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”. A 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 a 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
Green Insurance Associates P O Box 10654 Bedford, NH 03110 603-472-5188 or http://www.green-insurance.com or email at email@example.com
This is only an outline.
For actual policy language, see forms 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
The claim form is for members of the NHSFA, claims are only for a line of duty injury. A 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.