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Transamerica
Accident Plan Details
AccidentSelect® According to the National
Safety Council’s Accident Facts, 2006 Edition, every two seconds someone
in this country suffers an accidental injury. In addition, the Council points
out that for people ages 1 to 34, accidents are the number one cause of death.
AccidentSelect® provides Insureds with several
benefits to assist with injuries associated with certain accidents. More
importantly, it gives Insureds peace of mind in the event of a Covered Accident.
SCHEDULE OF BENEFITS
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PLAN I |
PLAN II |
Accident Specific
Sum Injuries Benefit
Pays for dislocations, burns, ruptured discs and torn knee
cartilage, eye injuries, lacerations, internal injuries,
fractures, and blood and plasma. See Rider for specific amounts
payable, definitions, and limitations for each specific
accident. (Benefits will not be paid for services rendered by a
member of the immediate family of a Covered Person.)
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$30 – $2,000 |
$60 – $4,000 |
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The following is an example of the Policy Schedule Benefits.
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A. Dislocations
(reduced under general anesthesia)
Hip
Open reduction
Closed reduction
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$2,000
$665 |
$4,000
$1,330 |
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Knee or shoulder
Open reduction
Closed reduction
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$665
$265 |
$1,330
$530 |
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Collar bone
Open reduction
Closed reduction
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$1,065
$200 |
$2,130
$400 |
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Ankle or foot
(excluding toes)
Open reduction
Closed reduction
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$665
$200 |
$1,330
$400 |
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Lower jaw
Open reduction
Closed reduction
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$665
$330 |
$1,330
$665 |
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Wrist or elbow
Open reduction
Closed reduction
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$530
$265 |
$1,065
$530 |
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Toe or finger
Open reduction
Closed reduction |
$130
$65 |
$265
$130
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B. Tendons and
Ligaments
Tendons and ligaments must be torn, ruptured or severed and must be
treated by a physician within 72 hours after the Covered Accident
and repaired through surgery within six months after the Covered
Accident. If a Covered Person receives a fracture and/or a
dislocation and also tears, ruptures, or severs a tendon/ ligament
in a Covered Accident, the Insurer will pay only one benefit. The
Insurer will pay the largest of this benefit, the Fractures Benefit
or the Dislocation Benefit.
Repair of one
Repair of all if more than one
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$330
$665 |
$665
$1,330 |
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C. Burns
(Treated by a physician within 72 hours
after the accident)
1. Second-degree burns of
at least 25% - 35% of body surface
2.
Second-degree burns of more than 35% of body surface
3. Third-degree burns covering 6
through 9 square inches of body surface
4. Third-degree burns covering 10
through 25 square inches of body surface
5. Third degree burns covering more
than 25 square inches of body surface
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$265
$665
$530
$1,330
$2,665 |
$530
$1,330
$1,065
$2,665
$5,330 |
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D.
Ruptured Disc or Torn Knee Cartilage
Must
be treated by a physician within 72 hours after the accident and
repaired through surgery within one year after the Covered Accident.
Accident during
first year of coverage
Thereafter
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$130
$400 |
$265
$800 |
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E.
Eye Injury
With
surgical repair
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$130 |
$265 |
Accident
Follow-up Treatment Benefit
Pays
for additional treatment of injuries sustained in a Covered Accident
over and above emergency treatment administered within 72 hours
following the accident. This benefit is payable for up to a maximum
of three treatments per Covered Person per Covered Accident. Such
treatment must begin within 30 days of the Covered Accident or
discharge from the hospital or extended care facility, and be within
the six-month period following the Covered Accident or discharge.
Treatments must be furnished by a physician in a physician’s office
or in a hospital on an outpatient basis. (Benefits will not be paid
for services rendered by a member of the immediate family of a
Covered Person.)
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$25/visit |
$25/visit |
Accident Emergency Treatment Benefit
Pays
for emergency treatment for a Covered Accident, we will pay the
amount shown in the Policy Schedule for treatment received. This
benefit is payable for treatment by a physician, x-rays or treatment
received in a hospital emergency room. Treatment must be received
within 72 hours of such accident for benefits to be payable. This
benefit is payable once per Covered Accident. (Benefits will not be
paid for services rendered by a member of the immediate family of a
Covered Person.)
