Accident Insurance

Accident Insurance

Accident Insurance pays you benefits for specific injuries and events resulting from a covered accident. The amount of benefit depends on the type of injury and the care received. The Accident Insurance Plan pays benefits for accident-related hospital care, follow-up care, common injuries, and emergency care. Accident Insurance is not health coverage, like the Company medical plans, but is a limited benefit policy that supplements your health coverage.

In addition to accident-specific benefits, the plan also provides you and your covered dependents with an annual wellness benefit if you receive a covered health screening.

 

How Accident Insurance Can Help

Accidents are among the highest-cost medical events and can result in large out-of-pocket expenses. Accident insurance can bridge the gap in your medical coverage by helping to pay your medical plan’s deductible and coinsurance.

You can use your accident insurance benefits to pay for your medical plan expenses and living expenses, such as:

• Medical plan deductibles and coinsurance
• Home health care costs
• Mortgage and rent
• Everyday expenses like utilities and groceries

 

Eligibility

• You—all active employees working 20+ hours per week. You are automatically enrolled at no cost to you if you are enrolled in a Company medical plan. If you are not enrolled in a Company medical plan, you have the opportunity to enroll for accident insurance when you are newly hired and during the annual Open Enrollment. 
• Your spouse or domestic partner—coverage is available only if you are enrolled in accident insurance. Spouses/domestic partners receive the same benefit as you.
• Your child(ren)—to age 26. Coverage is available only if you are enrolled in accident insurance. Children receive the same benefit as you. Note: If both you and your spouse/domestic partner are covered under the policy as an employee, then only one, but not both, may cover the same child(ren) under this benefit.

 

Cost

If you are enrolled in a Company medical plan

If you are enrolled in a Company medical plan, you will be automatically enrolled in the accident insurance plan at no cost to you. You may purchase coverage for your dependents through convenient payroll deductions at the following rates:

• Employee + Spouse/DP: $5.09
• Employee + Child(ren): $7.09
• Employee + Spouse/DP + Child(ren): $12.18

 

If you are not enrolled in a Company medical plan

If you are not enrolled in a Company medical plan, you will have the option to purchase coverage for yourself and your dependents through convenient payroll deductions at the following rates:

• Employee only: $5.73
• Employee + Spouse/DP: $10.82
• Employee + Child(ren): $12.82
• Employee + Spouse/DP + Child(ren): $17.91

 

Accident Insurance Benefits

 

EVENT	BENEFIT
Accident hospital care
Surgery open abdominal, thoracic	$2,500
Surgery exploratory or without repair	$350
Blood, plasma, platelets	$650
Hospital admission	$2,000
Hospital confinement per day, up to 365 days	$350
Critical care unit confinement per day, up to 15 days	$700
Rehabilitation facility confinement per day, up to 90 days	$225
Coma duration of 14 or more days	$11,500
Transportation per trip, up to one per accident	$840
Lodging per day, up to 30 days	$225
Accident care
Initial doctor visit	$120
Urgent care facility treatment	$300
Emergency room treatment	$300
Ground ambulance	$300
Air ambulance	$2,500
Follow-up doctor treament	$120
Medical equipment	$500
Physical or occupational therapy up to six per accident	$75
Prosthetic device (one)	$1,500
Prosthetic device (two or more)	$2,400
Common injuries
Burns second degree, at least 36% of the body	$1,750
Burns 3rd degree, at least nine but less than 35 square inches of the body	$10,000
Burns 3rd degree, 35 or more square inches of the body	$22,000
Skin grafts	50% of burn benefit
Emergency dental work while hospital confined	$480 crown, $180 extraction
Eye injury removal of foreign object	$120
Eye injury surgery	$420
Torn knee cartilage surgery with no repair or if cartilage is shaved	$280
Torn knee cartilage surgical repair	$1,000
Ruptured disk surgical repair	$1,000
Tendon/ligament/rotator cuff exploratory arthroscopic surgery with no repair	$720
Tendon/ligament/rotator cuff one, surgical repair	$1,020
Tendon/ligament/rotator cuff two or more, surgical repair	$1,520
Concussion	$450
Paralysis paraplegia	$20,000
Paralysis quadriplegia	$30,000
Lacerations
Laceration benefits are a total of all lacerations per accident.
Laceration treated no sutures	$60
Laceration sutures up to 2”	$120
Laceration sutures 2” – 6”	$480
Laceration sutures over 6”	$960
Dislocations	Closed reduction	Open reduction
Closed Reduction of Dislocation = Non-surgical reduction of a completely separated joint. Open Reduction of Dislocation = Surgical reduction of a completely separated joint.
Hip joint	$3,200	$6,400
Knee	$2,000	$4,000
Ankle or foot bone(s) other than toes	$1,200	$2,400
Shoulder	$1,500	$3,000
Elbow	$900	$1,800
Wrist	$900	$1,800
Finger/toe	$250	$500
Hand bone(s) other than fingers	$900	$1,800
Lower jaw	$900	$1,800
Collarbone	$900	$1,800
Partial dislocations	25% of the closed reduction amount
Fractures	Closed reduction	Open reduction
Closed Reduction of Fracture = Non-surgical. Open Reduction of Fracture = Surgical.
Hip	$3,000	$6,000
Leg	$2,500	$5,000
Ankle	$1,200	$2,400
Kneecap	$1,200	$2,400
Foot excluding toes, heel	$1,200	$2,400
Upper arm	$1,400	$2,800
Forearm, hand, wrist except fingers	$1,200	$2,400
Finger, toe	$160	$320
Vertebral body	$2,240	$4,480
Vertebral processes	$960	$1,920
Pelvis except coccyx	$2,250	$4,500
Coccyx	$400	$800
Bones of face except nose	$800	$1,600
Nose	$400	$800
Upper jaw	$1,000	$2,000
Lower jaw	$960	$1,920
Collarbone	$960	$1,920
Rib or ribs	$500	$1,000
Skull – simple except bones of face	$5,000	$10,000
Skull – depressed except bones of face	$2,000	$4,000
Sternum	$700	$1,400
Shoulder blade	$1,200	$2,400
Chip fractures	25% of the closed reduction amount

