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The Employers Resource Accident Reimbursement Arrangement (ARA) has comprehensive, no-hassle benefits inlcuding:
- No networks; you can get care conveniently
- 100% coverage (80% except for prescriptions)
- Deductibles and co-pays not required
- Easy to use and file with claims payer
- Up to $1,000 is reimbursed per accident
- NOT tied to medical plan participation
What's considered an accident?
The Accident Reimbursement Arrangement (ARA) provides immediate coverage in the event the covered employee has an accident that happens outside of work (not workers compensation). The accident must be without intention or design, is unexpected, unusual, and unforeseen, and results in a bodily injury. A bodily injury can be defined as a localized, abnormal condition of the body, internal or external, traumatically induced.
However, certain conditions which are not localized are also classified as "bodily injuries" (e.g., sunstroke, heat exhaustion, generalized freezing and certain toxic effects). Lifting, bending, stooping, simple exertion, etc. are not, in themselves, accidental events. However, if in the act which preceded the injury, something unforeseen, unexpected or unusual occurred which produced the injury, then the injury has resulted through accidental means.
What is the benefit for covered employees?
This benefit reimburses up to $1,000 per covered accident for each employee to a maximum of $5,000 per employee each calendar year.
Who is covered and who pays for this benefit?
All full- and part-time employees are covered for this benefit -- after any applicable new hire benefit waiting period.
The benefit is paid for by the work site employer. Note that dependents are not covered under this plan. Also, in some circumstances, this benefit is not provided, for example, to employees on HMO's or for clients who do not opt for this benefit.
How do I file a claim or find out more information?
- Present your Accident Reimbursement Arrangement ID card to your provider at the time of service (if you don't have a card and need one, contact an Employers Resource Client Service Representative or the Benefits Department, 866-214-9506). The provider may submit the claim on your behalf.
- You may submit a claim for reimbursement per the instructions on the back of the Accident Reimbursement Arrangement ID card. You can obtain a claim form at www.employersresource.com, click on "Employee Center", then "Employee Forms" or call P5 Health Solutions at 800-922-1855, they can also help with claims questions.
Additional Information
- Initial treatment must begin within 72 hours of the accident.
- All eligible ongoing charges must be incurred within 90 calendar days of the accident.
- All eligible charges must be related to the accident (i.e., follow-up visits, prescriptions, physical therapy, etc.).
- Reimbursements will not be applied towards any ERM medical plan deductibles.
- Prescriptions resulting from the accident are covered at 80% of the prescription cost.
- Any charges exceeding $1,000 may be submitted to your medical plan.
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