Medical & Dental Expense Benefits
- NO DEDUCTIBLE – NO COINSURANCE!
- Pays up to $500,000 for covered medical expenses incurred within two years of a covered occupational accident.
- Pays usual and customary charges, or up to 100% if using our Preferred Provider Network, for medical, surgical services and supplies, hospital, and prescription drug charges incurred as the result of a covered accident.
- Includes accident benefits for ambulance service, including air ambulance, home health care, and chiropractic treatment (subject to policy limits).
- Pays up to $3,600 per injury for accidental dental expenses.
Disability Income Insurance
Temporary Total Disability Benefit*
- Pays up to a maximum of $500 per week for up to 104 weeks.
- Payable if you are unable to perform your own occupation due to a covered occupational accident and are not otherwise employed.
- Payments begin after a 7-day waiting period and cannot exceed 70% of average weekly income, as calculated by policy.
Continuous Total Disability Benefit*
- Begins after temporary benefits cease, provided you apply for and receive a Social Security Disability Award for the covered injury.
- Payable up to age 70 providing you are totally disabled.
- Payments equal temporary benefit minus primary Social Security disability payment.
- Maximum payout of $200,000.
Accidental Death & Dismemberment & Paralysis Insurance*
- Up to $200,000 payable for loss of life.
- Up to $200,000 payable for loss of two limbs or sight in both eyes, or loss of one limb and sight in one eye or quadriplegia.
- Up to $150,000 payable for paraplegia.
- Up to $100,000 payable for loss of one eye, one limb or hemiplegia.
- Up to $50,000 for loss of thumb and index finger of the same hand or uniplegia.
Non-Occupational Accident Coverage
Medical & Dental Expense Benefits
- NO DEDUCTIBLE – NO COINSURANCE!
- Pays up to $10,000** for covered medical expenses incurred within two years of a covered non-occupational accident.
- Pays up to $1,000 per injury for accidental dental expenses.
Accidental Death & Dismemberment*
- Up to $15,000 payable for loss of life.
- Up to $15,000 payable for loss of two limbs or sight in both eyes, or loss of one limb and sight in one eye or quadriplegia.
- Up to $11,250 payable for paraplegia.
- Up to $7,500 payable for loss of one eye, one limb or hemiplegia.
- Up to $3,750 for loss of thumb and index finger of the same hand or uniplegia.
* Subject to certain restrictions and/or reductions.
** Inclusive of dental benefit maximum.
Important Notice: The coverages described above do not provide coverage for sickness. This is not Workers’ Compensation Insurance.
Important Facts About This Plan
You pay just $130.50/month…for up to $500,000 of occupational accident insurance, with benefits for medical and dental expenses, disability income and accidental death and dismemberment PLUS non-occupational accident benefits.
Eligibility:You are eligible if you are a current, dues paid member of Owner-Operator Independent Drivers Association, you are 18 or over, and under dispatch as a truck driver and are not required by law to carry Workers’ Compensation.
Effective Date: Your coverage will begin at 12:01 am the date after the following: Your enrollment form is taken by phone; the postmark on your envelope if your enrollment form is mailed to our office; or the fax date or email date if your enrollment form is faxed or emailed to our office providing your enrollment form is complete and required premium and dues, if necessary, are received. You must be actively at work on your effective date.
Medical Assistance Program: You will be given an ID card with your Insurance Certificate that provides you with immediate access to health care in case of an injury on the road. By calling a toll-free number listed on the card, you will be able to report your claim and receive information on participating network physicians or hospitals.
Waiver of Premium: If an insured becomes totally disabled, premiums will be waived for as long as that total disability lasts or up to age 70, provided coverage remains in effect.
Extent of Coverage: This plan is an accident only plan. Benefits are payable, as shown, for both occupational and non-occupational accidents. There is a pre-existing condition limitation for injuries incurred during the first 12 continuous months of coverage. The total maximum benefit payable under this plan cannot exceed $500,000 per person and/or $1,000,000 per accident.
Travel Assistance Services: Travel Assistance Services provide 24-hour, multilingual travel emergency services for you (and your dependents traveling with you) should you become sick or injured while traveling 100 or more miles from home. This 24/7 support network manages medical, legal, informational, personal and security services to ensure that you have access to the best possible care anywhere in the world.
Travel Assistance Service must be preauthorized by calling the number on the Travel Assistance identification card.
Identity Theft Resolution Services: From first call to crisis resolution, this service provides to you (and your eligible dependents), a personal specialist who will provide one-on-one counseling for all aspects of identity theft. You will have proactive protection of your identity, and the assistance you need to regain full restoration of your identity after falling victim to identity theft.
