Occupational Accident Insurance - Benefit Plans Summary
Plan A provides higher limits and lower deductibles.
Plan A |
Plan B |
|
|---|---|---|
Accident Medical Expense Benefits |
||
| Deductible Amount | $100 | $200 |
| Combined Single Limit (CSL) Per Covered Loss | $500,000 | $400,000 |
| Aggregate Limit of Liability | $1,000,000 | $800,000 |
(Applicable to all Covered Losses from any one Occupational Accident)
Death & Catastrophic Injury Benefits |
||
|---|---|---|
| Accidental Death Benefit | ||
| Principal Sum* | $50,000 | $25,000 |
| Accident Commencement Period | 365 Days | 365 Days |
| Survivor’s Death Benefit | ||
| Principal Sum* | $100,000 | $75,000 |
| Monthly Benefit Amount | $1,000 | $750 |
| Accidental Dismemberment Benefit | ||
| Principal Sum* | $150,000 | $100,000 |
| Accident Commencement Period | 365 Days | 365 Days |
| Paralysis Benefit | ||
| Principal Sum* | $150,000 | $100,000 |
| Accident Commencement Period | 365 Days | 365 Days |
Temporary Total Disability Benefit |
||
|---|---|---|
| Disability Commencement Period | 90 Days | 90 Days |
| Waiting Period | 7 days | 10 days |
| Benefit Percentage of Average Weekly Earnings | 70% | 66.66% |
| Minimum Weekly Benefit Amount | $125 | $125 |
| Maximum Weekly Benefit Amount | $500 | $400 |
| Maximum Benefit Period** | 104 Weeks | 104 Weeks |
Continuous Total Disability Benefit |
||
|---|---|---|
| Waiting Period | 104 Weeks | 104 Weeks |
| Benefit Percentage of Average Weekly Earnings | 70% | 66.66% |
| Minimum Weekly Benefit Amount | $50 | $50 |
| Maximum Weekly Benefit Amount | $500 | $400 |
| Maximum Benefit Amount | $100,000 | $100,000 |
| Maximum Benefit Period*** | To Age 70 | To Age 70 |
Accident Medical Expense Benefit |
||
|---|---|---|
| Medical Commencement Period | 90 days | 90 days |
| Deductible Amount | $100 | $200 |
| Maximum Benefit Period | 104 weeks | 104 weeks |
| Payments to Preferred Providers | 100% of negotiated rate | 100% of negotiated rate |
| Payments to Non-Preferred Providers | 100% of Usual and Customary Charge(s) | |
| (in no event will payment be less than 80% of the minimum rate paid to a Preferred Provider) | ||
| Dental Maximum per Accident | $2,500 | $2,500 |
| Maximum Benefit Amount per Accident | $500,000 | $400,000 |
| Lifetime Maximum Benefit | $500,000 | $400,000 |
Limits on Accident Medical Expense Benefits |
|---|
| Physical Therapy, Occupational Therapy, Work Hardening Therapy, no individual limit, but as any medical service, it is subject to the Accident Medical Expense Benefit, the Combined Single Limit and the Aggregate Limit of Liability stated in the Policy for Occupational Accident Benefits. |
| Services provided by a Chiropractor or Acupuncturist, not including Physical Therapy, Occupational Therapy, Work Hardening Therapy (Per Injury) | $1,000 | $1,000 |
| Ambulance – one round trip to and from a Hospital (but not more than $1,000 for any one Accident) | $1,000 | $1,000 |
| Air Ambulance – one round trip to and from a Hospital (but not more than $7,000 for any one Accident) | $7,000 | $7,000 |
| Mental and Nervous – Outpatient per visit (maximum 20 visits for any one Accident) | $25 | $25 |
| Mental and Nervous – Inpatient (maximum 25 Days for any one accident) | $1,000 | $1,000 |
Notes:
*The Accidental Dismemberment Benefit and the Paralysis Benefit will be paid as a Monthly Benefit at 1% of the applicable Principal Sum. The payment of this Monthly Benefit will cease upon the earliest of the following: (1) the date the total of the applicable Principal Sum has been paid; or (2) the date You die. The most the insurer will pay for this benefit, as well as the Accidental Death Benefit, in total, is Your maximum Principal Sum if You can recover benefits under more than one of the benefits as a result of the same Accident.
At age 65, Your Principal Sum will be based on the following schedule:
For Death and Survivor Benefits, Age at Date of Covered Loss
For Dismemberment and Paralysis Benefits,
|
% of Principal Sum |
|---|---|
| 65 | 80% |
| 66 | 60% |
| 67 | 40% |
| 68 | 20% |
| 69 | 15% |
| 70 and over | 10% |
** If You sustain a Covered Injury at or after age 70, the Maximum Benefit Period will be one (1) year.
*** If You sustain a Covered Injury after Your normal Social Security retirement age, as determined by federal law, You cannot qualify for Continuous Total Disability.
OneBeacon Accident & Health is a brand of OneBeacon Insurance Group. The OneBeacon Occupational Accident Insurance is underwritten by Atlantic Specialty Insurance Company, a OneBeacon Insurance Group underwriting company. The coverage highlights listed are only a summary of the policy coverages and benefits. Benefits may be subject to a reduction schedule (begins at age 65) based on age at date of loss or benefit payment. For complete details, please review the policy for terms, conditions, limitations and exclusions. If there is a conflict between these highlights and the policy, the policy will govern in all matters. Coverages and availability may vary by state, exclusions and deductibles may apply. Occupational Accident Insurance coverage is a not workers’ compensation coverage and is not a substitute for workers’ compensation coverage.
