TRANSPORTATION: A Transportation benefit will be payable if the Insured sustains an Injury due to a Covered Accident and: (1) he or she must travel more than one hundred (100) miles one way for treatment at a Hospital or other medical facility; (2) the treatment is prescribed by a Physician; (3) the treatment is not available locally; and (4) transportation is by bus, train, airplane or medical transportation vehicle. This benefit is payable for up to three (3) round trips for treatment for each person insured per Covered Accident. The Transportation benefit is not payable if transport is provided by ambulance or air ambulance. X-RAY: Benefits will be paid for an x-ray if the Insured sustains an Injury due to a Covered Accident. The x-ray must be: (1) prescribed by a Physician or Dentist; and (2) performed within 6 months of the Covered Accident. Only one benefit will be payable for each person insured per Covered Accident. ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS: Accidental Death and Dismemberment: An Accidental Death and/or Dismemberment benefit will be payable in accordance with the Schedule of Benefits if the Insured sustains an Injury due to a Covered Accident that results in death or dismemberment Loss, if death or dismemberment Loss occurs within 365 days of the Covered Accident. A Dismemberment benefit will be payable if a body part listed on the Schedule of Benefits as a Loss is surgically re- attached. If a Catastrophic Loss benefit is payable for a Covered Accident, no benefit will be payable under this benefit for the same Loss. Common Carrier: A Common Carrier benefit will be payable in addition to the Accidental Death Benefit if the Insured sustains an Injury due to a Covered Accident on a Common Carrier, as defined, which results in death within 365 days of the Covered Accident. Catastrophic Loss: A Catastrophic Loss benefit will be payable if the Insured sustains an Injury due to a Covered Accident that results in a Catastrophic Loss if such Loss occurs within 365 days of the Covered Accident. The benefit payable is shown on the Schedule of Benefits. If a Catastrophic Loss benefit is payable for a Covered Accident, no benefit will be payable under the Accidental Dismemberment benefit for the same Loss. The total benefit payable under this benefit cannot exceed that of the Accidental Death benefit. LRS-9547-0318-IN Page 8.6