SPECIFIC INJURIES EMPLOYEE/ SPOUSE/CHILDREN CONCUSSION A concussion or mild traumatic brain injury (MTBI) is de昀椀ned as a disruption of brain function resulting $200 from a traumatic blow to the head. COMA Coma means a state of profound unconsciousness caused by a covered accident. If you are in a coma $10,000 lasting 30 days or more as the result of a covered accident, we will pay the bene昀椀t shown. EMERGENCY DENTAL WORK (per accident; injury to sound, natural teeth) Repaired with crown $150 Resulting in extraction $50 BURNS (treatment within 72 hours and based on percentage of body surface burned) Second-Degree Burns Less than 10% $100 At least 10%, but less than 25% $200 At least 25%, but less than 35% $500 35% or more $1,000 Third-Degree Burns Less than 10% $1,000 At least 10%, but less than 25% $5,000 At least 25%, but less than 35% $10,000 35% or more $20,000 First-degree burns are not covered. LACERATIONS (treatment and repair within 72 hours) Under 2" long $50 2" to 6" long $200 Over 6" long $400 Lacerations not requiring stitches $25 Multiple Lacerations: We will pay for the largest single laceration requiring stitches. The plan has limitations and exclusions that may affect benefits payable. The plan has limitations and exclusions that may affect benefits payable. This brochure is for illustrative purposes only. Refer to your certificate for complete details, definitions, limitations, and exclusions.This brochure is for illustrative purposes only. Refer to your certificate for complete details, definitions, limitations, and exclusions.