Domestic Accident Only Plan 2013-2014
VENDOR: AIG INSURANCE COMPANY
Insurance cards will be available online from the AIG website after September 11, 2013.
POLICY LIMITS – When a covered injury requires treatment by a physician, this policy will provide benefits for 52 weeks from the date of the injury for the limits of the policy. The policy will allow benefits for expenses not covered by other valid and collectible coverage.
SCHEDULE OF ACCIDENTAL ONLY BENEFITS Maximum Benefit: $15,000; |
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Eligibility |
Domestic Students meeting the specified hours, all UL Lafayette Year-Round Visiting Groups: Boarding Programs and Day Camps |
Type of coverage |
Excess to any other valid / collectible health insurance coverage. |
Benefit Period |
For 52 weeks from the date of the Injury for the limits of the policy |
Deductible |
$0 |
POLICY FEATURES |
ACCIDENT ONLY |
Inpatient Hospital Services |
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Hospital Room and Board Expense |
100% U & C Semi-Private Room Rate |
Intensive Care Room and Board |
100% U & C |
Hospital Miscellaneous Expense |
100% U & C |
Outpatient Hospital Services |
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Emergency Room: When Hospital Confinement is not required, including all services billed by the facility |
100 % U & C |
Ambulatory Medical Centers and Outpatient Operating Room |
100 % U & C |
Physician Services |
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Surgery, including pre- and post-operative care: When a covered injury requires 2 or more covered surgical procedures which are performed through the same approach and at the same time or immediate succession, the Company will pay full value for the most expensive procedure and 50% of the value for the 2nd procedure performed and 25% of the value for any additional procedures performed. |
100 % U & C |
Anesthesia (including administration) |
100 % U & C |
Assistant Surgeon when medically necessary |
100 % U & C |
Physician’s visits other than for Physiotherapy or similar treatment when no surgery benefit is paid, beginning on the first day treatment is rendered |
100 % U & C |
Consultant and second opinions when required by attending Physician for confirming or determining a diagnosis, but not for treatment |
100 % U & C |
X-RAY, MRI and Laboratory Services |
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Diagnostic X-rays |
100 % U & C |
Laboratory Services |
100 % U & C |
MRI / Cat Scan |
100 % U & C |
Additional Services |
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Physiotherapy |
100 % U & C |
Ambulance Services |
100 % U & C |
Durable Medical Equipment |
100 % U & C |
Drugs and medications, when prescribed by a Physician |
100 % U & C |
Eye Glasses, Contact Lenses and Hearing Aids: Replacement of broken glasses and / or frames, contact lenses and hearing aids resulting from a covered injury |
100 % U & C |
Dental Services |
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Treatment, repair or replacement of each injured natural tooth: This will include Expenses Incurred for initial braces when required for treatment of a Covered Injury, examination, diagnosis, X-Rays, restorative treatment, endodontics and oral surgery, and treatment for gingivitis resulting from trauma. |
100 % U & C |
Part B: Accidental death and dismemberment. To provide for accidental death or accidental dismemberment for loss occurring within one hundred (100) days from the date of the accident, according to the following schedule |
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Accidental Death $2,500 Entire sight of both eyes $2,500 Both hands or feet $2,500 One hand or one foot or one eye $1,500 Thumb and index finger on either hand $750 |