Accident Advance

Pays benefits for unexpected injuries


Why Accident Insurance?  Accidents happen to everyone, slip on the ice, trip on a toy, fall down the steps, car accident, or from outdoor activities like hiking or skiing.  Accident Insurance is not designed to be stand-alone coverage but to supplement health coverages.  Accident Insurance helps you pay for the medical and out-of-pocket costs you may incur after an accidental injury for you or family member with Lump Sum payments.  The lump-sum payment that can be used for out-of-pocket expenses such as copayments and deductibles that apply to emergency room, hospital stays, medical expenses and other expenses you may face, such as transportation and lodging and income replacement while recovering from an accident.



Module 1 - Accident Emergency Treatment

5.00 Units

Accident Emergency Treatment Benefit
For physician treatment and X-rays in a hospital emergency room or doctor's office within 96 hours of the accident.


Major Diagnostic Examination Benefit
For one CT Scan, MRI, or EEG completed within 90 days of the accident.


Dislocation Benefit

Payable for joint dislocation reduced, under general anesthesia. Dislocation reduced without general anesthesia paid at 25% of the joint's benefit amount. Multiple reduced dislocations are paid at 1 1/2 times the highest benefit amount. No other amount will be paid under this benefit. Dislocated Joint Open Closed
Hip $4,000 $1,350
Knee or Shoulder $1,350 $550
Collar Bone $2,150 $400
Ankle or Foot (except toes) $1,350 $400
Lower Jaw $1,350 $700
Wrist or Elbow $1,100 $550
Toe or Finger $300 $150

Fractures Benefit


For repair of a fracture sustained in an accident. A chip fracture is paid at 10% of the fracture's benefit amount. Multiple repaired fractures are paid at 1 1/2 times the highest benefit amount. No other amount will be paid under this benefit. Fractured Bone Open Closed
Coccyx $700 $350
Hand (except fingers), Foot (except toes/heel), Wrist, Shoulder Blade, Forearm, Ankle, Elbow, Kneecap, Sternum or Lower Jaw $1,700 $850
Hip $5,000 $1,700
Leg $2,100 $1,700
Nose, Heel or Fingers $1,700 $350
Ribs $3,350 $350
Skull $2,700 $1,000
Toes $700 $350

Upper Jaw, Upper Arm or Face (except Nose), Collar Bone

$2,000 $850
Vertebrae, Pelvis $850 $850
Vertebral Processes $3,350 $500

For both dislocations and fractures, 1 1/2 times the highest dislocation or fracture benefit amount is paid.
No other dislocation or fracture benefit is paid.

Module 2 - Follow-Up Visits and Physical Therapy 5.00 Units

Accident Follow-Up Treatment Benefit
Maximum of three (3) follow-up visits per accident. Original treatment must have been within 96 hours of the accident. Treatment must be provided by a physician in their office or in a hospital on an outpatient basis; begin within 30 days of, and be completed within the 6 months following the later of: the accident; discharge from the hospital from a covered confinement; or discharge from an extended care facility.


Physical Therapy Benefit
For treatments by a licensed physical therapist under a physician's advice that begin within 120 days of the accident and are completed within 1 year of the accident, not to exceed 10 treatments per accident.

Module 3 - Initial Accident Hospitalization 5.00 Units

Initial Accident Hospitalization Benefit
Payable once for the first hospital admission due to an accident. Benefit is payable once for the first Intensive Care Unit admission due to an accident. The ICU benefit is paid even if admitted to the hospital initially and then transferred to ICU later during the same hospitalization.


Ambulance Benefit
For transportation to the nearest hospital for treatment within 96 hours of the accident by a licensed ambulance service.

Ground Ambulance $300
Air Ambulance $1,500
Additional Riders

Accidental Death and Dismemberment Rider (Form No. CRADD300)    4.00 Units

Accidental Death Benefit
Death must result from and occur within 90 days of the accident. Only one of the following benefits will be paid per covered person per accident and will be reduced by any dismemberment benefits previously paid for the same accident. Child benefit is 50% of the benefit amount.

Common Carrier Accidental Death
For death resulting from a covered accident that occurs while riding as a fare-paying passenger on a mode of public transportation


Automobile Accidental Death
If the covered person was:

wearing and properly utilizing a seat belt and was seated in a position protected by an air bag system that deployed during the accident, as evidenced by police report.

wearing and properly utilizing a seat belt, as evidence by police report, but an air bag was not present or was not deployed. $80,000
not wearing a seat belt. $60,000
Benefits are not payable if a covered person was driving without a valid drivers' license.

Other Accidental Death
Other than those described above.


Transportation of Remains Benefits
For transporting remains to a mortuary near the covered person's primary residence if death occurs more than 200 miles from primary residence. Child benefit is 50% of the benefit amount.


