Your accident coverage GUARDIAN® is a registered trademark of The Guardian Life Insurance Companyof America AESOPINTERMEDIATELLC Kit created 12/05/2022 ALL ELIGIBLE EMPLOYEES Groupnumber:00554984 FEATURES (Cont.) Diagnostic Exam (Major) $50 Dislocations Schedule up to $2,000 Doctor Follow-Up Visits $25, up to 6 treatments Emergency Room Treatment $100 Eye Injury $100 Fractures Schedule up to $3,000 Gun Shot Wound $250 Hospital Admission $500 Hospital Confinement $100/day - up to 1 year Hospital ICU Admission $1,000 Hospital ICU Confinement $200/day - up to 15 days Initial Dr. Office/Urgent Care Facility Treatment $50 Laceration Schedule up to $200 Medical Appliance—Wheelchair, motorized scooter, leg or back brace, cane, crutches, walker, walking boot that extends above the ankle or brace for the neck. Schedule up to $300 Outpatient Therapies $25/day, up to 10 days Surgery (Cranial, Open Abdominal, Thoracic, Hernia) Max Schedule up to $750 Hernia: $150 Surgery (Exploratory or Arthroscopic) $200 Tendon/Ligament/Rotator Cuff 1: $250 2 or more: $500 X - Ray $15 UNDERSTANDING YOUR BENEFITS: • Common Carrier – Benefit is paid if an insured's death occurs due to an accident while riding as a fare-paying passanger in a public conveyance. If this is paid, we do not pay the Accidental Death benefit. • Common Disaster – Benefit is paid if both you & your spouse die in a covered accident or separate covered accidents within the same 24 hour period. • Reasonable Accomodation – Benefit is payable if a modification is required to an insured's place of residence or vehicle due to an Accidental Dismemberment or Catastrophic loss. • Emergency Room Treatment – Benefit is paid only when an insured is examined or treated within 72 hours of a covered accident. 31