- $100,000 Accident Medical Expense Benefit (after a deductible of $25 per accident)
- $100,000 Accidental Death & Dismemberment Death Benefit
- $100,000 for the loss of either two hands, two feet, two eyes, or any combination of any two of the above
- $50,000 for the loss of either one hand, one foot, or one eye
- $400 Weekly Accident Indemnity Benefit (maximum 52 weeks)
- $10,000 Physical Therapy limit