Additional Benefits for Accidental Death
If an accidental death benefit is payable, the following benefits will be paid to the survivor. A reduced benefit will be paid to the beneficiary if no eligible survivor. Benefits do not require a spouse or child to be covered under this rider.

Surviving Child Educational Benefit
Payable for each eligible child ages 17 through 21, who is a full-time student at an accredited college, university, 2-year college, vocational or trade school within 365 days of the accidental death. Payable each year for up to 4 years while the child remains a full-time student.


Licensed Day Care Center Benefit
Child must be between newborn and 12 years old, attend a licensed day care, which is not an immediate family member, within 90 days from the accidental death date. Day care must be necessary for the survivor to work or obtain training for work.


Career Enrichment Benefit
Survivor must be a full-time student at a professional or trade training program from an accredited college, university, 2-year college, vocational, or trade school within 24 months of the accidental death. Training must be for the purpose of obtaining an independent source of income or enriching the survivor's ability to earn a living. This benefit will be paid for up to 4 years while the survivor remains a full-time student. Benefit not available for children.

Accidental Dismemberment Benefits Dismemberment must occur within 90 days of the accident. If accidental death benefit is payable after dismemberment benefits have been paid for the same accident, we will deduct the dismemberment benefits paid from the accidental death benefit due. Child benefit is 50% of the benefit amount. One or more fingers or toes $2,000

One eye, hand, foot, arm or leg

Two eyes, hands or feet $20,000

Speech or hearing in both ears

Two arms or two legs $20,000

Speech and hearing in both ears

Both arms and both legs $40,000

Total dismemberment benefits per covered person per accident will not exceed:

Accident Hospital and ICU Income Rider (Form No. CRHICU00) - 10.00 Units

Accident Hospital Income Benefit
For hospital confinement for treatment of injuries beginning within 30 days of the accident. Benefit is payable for up to 365 days per accident.


Accident ICU Benefit
For ICU confinement while the person is receiving the hospital income benefit. Benefit is payable for up to 15 days per accident.

Expanded Benefits Rider (Form No. CREXPB00) - 10.00 Units
The following benefits are payable once, per person, per accident for injuries sustained in a covered accident.

Must be treated by a physician within 96 hours of the accident. One or more skin grafts for a covered burn will be paid at 50% of the burn benefit amount paid for the burn involved.

Second-degree burns of body surface:
At least 25%, but not more than 35%

More than 35% $1,500

Third-degree burns of body surface:
6 through 10 square centimeters

10 through 25 square centimeters $4,000
25 through 35 square centimeters $9,000
more than 35 square centimeters $12,000

Must be treated or repaired within 96 hours of the accident.

Lacerations not requiring sutures $40
Single laceration less than 7.5 centimeters $80
Lacerations 7.6 to 20 centimeters $300
Lacerations over 20 centimeters $600
Eye Injury With surgical repair $400
Non-surgical removal of foreign body by physician $70
Emergency Dental Work One or more broken teeth repaired with crowns $300
One or more broken teeth resulting in extractions $80

Brain Concussion
Must be diagnosed by a physician within 96 hours of the accident.


Unconsciousness for 14 consecutive days with no reaction to external stimuli, no reaction to internal needs and require the use of life support systems.


Lasting a minimum of 30 days

Quadriplegia (paralysis of four limbs) $15,000
Paraplegia (paralysis of lower limbs) $7,500
Tendons, Ligaments and/or Rotator Cuffs
Must be detached, torn, ruptured or severed and surgically repaired by a physician within one (1) year of the accident. Only one of the benefits is payable.

Arthroscopic surgery with:
No repair

One repair $500
Two or more repairs $1,000
Ruptured Discs and/or Torn Knee Cartilage
Must be surgically repaired by a physician within one (1) year of the accident. Only one of the benefits is payable.
Shaved cartilage or arthroscopic surgery with:
No repair $200
One repair $500
Two or more repairs $1,000

Major Surgery
For an open abdominal, cranial or thoracic surgery performed by a physician within 1 year of the accident. Laparoscopic procedures are excluded.


For a physician-recommended medical appliance to aid personal locomotion, such as crutches, leg braces, wheelchairs and walkers. This benefit is not payable for prosthetic devices.


Prosthetic Devices
For one or more prosthetic devices received within 1 year of the accident. This benefit is not payable for hearing aids, dental aids (including false teeth), glasses, cosmetic prosthetic devices, such as wigs, or joint replacement, such as an artificial hip or knee.

One prosthetic device $750

Two or more prosthetic devices


Blood, Plasma and Platelets
Required for the treatment of injuries due to a covered accident. Immunoglobulin is not covered.