 

 

Accident insurance example

Lisa wasn’t sure she’d be able to cover her medical expenses after she broke her leg in a car accident while out of town with friends. Thanks to her accident insurance coverage, Lisa was able to use the benefits to help pay for her medical bills, as well as to offset her time away from work while going to various doctor appointments.

Item	Lisa's Costs	Accident Insurance Benefit
Ground ambulance	$1,050	$300
Emergency room treatment	$2,200	$300
Leg fracture	Incl. in ER treatment	$2,500
Transportation (one trip)	$85	$840
Lodging (one night)	$150	$225
Medical equipment	$300	$500
Follow-up doctor visit	$125	$120
Total	$3,910	$4,785

 

Accident Insurance Wellness Benefit

The plan provides the following annual benefit if you complete a health screening test:

• You: $75
• Your spouse/domestic partner: $75
• Your child: $75 per child

This wellness benefit is payable once per year. If you receive multiple health screenings, you will only receive one benefit from this plan. 

Screenings include, but aren't limited to:

• Blood test for triglycerides
• Flexible sigmoidoscopy
• Bone marrow testing
• Hemoccult stool analysis
• Breast ultrasound
• Mammography
• CA 15-3 (breast cancer)
• Fasting blood glucose test
• PSA (prostate cancer)
• Pap smear
• CEA (blood test for colon cancer)
• Serum cholesterol test for HDL & LDL levels
• Serum Protein Electrophoresis (myeloma)
• Chest x-ray
• Colonoscopy
• Stress test on bicycle or treadmill
• Thermography
• Any cervical cancer screening test approved by the FDA

 

Filing Claims

You can file an accident insurance or wellness benefit claim by phone or online. To file your claim by phone, call Voya at 877-236-7564.

To file your claim online, visit the Voya Claims Center.

• For an accident insurance claim, click the "Get Started" button under "Start a Claim" and follow the instructions.
• For a wellness benefit claim, click the “Start Your Claim” button in the “Have a Wellness Benefit Claim?” section and follow the instructions.

Have the following information available:

• The group number (CMSU's group number is 694924).
• The name, date of birth, and Social Security Number of the patient and his or her relationship to you.
• For accident insurance claims, you will need to provide accident details (dates, times, who was involved) and supporting documentation of your accident such as emergency records, itemized bills, or admittance/discharge summary.
• For wellness benefit claims, provide the type of health screening, medical provider, and the test date.

 

Exclusions and Limitations

Benefits are not payable for any loss caused in whole or directly by any of the following:

• Participation or attempt to participate in a felony or illegal activity.
• An accident while the covered person is operating a motorized vehicle while intoxicated. Intoxication means the covered person’s blood alcohol content meets or exceeds the legal presumption of intoxication under the laws of the state where the accident occurred.
• Suicide, attempted suicide or any intentionally self-inflicted injury, while sane or insane.
• War or any act of war, whether declared or undeclared, other than acts of terrorism.
• Loss that occurs while on full-time active duty as a member of the armed forces of any nation. Voya will refund, upon written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion.
• Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a doctor.
• Riding in or driving any motor-driven vehicle in a race, stunt show or speed test.
• Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any aircraft or hot air balloon, including those which are not motor-driven. Flying as a fare-paying passenger is not excluded.
• Engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting, kite surfing or any similar activities.
• Practicing for, or participating in, any semiprofessional or professional competitive athletic contests for which any type of compensation or remuneration is received.
• Any sickness or declining process caused by a sickness.
• Work for pay, profit or gain, if the employer elects to exclude work-related sicknesses or accidents under the policy.

 

For More Information

Visit the Voya website to learn more about accident insurance and file a claim
Review the accident insurance summary plan description