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Volunteer Accident & Medical Plan


CALIFORNIA STATE FIREFIGHTERS' ASSOCIATION SPONSORED

CSFEWBC has partnered with Provident Insurance to provide California volunteers with the best Accident & Health plans in the state.

Provident offers a 10% discount on rates to all CSFA members. They have been insuring firefighters and their families since 1928. A variety of plan designs are available to volunteer departments.

The following information will help your department receive a quote:

  • Summary of Benefits (Below)
  • 3 Suggested Plan Designs

Summary of Benefit:

Our benefits apply while Insured Members are performing an activity of the organization.

All classes of membership are covered equally.

Covered Injuries exclude organized league athletics, as they can be purchased separately. Covered Illnesses exclude Mental Stress, as it is covered in it's own section, which is discussed below.

Benefits for Disability:

Total Weekly Disability Benefits are payable up to Lifetime for Covered Injuries, and up to 5 years for Covered Illnesses.

Since there are situations where there is not a gross wage that needs to be replaced, we provide a Primary Weekly Disability Benefit which is payable in addition to any benefit from any source.

When our Primary Benefit and benefits from Workers' Compensation, or other loss of earnings coverage, are not enough to complete an Insured Member's gross wages, our Earned Income Replacement Weekly Disability Benefit is payable in order to replace 100% of lost Gross wages.

We realize that employers will not always be able to extend health insurance for an indefinite period. Any health insurance premium's previously paid by the Insured Member's employer, but, due to Covered Injuries or Covered Illness have been discontinued can be included as earned income.

Cost Of Living Adjustment - 5% adjustments are made on the anniversary date of the Covered Injury or Covered Illness for continuous disability. COLA's are compounded annually not to exceed three times the Total Weekly Disability Benefit limit.

Partial Disability Benefit are payable on return to any occupation and income loss. Benefit can be paid as much as for total disability. Injuries are payable for up to 5 years from the date of return to any occupation. Illnesses are payable for up to 5 years.

Inpatient and Outpatient Benefits:

Weekly Hospital Confinement Benefit is payable during inpatient confinement but not to exceed 730 days.

Following one day or more of such confinement, the benefit is payable for outpatient physical therapy or follow up medical treatment.

Outpatient Treatment Benefit is payable if an Insured Member receives outpatient physical therapy, rehabilitation or follow-up physician's appointments when inpatient stay is not required, we will pay 1/7 of the Weekly Hospital Confinement Benefit not to exceed 365 days for each day of such treatment.

Medical Expenses:

Medical Expense Benefit for Covered Injuries or Covered Illness are payable for actual cost to Insured Member of medical or surgical treatment, preventative inoculations, hospital confinement or employment of a trained nurse. There is No time limit for first medical treatment or for the rest of the benefit to be used.

When additional limits are necessary to cover plastic surgery, our Plastic Surgery Expense provides an additional 25% of the Medical Expense Benefit to be used for plastic surgery needed as the result of a Covered Injury.

Death Benefits and Related Coverage:

Covered Injury Death, Dismemberment, Loss of Sight, Speech or Hearing - All or part of this benefit is payable based upon loss. This is payable in addition to any other benefits that an Insured Member may receive, such as State and/or Federal Death Benefits.

Cosmetic Disfigurement from Burns - If an Insured Member suffers a cosmetic disfigurement due to a burn that is classified as a third degree burn as a result of a Covered Injury. This benefit will be based on a percentage of the Principal Sum and will depend on the area of the body, which was burned.

Covered Illness Death Benefit - If an Insured Member contracts or suffers any disease, sickness or infection, other than those relating to mental stress, during or resulting directly from a Covered Activity. The Covered Illness Death Benefit is payable if results in immediate death or directly causes death while receiving disability benefits. This is payable in addition to any other benefits that an Insured Member may receive, such as State and/or Federal Death Benefits. However, the broadness of our coverage will permit our benefit to pay in many instances that are not payable by either your state or the federal government.

Additional Benefits:

Rehabilitation Benefit is payable for voluntary participation in an approved program designed for occupational rehabilitation, either in your occupation or in a reasonable occupation. Although Workers' Compensation can provide coverage for rehab when a claim is compensable, and our benefit will provide additional protection for situations not covered by Workers' Compensation.

Family Expense Benefit provides protection for immediate family members. If an Insured Member requires medical treatment causing one or more of their immediate family to incur additional expenses, including loss of wages, to accompany the member or to help treat the member.

Mental Stress Management Benefit is payable for disability, medical expenses or hospital confinement if insured Member suffers a mental stress related illness. An Insured must continually receive care by a physician appropriate for the condition. Benefit is maximum paid per person, per Covered Activity.

Traumatic Incident Benefit is payable for such support services as traumatic incident stress defusing, debriefing, spousal support, and stress reduction. Benefit is maximum paid per Covered Activity.

 

 

 


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1001 K Street, 6th Floor, Sacramento, CA 95814 ~ Phone: 800-451-2732 ~ Fax: 916-446-9889

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