Rehabilitation facility confinement per day, up to 90 days $200 Non-Induced Coma (duration of 14 or more days) $18,500 Induced Coma (duration of 14 or more days) $200 Transportation per trip, up to three per accident $800 Lodging per day, up to 30 days $200 Family care per child per day, up to 45 days $30 Event Benefit Accident care Initial doctor visit $100 Urgent care facility treatment $250 Emergency room treatment $250 Ground ambulance $400 Air ambulance $2,000 Follow-up doctor treatment $100 Chiropractic treatment up to six per accident $60 Medical equipment $275 Physical or occupational therapy up to six per accident $60 Speech therapy up to 6 per accident $60 Mental Health Therapy (up to 10 per accident) $60 Prosthetic device (one) $1,250 Prosthetic device (two or more) $2,000 Outpatient surgery (one per accident) $250 X-ray $90 Common injuries Burns second degree, at least 36% of the body $1,500 Burns third degree, at least nine but less than 35 square inches of the $8,500 body Burns third degree, 35 or more square inches of the body $20,000 Skin grafts 50% of the burn benefit Emergency dental work $400 crown, $125 extraction Eye injury removal of foreign object $110 Eye injury surgery $400 Torn knee cartilage surgery with no repair or if cartilage is shaved $250 Torn knee cartilage surgical repair $900 1 Laceration treated no sutures $50 1 Laceration sutures up to 2” $90 1 Laceration sutures 2” – 6” $350 1 Laceration sutures over 6” $750 Puncture Wound $50 Ruptured disk surgical repair $900 Tendon/ligament/rotator cuff $600 exploratory arthroscopic surgery with no repair Tendon/ligament/rotator cuff one, surgical repair $925