benefits are payable for the replacement of external prosthetic devices.
COMA BENEFIT
If a Covered Person suffers an Injury that results in a Coma, the Company will pay the Coma Benefit shown in the
Certificate Schedule of Benefits.
This benefit is payable once during each Period of Confinement.
No benefits are payable for medically induced comas.
FRACTURE BENEFIT
If a Covered Person suffers an Injury that results in the diagnosis and treatment by a Physician for a Fracture specified in
the Certificate Schedule of Benefits within 30 days of the date of the Accident that caused the Injury, the Company will
pay the Benefit Amount listed in the Certificate Schedule of Benefits.
In the event of multiple Fractures during the same Accident, only one covered Fracture Benefit, the largest to which the
Covered Person would be eligible to receive, will be payable.
The Fracture must require Reduction of the bone under anesthesia to be covered under this provision.
No benefits are payable for:
Pathological Fracture;
Hairline Fracture or Green Stick Fracture;
Fractures to the Toes or Fingers; or
Fractures when Bone Degeneration Disease was diagnosed prior to the Covered Person’s Certificate Effective Date,
regardless if the Bone Degeneration Disease contributed to the Injury or not.
If a Covered Person is diagnosed as having Bone Degeneration Disease after their Certificate Effective Date and suffers
a Fracture, the first Fracture will be covered under the regular terms of the Policy. However, after the first, all further
Fractures of any area payable under the Policy will be reduced by 50%. This limitation applies regardless if the Bone
Degeneration Disease contributed to the Injury or not.
DISLOCATION BENEFIT
If a Covered Person suffers an Injury that results in diagnosis and treatment by a Physician for a Dislocation specified in
the Certificate Schedule of Benefits within 30 days of the date of the Accident that caused the Injury, the Company will
pay the Benefit Amount listed in the Certificate Schedule of Benefits.
The Dislocation must require Reduction of the joint or bone to a normal position under anesthesia to be covered under
this provision.
In the event of multiple Dislocations during the same Accident, only one covered Dislocation Benefit, the largest to which
the Covered Person would be eligible to receive, will be payable.
No benefits are payable for:
Dislocations of the Toes or Fingers;
Subsequent Dislocations of the hip, shoulder or knees after the first Dislocation; or
Dislocations when Bone Degeneration Disease was diagnosed prior to the Covered Person’s Certificate Effective
Date, regardless if the Bone Degeneration Disease contributed to the Injury or not.
If a Covered Person is diagnosed as having Bone Degeneration Disease after their Certificate Effective Date and suffers
a Dislocation, the first Dislocation will be covered under the regular terms of the Policy. However, after the first, all further
Dislocations of any area covered under the Policy will be reduced by 50%. This limitation applies regardless if the Bone
Degeneration Disease contributed to the Injury or not.
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BURN BENEFIT
If a Covered Person suffers an Injury that results in diagnosis and treatment by a Physician for a Second Degree Burn or
Third Degree Burn listed in the Certificate Schedule of Benefits, the Company will pay the Benefit Amount listed in the
Certificate Schedule of Benefits.
The Company has a right, at Our own expense, to have the Physician’s determination verified by a Physician of the
Company’s choice.
In the event of multiple Burns during the same Accident, only one covered Burn Benefit, the largest to which the Covered
Person would be eligible to receive, will be payable.
TRANSPORTATION BENEFIT
For each day that a Covered Person requires transportation by private automobile, aircraft, railroad, or bus between
his/her residence to a Hospital for treatment of an Injury, the Company will pay the Transportation Benefit subject to the
Maximum Number of Days shown in the Certificate Schedule of Benefits.
This benefit will be paid for the Covered Person for whom the treatment is prescribed by a Physician and, except for
transportation by private automobile, one adult Immediate Family Member of the Covered Person.
No benefits are payable for transportation to any Hospital located within a 100 mile radius of the residence of the Covered
Person or for transportation by ambulance.
LODGING BENEFIT
For each day that a Covered Person requires treatment of an Injury at a Hospital located more than 100 miles from
his/her residence that necessitates lodging at a motel, hotel or other Company approved facility for the Covered Person or
any one of his/her adult Immediate Family Members, the Company will pay the Lodging Benefit shown in the Certificate
Schedule of Benefits.
We will pay benefits subject to the Maximum Number of Days shown in the Certificate Schedule of Benefits.
This benefit does not apply to private residences. No benefits are payable for lodging occurring more than 24 hours prior
to treatment or for lodging occurring more than 24 hours following treatment.





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