Voluntary Accident Insurance

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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 New

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

CoverageBiweekly Rate
You$3.91
You + Spouse/Domestic Partner$7.26
You + Child(ren)$9.18
You + Family$12.17

Schedule of Benefits

BenefitsAmount
Ambulance$350 Ground, $1,750 Air
Blood, Plasma and Platelets$400
BurnsTo $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
DislocationTo $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
FracturesTo $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
LacerationsTo $800
Lodging (per Day)$175 per day up to 30 days if more than 100 miles from residence
Medical Appliances$200
Organized Youth Sports Benefit25% 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.

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Reliance Matrix

Disability, Life & AD&D, Accident, Critical Illness, Hospital Indemnity Insurance

Contact

Phone: 1-855-RSL-CLAIM (775-2524)