VAULT Accident & Sickness Forms
INSTRUCTIONS:
Please contact Customer Service for assistance before completing your Application, Payroll Card, or Claim form.
CCPOA Member Line:
888-211-6157
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WHAT DOES ACCIDENT & SICKNESS DO?
Vault’s Accident Champion pays cash direct to you. Any time. Any day. On-the-job. Off-the-job. Starting on Day One.
Accident Champion is a supplemental policy that helps cover the “money gap” left from any other coverage you may have. It will pay cash DIRECTLY TO YOU or to whomever you choose, and is PAID IN ADDITION to benefits provided by any other insurance policy, workers compensation, social security, even your Gold Shield plan.
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VAULT’S SHIELD PLUS: If an injury or illness leaves you unable to work, Shield Plus pays cash benefits to help cover expenses such as:
• Deductibles and co payments on your medical insurance
• Other out-of-pocket medical costs
• Monthly expenses such as mortgage or rent, car payments, utility bills and more
• Everyday needs like childcare, grocery and transportation
• Guarantee Issue -you cannot be denied coverage
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One form for both Accident Champion & Sick Pay Plus
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VAULT Accident & Sickness Brochure and Price List
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Pricing for Accident Champion & Shield Plus
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For Non-Custody Only
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Authorize deductions from your pay warrant
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download certificate
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download certificate
