Good things in life happen every day, and unfortunately,
accidents happens too. You need a champion to defend
and protect everything you value—your family, your goals,
your dreams, your independence—in essence, your life.
If they need you, you need a Champion
ACCIDENT | CHAMPION
ACCIDENT | CHAMPION
First Accident Benefit pays
you $100 immediately.
Sports Package pays
25% higher benefits.
Accident Champion helps pay
for the unexpected costs of an
accidental injury by providing
benefits for initial care, injuries,
treatment, facility care and
follow-up care.
If you get injured at soccer
practice and break your leg,
here’s how benefits may
stack up:
Pays you $100 immediately when you report your first claim for covered
benefits! If you get injured, we get you cash fast and begin processing your
claim right over the phone.
First Accident $ 100
Ambulance $ 120
ER Visit $ 75
X-Ray $ 20
Fracture $ 750
Crutches $ 75
Physical Therapy $ 500
Follow-up Visits $ 150
Subtotal $ 1,790
PLUS Sports Package $ 448
Total Payment $2,238
BENEFITS
INCREASE
$448
The Sports Package
increases the total benefit
payment by 25%
No one plans on getting injured …
but just in case, we’ve got you covered.
You do everything you can to stay active and healthy,
but accidents happen every day, especially sports-related
accidents. An injury that hurts an arm or a leg can hurt your
finances too. That’s where Accident Champion can help.
Accident Champion pays cash benefits directly to you or anyone
you choose regardless of any other coverage you have. And
Accident Champion pays extra benefits for injuries resulting from
participating in organized sports. Let Accident Champion help
take care of your bills so you can take care of yourself and
your family.
Accident Champion Benefits always include:
Here’s How Accident Champion Benefits Work:
First Accident Package
Sports Package
Your benefits increase 25%, up to $1,000 per person per year, for injuries
resulting from participating in organized sports! Playing sports can lead to
injuries and unwelcome expenses. We’ll increase your benefits to help pay
those expenses.
Rehabilitation Package
We pay cash benefits for Admission, Daily Confinement and Recovery!
Whether you are released to a Rehabilitation Center following a hospital stay or
you recover at home, we pay a daily recovery benefit to help with your transition.
This is only an example of the benefits that could be payable for the covered loss noted above. Refer to the certificate
of insurance for details
GOLD PLAN
Innovative | Flexible | Affordable | Competitive
Benefits may vary by state. Most benefits are paid once per accident unless otherwise noted.
Schedule of Benefits 24-hour coverage
GOLD & DIAMOND PLANS
Initial Care
Ambulance
Ground $120 $200
Air $1,000 $2,000
Emergency Room $75 $150
Initial Doctor’s Oce Visit $75 $75
Urgent Care $25 $25
Emergency Dental
Crown $200 $400
Extraction $50 $100
Hospital and Rehabilitation
Hospital Admission $1,000 $1,500
ICU Admission $2,000 $3,000
Rehabilitation Admission $1,000 $1,500
Hospital Confinement
Per day, up to 365 days $250 $500
ICU Confinement
Per day, up to 30 days $500 $1,000
Rehabilitation Confinement
Per day, up to 30 days $150 $300
Recovery
Per day, up to seven days $25 $25
Follow-up Care & Treatment
Abdominal or Thoracic Surgery $750 $1,500
Appliances $75 $100
Blood, Plasma, Platelets $200 $300
Chiropractic Care
Per visit, up to three visits $25 $25
Concussion $60 $100
Follow-up Treatment
Per visit, up to three visits $50 $75
Lodging
For treatment 100 miles
or more away, per night,
up to 30 nights $100 $150
Major Diagnostic Exam
(CT, MRI, etc.) $100 $200
Organ Loss $2,500 $2,500
Outpatient Surgery Facility $25 $25
Physical Therapy
Per visit, up to 10 visits $50 $75
Prosthetics $500 $1,500
Tendon, Ligament,
Rotator Cu Surgery $400 $750
Transportation
For treatment 100 miles
or more away, per trip
up to three trips $300 $600
X-ray $20 $40
Injuries
Burns
Level 1 $750 $1,000
Level
2 $1,500 $2,000
Level 3 $7,500 $10,000
Skin Graft 25% of the burn benefit
Coma $7,500 $12,500
Dislocations
Open reduction, up to ... $3,600 $3,840
Closed reduction, up to ... $1,800 $1,920
Eye $200 $300
Fractures
Open reduction, up to ... $5,000 $5,600
Closed reduction, up to ... $2,500 $2,800
Herniated Disc $400 $750
Knee Cartilage – Torn $400 $750
Lacerations $20-$300 $20-$500
Loss of Hands, Feet or Sight, up to ... $10,000 $20,000
Loss of Fingers or Toes, up to ... $1,200 $2,000
Additional Benefits
First Accident
Once per policy $100
Accidental Death
Employee & Spouse $20,000 $25,000
Child $4,000 $5,000
Catastrophic Accident
Prior to Age 70
Employee & Spouse $10,000 $10,000
Child $5,000 $5,000
On or after Age 70 50%
Family Care
For each child in a child care
center: Per day, up to 30 days $25
Sports Package Benefits are 25% higher
when accident is due to organized sports.
