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 Premiums

Coverage Premium
You
$4.64
You + Spouse/Domestic Partner
$8.50
You + Child(ren)
$12.72
You + Family
$16.53

Schedule of Benefits

Benefits Amount
Ambulance
$300 Ground, $1,500 Air
Blood, Plasma and Platelets
$300
Burns
To $1,600 for 2nd degree burns; To $12,800 for 3rd degree burns;
Skin Graft – 25% of benefit payable for Burns
Chiropractic Services (per visit)
$50 per session, 6 sessions maximum
Coma
$7,500
Concussion
$150
Dental Injury
$300 for Crown; $100 for Extraction
Diagnostic Exams
$200 per CT/MRI scan
Dislocation
To $2,400 for Non-surgical; To $4,800 for Surgical;
Partial – 25% of full dislocation;
Multiple – 100% of highest dislocation benefit
Emergency Treatment
$150
Epidural Anesthesia Injection (per injection)
$200, 2 maximum
Eye Injury
$150 for removal of foreign object, $300 for surgical repair
Fractures
To $7,500 for Non-surgical; To $15,000 for Surgical repair;
Chip fracture: 25% of nonsurgical benefit; Multiple fractures: 100% of highest sustained fracture
Initial Hospital Admission
$1,000
Initial Intensive Care Unit (ICU) Hospital Admission
$1,500
Hospital Confinement (per day)
$300, 365 days maximum
Intensive Care Unit (ICU) Confinement (per day)
$600, 30 days maximum
Lacerations
to $800
Lodging (per day)
$150 per day up to 30 days if more than 100 miles from residence
Medical Appliances
$150
Organized Youth Sports Benefit
25% of the benefit amount
Paralysis
$15,000 quadriplegia; $7,500 paraplegia/hemiplegia
Physical Therapy (per session)
$50, 6 sessions maximum
Physician Visit
$150 Initial, $150 Follow-up
Prosthesis
$750 for one, $1,500 for two or more
Rehabilitation Facility Confinement (per day)
$100, 30 days maximum
Surgery
$200 for Exploratory; $600 for Knee Cartilage;
$2,000 for Abdominal or Thoracic; $1,000 for Ruptured Disc;
to $1,200 Tendon, Ligament, or Rotator cuff
Transportation
$450, if more than 100 miles from residence
X-rays
$50

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.

Guides for Filing Claims with Matrix

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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