What’s covered? The plan pays benefits for several types of accidental injuries, including: • Comas • Dental injuries • Dislocations • Eye injuries • Fractures • Lacerations • Paralysis • Second- and third-degree burns • Torn knee cartilage with surgery • Torn ligaments • Torn tendons with surgery The plan also pays benefits for the following medical services if they’re required as a result of a covered accident that occurs while the policy is in effect. Emergency care and diagnostics • Ambulance transportation • Emergency room visits • Initial doctor’s visit • MRIs, CT or CAT scans, and EEGs • Pain management/epidurals • X-rays Follow-up care • Chiropractic visits • Doctor visits • Medical equipment • Physical therapy • Prosthetic devices Hospitalization and surgical procedures • Family lodging • Hospital admissions and confinements • ICU admissions and confinements • Rehabilitation • Surgery • Transportation S PO U S E AN D C H I LD COVE R AG E Spouse and dependent benefits may be available.* * Eligible dependents may include your spouse or domestic partner (as defined by state or federal law) and your biological children, adoptive children or stepchildren. Contact your benefits representative to determine eligibility for dependent coverage. This is a brief description of available benefits. For a complete description of coverage, please refer to your enrollment materials or contact your benefits representative. 2 Accident Insurance