Insured & Spouse
Children
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$100
$70 |
$150
$105 |
Initial Hospitalization For Injury Benefit
When
a Covered Person is hospital confined for 24 hours or more for a
covered accidental bodily injury, the Insurer will pay the benefit
amount shown in the Policy Schedule. This benefit is payable only
once per Hospital Confinement and only once for each Covered Person
per calendar year. |
$500 |
$1,500 |
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Accident Hospital Income Benefit
Pays
for hospital confinement for treatment of a Covered Accident, the
Insurer will pay the daily amount shown in the Policy Schedule for
each day of such confinement. Such confinement must start within 30
days of the accident. The Insurer will pay this benefit for up to
365 days per Covered Accident.
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$100/day |
$200/day |
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Additional Intensive Care Unit Benefit
Pays
an additional benefit equal to three times the Accidental Hospital
Income Benefit for each day the Covered Person is confined in an
Intensive Care Unit (ICU). This ICU benefit is payable for up to 15
days per Covered Accident.
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$300/day |
$600/day |
Ambulance Benefit
Pays
for ambulance transportation to a hospital or emergency center for
injuries sustained in a Covered Accident. Ambulance transportation
must be within 72 hours of the accident. Pays four times the
Ambulance Benefit for transportation provided by an air ambulance.
The hospital or emergency center must be within 100 miles of the
site of the accident or residence of the Covered Person. A licensed
professional ambulance company must provide the ambulance service.
Benefit is limited to one trip per Covered Accident per Covered
Person.
Ground Ambulance
Air
Ambulance
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$150
$600 |
$150
$600 |
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Appliances Benefit
Pays
if a physician advises a Covered Person to use a medical appliance
as an aid in personal mobility as a result of injuries sustained in
a Covered Accident. Benefits include and are payable for: crutches,
leg braces, wheelchairs, and walkers. This benefit is not payable
for prosthetic devices. Benefit is payable once per Covered Accident
per Covered Person.
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$100 |
$150 |
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Physical Therapy Benefit
Pays
if a physician advises a Covered Person to seek treatment from a
physical therapist. Physical therapy must be for injuries sustained
in a Covered Accident and must start within 30 days of such accident
or discharge from the hospital. Pays for one treatment per day for
up to six treatments per Covered Accident. The six treatments must
take place within six months after the accident.
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$50/day |
$75/day |
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Prosthesis Benefit
Pays
if a Covered Person requires use of a prosthetic device as a result
of a Covered Accident. This benefit is payable once per Covered
Accident per Covered Person. Benefit is not payable for hearing aids
or any dental aids (including false teeth).
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$500 |
$750 |
Transportation Benefit
Pays
for transportation to a hospital for special treatment and
confinement for injuries sustained in a Covered Accident. This
benefit is payable for the trip to the hospital. The local attending
physician must prescribe the treatment, and the treatment must not
be available locally. This benefit is not payable for transportation
to any hospital located within a 100-mile radius of the site of the
accident or residence of the Covered Person. This benefit is payable
for up to three trips per calendar year per Covered Person.
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$300 |
$300 |
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Family Lodging Benefit
Pays
for one motel or hotel room for a member (or members) of the
immediate family to accompany the Covered Person for hospital
confinement for the treatment of injuries sustained in a Covered
Accident. This benefit is payable only during the same period of
time the injured Covered Person is confined to the hospital. Benefit
is not payable for the trip to the hospital. The hospital and the
motel or hotel must be more than 100 miles from the residence of the
Covered Person. The local attending physician must prescribe the
treatment. This benefit is payable for up to 30 days per Covered
Accident. |
$100/day |
$100/day |
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Wellness Benefit
After
12 months of paid premium for this benefit, the Insurer will pay for
an Insured to undergo routine examinations or other preventive
testing. Benefits include and are payable for: annual physical
exams; mammograms, pap smears, immunizations, flexible sigmoidoscopy,
Prostatic Specific Antigen, and blood screenings. This benefit will
become available following each anniversary of this Rider ’s
Effective Date, and is payable only once each 12-month period.
Family members include an insured employee’s spouse and dependent
children. Services must be under the supervision of, or recommended
by a physician, and a charge must be incurred. |
$60/year |
$60/year |
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Accidental Death Benefit
Death
must occur as a result of a Covered Accident and must occur within
90 days of a Covered Accident.
