Voluntary Accident Insurance
Voluntary Accident Insurance
Plan Information
The Voluntary Accident Insurance plan, administered by Reliance Matrix, provides a range of fixed, lump-sum benefits for injuries resulting from a covered accident. These benefits are paid directly to the insured and may be used for any reason, from deductibles and prescriptions to transportation and childcare.
Voluntary Accident Insurance Plan Highlights: English | Spanish
The Voluntary Accident Insurance plan, administered by Reliance Matrix, provides a range of fixed, lump-sum benefits for injuries resulting from a covered accident. These benefits are paid directly to the insured and may be used for any reason, from deductibles and prescriptions to transportation and childcare.
Voluntary Accident Insurance Plan Highlights: English | Spanish
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Eligibility
All benefits-eligible full-time Team Members and covered dependents are eligible for Voluntary Accident Insurance.
Dependents can include:
- Your legal spouse or domestic partner who is under the age of 70 on the date of application.
- Your dependent children from birth to 26 years.
A person may not have coverage as both a Team Member and a dependent.
Biweekly Plan Costs
| Coverage | Biweekly Rate |
|---|---|
| You | $3.91 |
| You + Spouse/Domestic Partner | $7.26 |
| You + Child(ren) | $9.18 |
| You + Family | $12.17 |
Schedule of Benefits
| Benefits | Amount |
|---|---|
| Ambulance | $350 Ground, $1,750 Air |
| Blood, Plasma and Platelets | $400 |
| Burns | To $2,000 for 2nd degree burns; To $16,000 for 3rd degree burns; Skin Graft - 50% of benefit payable for Burns |
| Chiropractic Services (per Visit) | $60 per session, 6 sessions maximum |
| Coma | $10,000 |
| Concussion | $300 |
| Dental Injury | $300 for Crown; $100 for Extraction |
| Diagnostic Exams | $250 per CT/MRI scan |
| Dislocation | To $4,000 for Non-surgical; To $8,000 for Surgical; Partial - 50% of full dislocation; Multiple - 200% of highest dislocation benefit |
| Emergency Treatment | $225 |
| Epidural Anesthesia Injection (per Injection) | $200, 2 maximum |
| Eye Injury | $200 for removal of foreign object, $400 for surgical repair |
| Fractures | To $6,250 for Non-surgical; To $12,500 for Surgical repair; Chip fracture: 50% of nonsurgical benefit; Multiple fractures: 200% of highest sustained fracture |
| Initial Hospital Admission | $2,000 |
| Initial Intensive Care Unit (ICU) Hospital Admission | $2,000 |
| Hospital Confinement (per Day) | $350, 365 days maximum |
| Intensive Care Unit (ICU} Confinement (per Day) | $700, 30 days maximum |
| Lacerations | To $800 |
| Lodging (per Day) | $175 per day up to 30 days if more than 100 miles from residence |
| Medical Appliances | $200 |
| Organized Youth Sports Benefit | 25% of the benefit amount |
| Paralysis | $15,000 quadriplegia; $7,500 paraplegia/hemiplegia |
| Physical Therapy (per Session) | $60, 12 sessions maximum |
| Physician Visit | $200 Initial, $200 Follow-up |
| Prosthesis | $1,000 for one, $2,000 for two or more |
| Rehabilitation Facility Confinement (per Day) | $125, 30 days maximum |
| Surgery | $250 for Exploratory; $750 for Knee Cartilage; $2,500 for Abdominal or Thoracic; $1,250 for Ruptured Disc; to $1,500 Tendon, Ligament, or Rotator cuff |
| Transportation | $600, if more than 100 miles from residence |
| X-Rays | $100 |
Features
- Portability to Team Member age 70
- FMLA/MSLA continuation
- Newlywed and newborn provision
- 24-hour travel assistance services
Exclusions
Benefits will not be paid for any loss caused by:
- suicide;
- war;
- air travel (except as a passenger on commercial flights);
- assault/felony;
- acute or chronic intoxication;
- voluntary consumption of illegal or controlled substance or prescribed narcotic or drug; or
- injuries arising out of or in the course of employment for wage or profit.
For a comprehensive list of exclusions and limitations, please refer to the Certificate of Insurance. The Certificate also provides all requirements necessary to be eligible for benefits.
The plan highlights are a brief description of the key features of the RSL insurance plan. The availability of the benefits and features described may vary by state. It is not a certificate of insurance or evidence of coverage. Insurance is provided under group policy form LRS-9547-0318, et al.
Portability/Conversion
Contact Team Member Services at 855-432-MIKE (6453), Option 2, about Portability/Conversion information within 31 days of the date your coverage ends. The appropriate forms will be emailed to you. For more information, follow this link: Conversion & Portability Provisions.
Video Overview of Leave, Disability & Voluntary Benefits
Get Support
For assistance, contact Team Member Services at 855-432-MIKE (6453) and select option 2, available Monday through Friday from 8 a.m. to 5 p.m. CT. You can also open a Knowledge Zone support ticket.
File Your Claim(s) Online with Reliance Matrix
Guidance for Filing Claims with Reliance Matrix
How-To Guides
- Easy Access Claims Filing - Process flow overview for filing claims with Reliance Matrix.
- Filing Claims with Reliance Matrix - Applies to Leave of Absence (LOA), Disability, and Voluntary benefits.
- How to File Claims for Short-Term Disability (STD) & Family Medical Leave of Absence (FMLA)
- How to File Claims for Voluntary Accident, Hospital Indemnity & Critical Illness
- Download the Matrix eServices App
Important Note About Claims for Kaiser Members
Team Members who are enrolled in a Kaiser medical plan must complete an authorization release form in order to file a claim with Reliance Matrix.
- Reliance Matrix will provide you with the authorization release form to sign and return.
- This form is required in order for Reliance Matrix to obtain the required medical certification from your physician.
- Failure to provide the signed authorization release form to Reliance Matrix will result in your claim being denied.
Reliance Matrix
Disability, Life & AD&D, Accident, Critical Illness, Hospital Indemnity Insurance
Contact
Phone: 1-855-RSL-CLAIM (775-2524)