Benefits apply to all classes of membership while performing an activity of the organization. Claims are for members of the NHSFA, claims are only for “line of duty injury”. Reminder that claims must be submitted within 60 days of injury and must be signed by the Chief officer or their designee. Claims will be rejected for late submission.
- Covered Injury Death Benefit – payable for bodily injuries that result in death and are directly related to a covered activity – $10,000
- Includes Dismemberment, Loss of sight, speech or hearing according to the Table of Losses – up to $10,000.
- Seat Belt Benefit – Pays an additional 20% of the Principal sum $2,000.
- Dependent Child Benefit – Pays an additional $10,000 per dependent child.
- Bereavement Benefit – Pays an additional 10% of the Principal Sum up to $1,000.
- Cosmetic Disfigurement from Burns – Payable for third and fourth degree burns, up to $10,000.
- Covered Illness Death Benefit – Payable for illness that are contracted or suffered during or resulting from a covered activity of the organization. $10,000.
- Total Weekly Disability Benefits – Covered injury(s) and illness payable up to 2 years. $75/wk
- Cost of Living Adjustment – COLA can triple disability payments, up to $225/week
- Transition Benefit – Payable up to 26 weeks when employer eliminates insured’s position. $75/wk
- Medical Expense Benefit – No time limit for first medical treatment, up to $5,000
This program administered by:Provident Agency, Inc.,
PO Box 11588
Pittsburg, PA 15238-0588. Toll-Free 1-800-447-0360
For more information please contact your County Representative or
This is only an outline.
For actual policy language, see form 209 and 209-AMD, issued by Provident Life and Accident Insurance Co., Chattanooga, TN.
Injury claim form for current members in good standing: Provident First Notice of Claim form
Claim form is for members of the NHSFA, claims are only for line of duty injury. Reminder that claims must be submitted within 60 days of injury and must be signed by the Chief officer or their designee. Claims will be rejected for late submission.