| Example of Benefits | Low Plan | High Plan |
|---|---|---|
| Fractures & Dislocations | $50 – $3,000 | $100 – $6,000 |
| Second & Third Degree Burns | $50 – $5,000 | $100 – $10,000 |
| Concussions | $200 | $400 |
| Eye Injuries | $200 | $300 |
| Ambulance | $200 – $750 | $300 – $1,000 |
| Emergency Care | $25 – $50 | $50 – $100 |
| Physician Follow-Up | $50 | $75 |
| Medical Appliances | $50 – $500 | $100 – $1,000 |
| Inpatient Surgery | $100 – $1,000 | $200 – $2,000 |