Up to $1,000 per person per year
Wellness
Per person, once per year; $50 $50
90 day waiting period
Premiums
Employee $2.80 $3.90
Employee + Spouse $4.32 $6.08
Employee + Child(ren) $6.66 $9.34
Family $5.94 $11.50
DIAMONDGOLD
DIAMONDGOLD DIAMONDGOLD
Combined Insurance Company of America
This document is a brief description of Certificate Form No. C14059R. Benefits, rates, exclusions
and limitations may vary by state. Refer to your certificate of insurance for specific details.
Features
Date of Application Coverage
Coverage becomes eective as soon
as your application is signed, you have
authorized payment and the Initial
Eligibility requirements are met.
No Exclusions for Preexisting
Conditions
Guaranteed Issue
No medical history is required for
coverage to be issued.
Guaranteed Renewable
Your coverage cannot be cancelled as
long as your premiums are paid as due.
Fully Portable
You can keep your coverage at the same
cost even if you change jobs or retire.
HSA Compatible
Initial Eligibility
Employee
• Actively employed working at least
17.5 hours per week
• Ages 18 and up
Spouse
• Ages 18 and up
Children
• Ages 0 to 26
• No student status required
Exclusions & Limitations
This is an Accident-Only Insurance.
• No benefits will be paid for an injury that
is caused by, contributed to, or occurs as a
result of a covered person’s:
• Being intoxicated, or under the influence
of alcohol or any narcotic or other
prescription drug unless administered
on the advice of a Physician and taken
according to the Physician’s instructions
(the term “intoxicated” means the minimum
blood alcohol level required to be considered
operating an automobile under the influence
of alcohol in the jurisdiction in which the
accident occurred);
• Participating in an illegal activity or
attempting to commit or actually committing
a felony (“felony” is as defined by the law of
the jurisdiction in which the activity takes
place);
• Committing or attempting to commit suicide
or intentionally injuring himself or herself;
• Having dental treatment, except for such
care or treatment due to injury to sound
natural teeth within twelve (12) months of
the Covered Accident;
• Being exposed to war or any act of war,
declared or undeclared, or serving in any of
the armed forces or units auxiliary thereto; or
• Participation in any contest using any type
of motorized vehicle.
You do everything you can to keep your family safe, but
accidents happen, and when they do, it’s good to know
we’ve got you covered. Let Accident Champion help take
care of your bills, so you can take care of your family.
1) National Hospital Ambulatory Medical Care
Survey: 2009 Emergency Department
Summary Tables
2) CDC Injury Fact Book, Injury—A Risk at Any
Stage of Life, National Center for Injury Preven-
tion and Control, Centers for Disease Control and
Prevention, November 2006
3) Centers for Disease Control and Prevention,
Data & Statistics, WISQUARS™
Facts
45 million emergency room visits
each year are due to injuries
1
13.6 million adults age 20-49 are
injured each year
2
Average cost of a broken arm or
leg, without a hospital stay is over
$4,000
3
How does ACCIDENT CHAMPION help?
Accident Benefits Summary
Name:
Type of Coverage Payroll Deduction
Employee
Employee + Spouse
Employee + Child(ren)
Family $
CBS-456R2-BrowardCtyPS-GD (7-14)
If you have questions about this product or want to take advantage
of our “Tele-claim” expedited claims service, call 1-800-544-9382.
This is a supplement to health insurance and is not a substitute for
major medical insurance. Lack of major medical coverage (or other
minimum essential coverage) may result in an additional payment
with your taxes.
