Texas “Flex Plan”

Occupational Accident Policy:
Covers injuries to employees for AD&D, medical, weekly disability and occupational disease/cumulative trauma that are the result of an on-the-job injury.

1. •Rates are calculated based on payroll
   

2. •Twelve month rate guarantee
   - 52 weeks, 116 weeks or 156 weeks benefits period available
   - Combined benefit amounts from $100,000 to $6,000,000
   

3. •Includes Weekly Accident Disability Benefits (WAD), Accident Medical Benefits and Accidental Death & Dismemberment Benefits (Occupational Disease/Cumulative Trauma is an option that can be added for additional premium).
   

4. •Workers' Comp codes used in classifications or comparable job descriptions
   

5. •Full-time and Part-time employees covered.
   - Combined deductible amounts of $500, $1,000, $2,500, $5,000, $10,000 or $25,000 (larger deductible options available)
   

6. •Accidental Loss of Life has a maximum benefit of $150,000. Guaranteed 15% of Combined Benefit Amount if all benefits used. - Lump Sum
   

7. •Weekly Accident Disability Elimination Period 7 days, paid at 75% of weekly wage up to $700
   

8. •Hernia covered as any other injury if the result of an on-the-job injury
   

9. •Disability must commence within 365 days of the injury in order to receive benefits
   

10. •ERISA Plan included
    

11. •$10,000,000 Per Occurrence Medical Aggregate.  $50,000,000 General Policy Aggregate
    

12. •Up to 6,000,000 per person; 50,000,000 policy aggregate
    

13. •GHS also offers free 2-hour CE Courses: Texas Non-Subscription and Street Level Ethics
    

Limited Employers Liability (LEL):

1. •Reimburses the employer for his reasonable settlement, defense and adjustment costs.
   

2. •Includes Employer’s Indemnity coverage for injuries due to accidents, cumulative trauma and occupational disease.
   

3. •The carrier has the right but not the duty to defend and suit against the insured for claims, the basis of which is an Occupational injury, whether real or alleged.
   

4. •Legal Defense costs are outside of the policy limits. - Unlimited
   

5. •Deductible is reduced or eliminated by benefit payments made by the benefits carrier.
   

6. •Combined Single Limit amounts from $100,000 up to $6,000,000.
   

7. •Coverage period options of 116 weeks or 156 weeks.
   

8. •Gives the employer comprehensive coverage for an affordable cost.
   

ADMITTED Policy Form: – backed by the state guaranty fund

1. •Prescription Card Included – full payment for prescriptions due to on-the-job injuries
   

2. •NO PPO Network Required
   

3. •NO balance bills
   

Note:   Each policy form has a separate deductible. The minimum legal deductible is $2,500.  Benefits paid by the occupational accident policy erode the deductible under the employers’ liability policy. 
The client will receive only one bill each month to pay the premium for these coverages.