Group Accident & Sickness Insurance
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Table of Benefits |
Resident Plan A .24 per person per day |
Resident Plan B .30 per person per day |
Day Only Plan C .12 per person per day |
| For expense incurred within 52 weeks of the date of Accident for Medical and Surgical Treatment, x-Ray Examinations, Hospital Confinement and Ambulance Expense, up to a maximum of... |
$2,500 |
$3,000 |
$2,500 |
| Dental Services incurred within 52 weeks of the Accident, Involving Sound, Natural Teeth, up to a maximum of... | $300 | $500 | $300 |
| Medical and Hospital Expense for Illness having its inception on the day or days this policy is in force, up to a maximum of... | $750 | $1,000 | none |
| For Medical Expenses from these specified diseases: Poliomyelitis, Diphtheria, Scarlet Fever, Smallpox, Tetanus, Cerebrospinal Meningitis, Typhoid Fever, Leukemia, or Primary Encephalitis, up to a maximum of ... | $2,500 | $3,000 | none |
| For losses within 100 days of the accident which result in the loss of life... | $2,500 | $3,000 | $2,500 |
| For losses within 100 days of the accident which cause loss of both hands, or both feet, or the total sight of both eyes or one hand and one foot... | $7,500 | $7,500 | $2,500 |
| For losses within 100 days of the accident which cause the loss of one hand or one foot or sight of one eye... | $3,750 | $7,500 | $1,250 |
This policy does not cover the following:
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Unique Coverage Needs?? Call 1-800-849-4820 We'll design a plan to fit your needs! |
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Transportation Coverage: This insurance includes direct group travel to and from the sponsored activity. It is required that such group be accompanied by and Adult Leader. The enroute day or part of a day must be included in insurance is applied. |
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Policy Number SRP 106 REV 3-81