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Level One
Age
Employee
Employee
& Spouse
Employee
& Children Family
18-50
$2.98
$5.96
$6.93
$9.91
51-67
$3.41
$6.82
$7.36
$10.77
Level Two
18-50
$3.55
$7.09
$8.28
$11.83
51-67
$3.98
$7.95
$8.71
$12.68
Level Three
18-50
$4.02
$8.04
$9.77
$13.79
51-67
$4.45
$8.90
$10.20
$14.65
Level Four
18-50
$4.45
$8.89
$10.93
$15.38
51-67
$4.88
$9.75
$11.36
$16.24
Accident Insurance
This voluntary plan offered through Humana offers coverage for accidents, injuries, ambulance services, and accidental
death in addition to your primary medical insurance. It’s also available to your spouse and children.
The following is displaying weekly payroll
deductions.
Benefit:
Level
One
Level
Two
Level
Three
Level
Four
Accident medical expense:
Pays the actual expenses up to the amount
selected for diagnosis or treatment by a physician or in an emergency
room. ER subject to a $50 deductible.
$500
$1,000
$1,500
$2,000
Ambulance:
Pays actual expenses up to the amount selected if injury
requires ground or air ambulance transportation.
$250
$500
$750
$1,000
Hospital indemnity:
Pays a benefit equal to the amount selected if an
injury requires inpatient hospital confinement, including a room charge,
that starts within 30 days after the accident. The benefit is limited to 30
days per accident.
$75
$150
$225
$300
Accidental death, dismemberment and loss of sight (AD&D):
Loss of life
Any combination of two or more hands, feet, or eyes
Loss of single hand, foot or eye
Multiple fingers and/or toes
Single finger or toe
$5,000
$5,000
$2,500
$500
$250
$10,000
$10,000
$5,000
$1,000
$500
$15,000
$15,000
$7,500
$1,500
$750
$20,000
$20,000
$10,000
$2,000
$1,000