Now there’s help if you suffer an accident.
Accidents are a part of everyday life, but are you prepared for the added financial
burden? If you have a serious accident, you’ll want extra cash to help pay your
increased expenses. Accident insurance pays benefits you can use for medical bills
and other out-of-pocket expenses – or for any other purpose, including paying your
mortgage or other bills. Your medical insurance may not take care of all of the added
expenses you’ll have after an accident.
Extended physical therapy benefits, emergency room treatment, and more.
Your life won’t get a time out because of an accident. You’ll want your family
protected. This policy helps provide protection for you and your insured family every
day of the year for covered accidents. Pays benefits for:
• Accident only emergency benefit, including X-rays and physician care received
within 96 hours of an accident
• Accident only follow-up visits and physical therapy benefit, which could be
important for recovery
• Initial accident only hospitalization benefit, including ambulance and intensive care
These benefits are paid directly to you, not to your doctor or hospital. You can use
this money for anything you need. The extra cash can really help you and your family
during a difficult time.
Help Protect yourself, your spouse, and your eligible dependents.
Employee and spouse issue ages are 18 and up, eligible children through age 25.
This is a brief summary of AccidentAdvance, Accident Insurance.
Policy form series CPACC100 and CCACC100.
Forms and form numbers may vary, coverage available where approved.
Limitations and Exclusions apply. Refer to the policy, certificate and riders for complete details.
CAV01C-0114
Help offset your major
medical deductible with
benefits paid directly to you
Spouse and children
coverage available
Convenient payroll deduction
Guarantee issue available
Competitively priced premiums
You can keep this insurance
if you change jobs or retire
Up to date information regarding our compensation practices can be found in the Disclosures section of our website at: www.tebcs.com.
Underwritten by Transamerica Life Insurance Company, Cedar Rapids, Iowa.
Everyone deserves
a better Tomorrow.
AccidentAdvance
SM
is accident
insurance designed to be cost-effective
as it provides valuable benefits.
Heifer
Plan 1
24 Hour
Module 1 Accident Emergency Treatment
Accident Emergency Treatment Benefit
For physician treatment and X-rays in a hospital
emergency
room or
doctor's
office
within
96 hours of the accident.
$
125
Major Diagnostic Examination Benefit
For one CT Scan, MRI, or EEG completed within 90 days of
the accident.
$
200
Dislocation Benefit
Reduction
Payable for joint dislocation reduced
under general anesthesia. Dislocation
reduced without general anesthesia paid
at 25% of the joint's benefit amount.
Multiple
reduced dislocations are paid at 1
1/2 times
the highest benefit amount. No
other
amount will be paid under this
benefit.
Dislocated Joint
Open
Closed
Hip
$
4,000
Knee or Shoulder
$
1,350
$
550
Collar Bone
$
2,150
$
400
Ankle or Foot (except toes)
$
1,350
$
400
Lower Jaw
$
1,350
$
700
Wrist or Elbow
$
1,100
$
550
Toe or Finger
$
300
$
150
Fractures Benefit
Reduction
Fractured Bone
Open
Closed
For repair of a fracture sustained in an
accident. A chip fracture is paid at 10% of
the fracture's benefit amount. Multiple
repaired fractures are paid at 1 1/2 times
the
highest benefit amount. No other
amount
will be paid under this benefit.
Coccyx
$
700
$
350
Hand (except fingers), Foot
(except toes/heel), Wrist,
Shoulder Blade, Forearm,
Ankle, Elbow, Kneecap,
Sternum or Lower Jaw
$
1,700
$
850
Hip
$
5,000
$
1,700
Leg
$
2,100
$
1,700
Nose, Heel or Fingers
$
1,700
$
350
Ribs
$
3,350
$
350
Skull
$
1,000
$
2,700
Toes
$
700
$
350
Upper Jaw, Upper Arm or
Face (except Nose),
Collar Bone
$
2,000
$
850
Vertebrae, Pelvis
$
850
$
850
Vertebral Processes
$
3,350
$
500
For both dislocations and fractures, 1 1/2 times the highest dislocation or fracture benefit amount is paid.
No other dislocation or fracture benefit is paid.