This Policy does not cover any losses caused in whole or in part by, or resulting in whole or in part from, the following:
- suicide, attempted suicide; intentionally self-inflicted Injury or any attempt at intentionally self-inflicted Injury or any Injury resulting from a provoked attack;
- illness or disease; medical or surgical treatment of illness or disease; or complications following the surgical treatment of illness or disease; or Occupational Disease, unless specifically provided by this Policy;
- Hernia of any kind, Cumulative Trauma and/or Repetitive Conditions, unless as shown in the Schedule;
- Hemorrhoids of any kind;
- performing, learning to perform or instructing others to perform as a crew member of any vessel while covered under the Jones Act or the United States Longshore and Harbor Workers’ Act, or similar coverage;
- war, or any act of war, whether declared or undeclared; or involvement in any type of active military service;
- any injury for which the Insured Person is entitled to benefits pursuant to any Workers’ Compensation Law or other similar legislation; or any loss insured by Employers’ Liability Insurance;
- the Insured Person being intoxicated, or alcoholism, drug addiction or the use of any drug or narcotic except as prescribed by a Physician operating within his or her scope of authority;
- the deliberate ingestion of a poison, fume, or noxious chemical substance; the use of a prescription drug unless taken as prescribed by a Physician or a non-prescription drug, unless taken in accordance with its directions. This exclusion shall not apply to the ingestion of alcohol;
- participation in the commission or attempted commission of a crime;
- travel or flight in or on any vehicle used for aerial navigation, while riding as a passenger in any aircraft not licensed for the transportation of passengers; performing, learning to perform or instructing others to perform as a pilot or crew member of any aircraft; or riding in an aircraft owned, leased or operated by the Policyholder, its designee or the Insured Person;
- participation in any of the following activities: skydiving, hang gliding, parachuting, parasailing, automobile racing or stunts, bungee-jumping, scuba diving, heli-skiing, motorcycle racing or stunts, endurance tests, fire fighting, racing, acrobatic or stunt flying, extreme sport stunts, hunting, flight on a rocket-propelled or rocket launched aircraft or any other extra-hazardous activity;
- the use or release of explosives (however delivered), nuclear energy, radiation, chemicals, biological agents or diseases, or an organism or agent which disrupts the environmental or ecological balance of a geographic area, which results directly or indirectly from the intentional or unlawful act of a person or persons, including any resulting sickness or disease;
- a cardiovascular event or stroke caused by exertion prior to or at the same time as an Accident.
AME Benefit Exclusions
In addition to General Exclusions contained within the policy, charges for covered accident medical expenses do not include, and benefits are not payable with respect to any expense for or resulting from:
- Repair or replacement of existing artificial limbs, artificial eyes or other prosthetic appliances or repair of existing Durable Medical Equipment unless for the purpose of modifying the item because Injury has caused further impairment in the underlying bodily condition;
- dentures, bridges, dental implants, or treatment not related to the Injury; cosmetic, plastic or restorative surgery unless Medically Necessary for the treatment of an Injury;
- eye glasses or contact lenses; hearing aids or hearing examinations;
- that portion of rental expense for Durable Medical Equipment that exceeds the usual purchase cost for similar equipment in the locality where the expense is incurred;
- Custodial Services; Personal Comfort or Convenience Items; services of a Federal, Veterans, State or Municipal Hospital for which an Insured Person is not liable for payment;
- services or treatment which is covered by Medicare, or for which an Insured Person is not legally obligated to pay;
- that portion of the fee for services or treatment which is more than the Usual and Customary Charge;
- services or treatment which are provided for in a settlement or court judgment; or
- those which are covered under any other insurance of any kind;
- an Extended Care Facility stay that does not follow a Hospital confinement of five (5) days or more;
- any mileage, translation, or lodging charges related to the Covered Injury unless authorized by the Company.
The Occupational Accident Policy is underwritten by Atlantic Specialty Insurance Company, a member company of OneBeacon Insurance Group, LLC, whose executive offices reside at 605 Highway 169 North, Suite 800, Plymouth, MN 55441. The Travel Assistance Services and Identity Theft Resolution Services included in this brochure are provided by third-party vendors. OneBeacon reserves the right to change vendors at any time, without prior written notice. Travel Assistance Services must be pre-authorized.
This brochure is a brief, but accurate, description of the coverage. It is only a summary and not the contract. All coverages are subject to the policy terms and conditions. If there is a conflict between the coverage descriptions shown here and the actual insurance policy, the policy will prevail. Full details of your rights and obligations are in the Group Master Policy Number 216-000-559 . For more information, contact the Life & Health Benefits Department at 800-715-9369.
MED 2 Rev 07/19