Benefit is payable for up to 2 round trips to the hospital per accident per covered person if special treatment and hospital confinement occurs within 30 days of the accident. The local attending physician must prescribe treatment that is not available locally. Benefit is not payable for transportation to any hospital within a 100-mile radius of the accident site or covered person's residence.


Family Lodging Benefit
Benefit is payable per day, maximum of 30 days, for one motel/hotel room for a member of the immediate family to accompany the covered person for treatment of injuries prescribed by a physician. Hospital confinement must be in a facility at least 100 miles from the covered person's residence and confinement must begin within 30 days of the accident. Benefits are not payable for services rendered by an immediate family member.

Wellness Benefit Rider (Form No. CRWELB00)          6.00 Units
Benefit is payable per calendar year for one annual health screening test listed for the covered employee and one test for a covered spouse.
  • Blood test for triglycerides
  • Flexible sigmoidoscopy
  • Bone marrow testing
  • Hemocult stool analysis
  • Breast ultrasound
  • Mammography
  • CA 125 (blood test for ovarian cancer)
  • Pap Test
  • PSA (blood test for prostate cancer)
  • CA 15-3 (blood test for breast cancer)
  • Serum cholesterol test to determine HDL/LDL level
  • CEA (blood test for colon cancer)
  • Serum Protein Electrophoresis Chest X-ray (blood test for myeloma)
  • Colonoscopy
  • Stress test on a bicycle or treadmill
  • Fasting blood glucose test
  • Thermography



$29.64 per Month for Individual
$35.94 per Month for Individual + Children
$44.01 per Month for Individual + Spouse
$51.38 per Month for Family

Payment Authorization

You authorize Enrollment123 dba Administration123 to charge the debit card, credit card or ACH bank account as indicated in this authorization on behalf of the Insurance Companies and benefit providers, and their respective plans which you have selected through this enrollment website. Furthermore, you acknowledge and agree that future payments may be charged to the debit card, credit card or ACH bank account you have provided on a recurring monthly basis with your full authorization for the amount associated with the products and services selected above.

Recurring monthly premium payments are billed in advance of the next coverage period, 25 calendar days after your effective date each month. If the recurring payment date falls on a weekend or holiday, you understand that the payment may be executed on the prior or next business day. You understand that this authorization will remain in effect until you cancel it in writing via email or mailed letter. You agree to make any account changes on with your secure online portal or notify Enrollment123 dba Administration123 in writing of any changes in your account information.

You certify that you are an authorized user of this debit card, credit card or bank account and that you will not dispute the scheduled payments with your Credit Card Company or bank provided the transactions correspond to the terms indicated in this authorization form.

Cancellation Policy

You may cancel service at any time. All notices of cancellation must be submitted in writing only, via email or mailed letter. All cancellation notification must be made by the primary account holder. To avoid billing for unwanted services, all cancellation notices must be received no later than fifteen (15) calendar days prior to your next billing date. Upon receipt of your cancellation notice, coverage for the services/products listed will be terminated to the last day of the month of your coverage period. Cancellation notices received less than fifteen (15) days prior to the next billing date will result in cancellation of service postdated to the end of your next coverage period month.

Written notification may be sent via email to

Refund Policy

You may only receive a refund, if applicable, provided you have submitted a written notice of cancellation.

You may request a refund (refund requests MUST be made in writing) ONLY if you are cancelling your coverage within the first ten (10) calendar days following your product or policy effective date. If you are cancelling coverage for a product or policy and requesting a refund within the first ten (10) days following your effective date service; you are entitled to a full refund of the monthly premium or fee. Administration fees or enrollment fees ARE NOT refundable. You are not eligible for any refund if any claims have been filed by the policy holder or his/her dependents during the initial ten (10) days following the effective date.

Billing Questions

Any questions regarding billing should be directed to

Policy / Benefit Notification

You authorize Enrollment123 dba Administration123 to contact you via email and/or sms (text messaging) with regards to the policy(s) or benefit(s) which you have enrolled and updates regarding related products and services. You agree to provide Enrollment123 dba Administration123 with any updates/changes to your email address or phone number through the "Member Portal" or via email at with these updates.

This authorization shall remain in effect until revoked by you in writing. You understand and agree that this authorization, an updated email address and phone number is required to receive important updates regarding your enrolled benefits and insurance coverage; and that revoking this authorization will result in missing important notification(s) that may adversely affect your coverage, including termination of benefits. Enrollment123 dba Administration123 shall not be held responsible or liable for any missed notifications due to incorrect contact mailing address, email address or phone number that results in a change to or loss of coverage or benefits.

Standard 1-5 business days $7.95
Two Day 2 business days $15
Next Day 1 business day $30
* Free on orders of $50 or more

All Products Guaranteed Issue. No Medical Questions. Everyone Accepted.


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