Voluntary Accident Insurance

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Heads up! This page reflects content for the new 2024-2025 plan year, which begins July 1. Select the button to switch to the current plan year information.

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

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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.

Provider

Heads up! This page reflects content for the current plan year that will change July 1. Select the button to switch to the new plan year information.

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

(blank)

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.

Provider