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PLAN I |
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Insured |
Spouse |
Child |
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Common-Carrier Accidents
Motorized-Vehicle or Pedestrian Accidents
Other
Accidents |
$35,000
25,000
15,000 |
$17,500
$12,500
$7,500 |
$3,500
$2,500
$1,500 |
PLAN II
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Common-Carrier Accidents
Motorized-Vehicle or Pedestrian Accidents
Other
Accidents |
$70,000
50,000
30,000 |
$35,000
25,000
15,000 |
$7,000
$5,000
$3,000 |
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Accidental Dismemberment
Pays
a percentage of the Accidental Death Benefit selected. |
PLAN I
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PLAN II
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Both
arms and both legs
Two
arms or two legs
Two
eyes, hands, or feet
One
eye, hand, foot, arm, or leg
One
or more fingers and/or one or more toes |
100%
50%
50%
20%
5% |
100%
50%
50%
20%
5% |
Important Information
Renewability
You are guaranteed the right to renew this policy for your lifetime by the
payment of premiums in effect at the beginning of each term. You can never be
singled out for a rate increase. Rates can be changed only if the rate is
changed for all policies of this class. While this policy is in force, no change
will be made because of your age or physical condition.
Effective Date
The Effective Date of the policy and riders will be the date shown on the Policy
Schedule or endorsement, not the date the application is signed.
Issue Ages
AccidentSelect is available to individuals 18 - 64. Coverage is available for
dependent children under age 19, if living with the Insured (24 if the child is
a full-time student). This may vary by state.
Family Coverage
Spouse and dependent children coverage is available. Family
Coverage includes the Insured, his or her spouse, and all dependent, unmarried
children through age 24. Newborn children are automatically covered under the
terms of the policy from the moment of birth. Single-Parent Coverage includes
the Insured and all of his or her eligible dependent children who are unmarried
and under 19. Coverage is extended to your eligible dependent children who are
age 19 through 24 if they are full time students.
Time Limit on Certain Defenses
(1) Misstatements in the Application: After two years from the issue date only
fraudulent misstatements in the application may be used to void the policy or
deny any claim for loss incurred or disability that starts after the two-year
period.
(2) Pre-Existing Conditions: No claim for loss incurred or
disability that starts after two years from the issue date will be reduced or
denied because of a physical condition not excluded by name or specific
description before the date of loss, had existed before the Effective Date of
coverage.
Fraudulent Misstatement
If a fraudulent misstatement is made in the application for this policy, the
Insurer may reduce or deny any claim or void the policy at any time.
Additional Limitations and Exclusions
The Insurer will not pay benefits for a Covered Accident that is caused by or
occurs as a result of:
a) Driving any taxi or intrastate or interstate
long-distance vehicle for wage, compensation or profit. (Does not apply
in Iowa.)
b) Mountaineering, parachuting or hang gliding. (Does not
apply in Iowa.)
c) Poison, gas or fumes voluntarily taken, administered,
absorbed or inhaled;
d) Alcoholism or drug addiction.
e) Participating in any sport or activity for wage,
compensation or profit; or racing any type vehicle in an organized event.
(Does not apply in Iowa.)
f) Travel in, or descent from any vehicle or device for
aerial navigation, except as a fare-paying passenger in an aircraft operated
by a commercial airline (other than a chartered airline) on a regularly
scheduled passenger trip.
g) War, or any act of war, whether declared or undeclared.
h) Participating in any activity or event, including the
operation of a vehicle, while under the influence of a controlled substance
(unless administered by a physician or taken according to the physician’s
instructions), or committing an illegal act while intoxicated (intoxicated
means that condition as defined by the law of the jurisdiction in which the
accident occurred).
i) Participating in, or an attempt to participate in, an
illegal activity that is defined as a felony, whether charged or not. (A
felony is defined by the law of the jurisdiction in which the activity takes
place.) (Does not apply in Iowa.)
j) Intentionally self-inflicted bodily injury or attempting
suicide, while sane or insane (while sane in Missouri).
k) Any loss incurred while on active duty status in the
armed forces. (If the Insurer is notified of such active duty, a refund will
be provided for any premiums paid for any period for which no coverage is
provided as a result of the exception.)
"Hospital " does not include an institution, or that part of
an institution operated as a:
1)convalescent home or skilled nursing care facility or hospice care center; or
2) facility primarily affording custodial rehabilitative or educational care; or
3) facility for the aged, drug addicts, or alcoholics.
This provides information about AccidentSelect I and II (Policy
Form Series TPA0100 with Riders Form Series TRA0100, TRA0200, TRA0300, TRA0400,
TRA0500, TRA0600, TRA0700, TRA0800, TRS0100, TRW0100, and TRIH0200),
underwritten by Transamerica Assurance Company. Form and number may vary and
coverage may not be available in all jurisdictions.
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Industry Class B - Plan I |
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Individual |
Single Parent Family |
Two-Adult Family |
Family |
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$12.06 |
$17.85 |
$17.37 |
$23.16 |
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Industry Class B - Plan II |
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Individual |
Single Parent Family |
Two-Adult Family |
Family |
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$20.33 |
$31.55 |
$30.46 |
$41.68 |
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