5.00
Units
$
1,350
QT0000090646-01
Transamerica Life Insurance Company
Module 2 Follow-Up Visits and Physical Therapy
5.00
Units
Accident Follow-Up Treatment Benefit
Maximum of three (3) follow-up visits per accident. Original treatment
must have been within 96 hours of the accident. Treatment must be
provided by a physician in their office or in a hospital on an outpatient
basis; begin within 30 days of, and be completed within the 6 months
following the later of: the accident; discharge from the hospital from a
covered confinement; or discharge from an extended care facility.
Physical Therapy Benefit
$
50
For treatments by a licensed physical therapist under a physician's
advice that begin within 120 days of the accident and are completed
within 1 year of the accident, not to exceed 10 treatments per accident.
$
50
Module 3 Initial Accident Hospitalization
5.00
Units
Initial Accident Hospitalization
Benefit
Payable once for the first hospital admission due to an accident. Benefit
is payable once for the first Intensive Care Unit admission due to an
accident. The ICU benefit is paid even if admitted to the hospital initially
and then transferred to ICU later during the same hospitalization.
$
1,500
Ambulance Benefit
Ground Ambulance
$
300
For transportation to the nearest hospital
for treatment within 96 hours of the
accident by a licensed ambulance service.
Air Ambulance
$
1,500
Additional Riders
Accidental Death and Dismemberment Rider (Form No.
CRADD300
)
4.00
Units
Accidental Death Benefit
Death must result from and occur within
90 days
of the accident. Only one of the following benefits will be paid per
covered person per accident and will be reduced by any dismemberment benefits previously paid for the same accident.
Child benefit is 50% of the benefit amount.
Common Carrier Accidental Death
For death resulting from a covered accident that occurs while riding
as a fare-paying passenger on a mode of public transportation
$120,000
Automobile Accidental Death
If the covered person was:
wearing and properly utilizing a seat belt and was seated in a
position protected by an air bag system that deployed during the
accident, as evidenced by police report.
$88,000
wearing and properly utilizing a seat belt, as evidence by police
report, but an air bag was not present or was not deployed.
$80,000
not wearing a seat belt.
$60,000
Benefits are not payable if a covered person was driving without a valid drivers' license
Other Accidental Death
Other than those described above.
Transportation of Remains Benefits
For transporting remains to a mortuary near the covered person's
primary residence if death occurs more than 200 miles from primary
residence.
Child benefit is 50% of the benefit amount.
$40,000
$1,600
QT0000090646-01
Transamerica Life Insurance Company
Additional Benefits for Accidental Death
If an accidental death benefit is payable, the following benefits will be paid to the survivor. A reduced benefit will be paid
to the beneficiary if no eligible survivor. Benefits do not require a spouse or child to be covered under this rider.
Surviving Child Educational Benefit
Payable for each eligible child ages 17 through 21, who is a full-time
student at an accredited college, university, 2-year college,
vocational or trade school within 365 days of the accidental death.
Payable each year for up to 4 years while the child remains a
full-time student.
Licensed Day Care Center Benefit
Child must be between newborn and 12 years old, attend a licensed
day care, which is not an immediate family member, within 90 days
from the accidental death date. Day care must be necessary for the
survivor to work or obtain training for work.
Career Enrichment Benefit
Survivor must be a full-time student at a professional or trade
training program from an accredited college, university, 2-year
college, vocational, or trade school within 24 months of the
accidental death. Training must be for the purpose of obtaining an
independent source of income or enriching the survivor's ability to
earn a living. This benefit will be paid for up to 4 years while the
survivor remains a full-time student. Benefit not available for
children.
$3,200
Accidental Dismemberment Benefits
Dismemberment must occur within
90
days
of the accident. If accidental death
benefit is payable after dismemberment
benefits have been paid for the same
accident, we will deduct the
dismemberment benefits paid from the
accidental death benefit due. Child
benefit is 50% of the benefit amount.
