- $50,000 Accident Medical Expense Benefit (after a deductible of $25 per accident)
- $50,000 Accidental Death & Dismemberment Death Benefit
- $50,000 for the loss of either two hands, two feet, two eyes, or any combination of any two of the above
- $25,000 for the loss of either one hand, one foot, or one eye
- $200 Weekly Accident Indemnity Benefit (maximum 52 weeks)
- $2,500 Physical Therapy Limit