One or more fingers or toes
$2,000
One eye, hand, foot,
arm or leg
$8,000
Two eyes, hands or feet
$20,000
Speech
or
hearing
in both ears
$20,000
Two arms or two legs
$20,000
Speech
and
hearing
in both ears
$40,000
Both arms and both legs
$40,000
Total dismemberment benefits per covered person per accident will not
exceed:
$40,000
$3,200
$1,200
Accident Hospital and ICU Income Rider (Form No. CRHICU00)
10.00
Units
Accident Hospital Income Benefit
For hospital confinement
for treatment of
injuries beginning within
30
days of the accident. Benefit is payable for up to 365 days per accident.
$250
Accident ICU Benefit
For ICU confinement while the person is receiving the hospital income
benefit. Benefit is payable for up to 15 days per accident.
$750
QT0000090646-01
Transamerica Life Insurance Company
Expanded
Benefits Rider (Form No. CREXPB00)
10.00
Units
The following benefits are payable once, per person, per accident for injuries sustained in a covered accident.
Burns
Must be treated by a
physician within 96 hours of
the accident. One or more
skin grafts for a covered
burn will be paid at 50% of
the burn benefit amount paid
for the burn involved.
Second-degree burns of body surface:
At least 25%, but not more than 35%
$600
More than 35%
$1,500
Third-degree burns of body surface:
6 through 10 square centimeters
$1,500
10 through 25 square centimeters
$4,000
25 through 35 square centimeters
$9,000
more than 35 square centimeters
$12,000
Lacerations
Must be treated or repaired
within 96 hours of the
accident.
Lacerations not requiring sutures
$40
Single laceration less than 7.5 centimeters
$80
Lacerations 7.6 to 20 centimeters
$300
Lacerations over 20 centimeters
$600
Eye Injury
With surgical repair
$400
Non-surgical removal of foreign body by physician
$70
Emergency
Dental Work
One or more broken teeth repaired with crowns
$300
One or more broken teeth resulting in extractions
$80
Brain Concussion
Must be diagnosed by a physician within 96 hours of the accident.
$200
Coma
Unconsciousness for 14 consecutive days with no reaction to external
stimuli, no reaction to internal needs and require the use of life support
systems.
$15,000
Paralysis
Lasting a minimum of 30 days
Quadriplegia (paralysis of four limbs)
$15,000
Paraplegia (paralysis of lower limbs)
$7,500
Tendons, Ligaments and/or Rotator Cuffs
Must be detached, torn, ruptured or severed
and surgically repaired by a physician within
one (1) year of the accident. Only one of the
benefits is payable.
Arthroscopic surgery with:
No repair
$200
One repair
$500
Two or more repairs
$1,000
Ruptured Discs and/or
Torn Knee Cartilage
Must be surgically repaired by a
physician within one (1) year of
the accident. Only one of the
benefits is payable.
Shaved cartilage or
arthroscopic
surgery
with:
$200
One repair
$500
Two or more repairs
$1,000
No
repair
QT0000090646-01
Transamerica Life Insurance Company
Major Surgery
For an open abdominal, cranial or thoracic surgery performed by a
physician within 1 year of the accident. Laparoscopic procedures are
excluded.
$1,500
Appliance
For a physician-recommended medical appliance to aid personal
locomotion, such as crutches, leg braces, wheelchairs and walkers.
This benefit is not payable for prosthetic devices
.
$200
Prosthetic Devices
For one or more prosthetic devices received
within 1 year of the accident. This benefit is
not payable for hearing aids, dental aids
(including false teeth), glasses, cosmetic
prosthetic devices
, such as wigs, or
joint
replacement, such as an artificial hip or
knee.
One prosthetic device
$750
Two or more prosthetic
devices
$1,500
Blood, Plasma and Platelets
Required for the treatment of injuries due to a covered accident.
Immunoglobulin is not covered.
$400
Transportation
Benefit is payable for up to 2 round trips to the hospital per accident per
covered person if special treatment and hospital confinement occurs
within 30 days of the accident. The local attending physician must
prescribe treatment that is not available locally. Benefit is not payable
for transportation to any hospital within a 100-mile radius of the accident
site or covered person's residence.
$600
Family Lodging Benefit
Benefit is payable per day, maximum of 30 days, for one motel/hotel
room for a member of the immediate family to accompany the covered
person for treatment of injuries prescribed by a physician. Hospital
confinement must be in a facility at least 100 miles from the covered
person's residence and confinement must begin within 30 days of the
accident.
Benefits are not payable for services rendered by an
immediate family member.
$150
6.00
Units
After a 30-day waiting period, benefit is payable per calendar year for one annual health screening test listed for the
covered
employee
and one test for a covered spouse.
Blood test for triglycerides
Bone marrow testing
Breast ultrasound
CA 125 (blood test for
ovarian cancer)
CA 15-3 (blood test for
breast cancer)
CEA (blood test for colon cancer)
Chest X-ray
Colonoscopy
Fasting blood glucose test
Flexible sigmoidoscopy
Hemocult stool analysis
Mammography
Pap Test
PSA (blood test for prostate cancer)
Serum cholesterol test to determine
HDL/LDL level
Serum Protein Electrophoresis
(blood test for myeloma)
Stress test on a bicycle or treadmill
Thermography
$60
Wellness Benefit Rider (Form No. CRWELB00)
QT0000090646-01
Transamerica Life Insurance Company
We will not pay benefits for losses caused by or as a result of a covered person:
Driving any taxi for wage, compensation or profit;
Mountaineering, parachuting or hang gliding;
Voluntarily
taking, administering, absorbing or inhaling poison, gas or fumes;
Alcoholism or drug addiction;
Participating in any sport or sporting activity for wage, compensation, profit, or racing any type of vehicle in an
organized event;
Traveling in or descending from any vehicle or device for aerial navigation, except as a fare paying passenger in an
aircraft operated by a commercial airline (other than a charter airline) on a regularly scheduled passenger trip;
War, or any act of war, whether declared or undeclared
;
Participating in any activity or event, including the operation of a vehicle, while intoxicated or under the influence
according to the laws of the jurisdiction in which the accident occurred;
Participating in a riot, civil commotion, civil disobedience or unlawful assembly;
Committing, attempting to commit, or taking part in a felony or assault or engaging in an illegal occupation;
Intentionally self-inflicting bodily injury or attempting suicide while sane
or insane;
Any loss incurred while on active duty status in the armed forces. If you notify us of such active duty, we will refund
any premiums paid for any period for which no insurance is provided as a result of this exception.
Termination of Insurance
Subject to the Portability Option, insurance on the
employee
will end on the earliest of:
the date of his or her death;
the date he or she ceases to be eligible for insurance
;
the last date for which premium payment has been made to us, subject to the grace period;
the date he or she terminates
employment
;
the date the group master policy terminates;
the date he or she sends us a written notice to cancel insurance.
The insurance
on a dependent will cease on the earliest of:
the date of the
employee
's death;
the date the
employee
's insurance terminates;
the last date for which premium payment has been made to us, subject to the grace period;
the date the dependent no longer meets the definition of dependent;
the date the certificate is modified so as to exclude dependent insurance;
the date the
employee
sends us a written notice to cancel insurance on a dependent.
Extension of Benefits
Whenever termination of insurance under this section occurs due to termination of
employment
, such termination will be
without prejudice to:
any hospital confinement which began while insurance
was in force; or
any covered treatment or service for which benefits would be provided and which began while insurance
was
in
force; provided, however that the covered person is and continues to be hospital confined or receiving
treatment.
Such Extension of Benefits will continue for up to the earlier of:
30
days; or
the date on which the covered person is no longer
hospitalized or receiving treatment
.
Portability
Option
If
an
employee
loses eligibility for this insurance for any reason other than nonpayment of premiums, insurance can be
continued by paying the premiums directly to us within 31 days after termination. We will bill the
employee
directly once
we receive notification to continue your insurance.
QT0000090646-01
Transamerica Life Insurance Company
Termination of the Group Master Policy
The policyholder may end the policy on any premium due date by submitting a 60-day advance written notice. A group
will not be continued if it drops below the minimum required participation. The group master policy will be terminated and
coverage of all remaining insureds will end
, subject to the Portability Option.
Other Insurance with Us
An individual can only have one accident policy or certificate with us. An individual can only have one disability income
policy, certificate, or rider with us. If a person already has accident insurance with us, such person is not eligible to apply
for this coverage. If a person already has
disability income insurance with us, such person is not eligible to apply for
the
disability income riders.
QT0000090646-01
Transamerica Life Insurance Company
