Personal Accident Insurance | What Is PAI Coverage?

Personal Accident Insurance

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Typically, Personal Accident Insurance (PAI) plans are offered through employer and the term may be used to refer to individual accident insurance.

Accidents happen more frequently than you might expect, and they are almost always unforeseen. Each year in the United States over 35 million people end up in the emergency room due to an injury related visits.¹ With expensive medical bills and high deductibles, it can be difficult for many families to afford the out-of-pocket costs associated with an accident. However, if you have accident insurance, you don’t have to worry about being able to pay for medical bills or everyday expenses if you are injured as a result of an accident.

Having individual accident insurance is a good way ensure that you and your family will have the money that you need if you are injured. Accident insurance coverage typically pays a cash benefit directly to you that can be used to pay for anything that you need including groceries, medical bills, or even your mortgage. This means that if you have to miss work as a result of your injury, your family will still have access to funds to pay for unexpected out of pocket expenses.

Individual accident insurance is insurance that helps cover your out of pocket needs in the event that you are injured in an unforeseen accident. Although accident insurance doesn’t cover health issues like sickness or disease, it does cover many different injury and treatment types typically including:

  • Injuries – covers accident-related lacerations, burns, broken bones, dislocations, concussions, coma, surgery, loss of limbs, and death.

  • Ambulance Services – covers both regular ambulance rids and air ambulance.

  • Emergency Care – covers urgent care doctors visits, emergency room fees, and follow-up doctors’ appointments.

  • Diagnostic tests – covers MRIs, CT scans, X-rays, and EEGs.

  • Hospital Treatment – covers hospitals stays, including in intensive care units (ICUs). Restorative Treatment -- covers prescribed appliances, prosthetics, injury-related dental crowns or extractions, and injury-related eye surgery or object removal.

  • Rehabilitation Treatment – covers physical therapy sessions and rehabilitation center stays.

Accident insurance coverage is considered a gap insurance, meaning that it helps cover expenses that may not be covered by your primary health insurance. Gap insurance policies are not meant to replace primary health insurance, and typically will cover items that are not covered by your health insurance.

Features of an individual accident insurance plan

Not all accident insurance plans are the same. Like any purchase, it is a good idea to shop around before settling on a final product. Insurance carriers offer different coverage amounts at different premiums and what is covered on one plan isn’t always covered on another.

When you purchase a supplemental accident insurance plan there are a couple of common features that are important to keep in mind.

One feature that sets accident coverage apart from other types of insurance is that it is easy to get signed up. Getting a quote and policy for accident insurance is a no-hassle process and there are guaranteed issue options that allow you sign up without hesitation and with no approval needed. This means no medical exams are required when signing up for certain accident insurance policies. The reason for this is that your personal health doesn’t really impact the likelihood of getting injured in an accident.

Another common feature with accident insurance is that insurance plans are able to cover health expenses that would ordinarily require you to pay your full deductible. A trip in an ambulance can cost as much as $2,000², a trip to the emergency room can likely set you back between $250 and $1,000³, and an overnight stay in the hospital costs over $10,000 per day without insurance⁴. All of these services would normally max out your deductible and potentially also your out-of-pocket maximum. Accident insurance plans typically have a $0 deductible, you just pay your monthly premium to keep the plan in force and if an accident happens, your coverage will kick in.

How can you find the best accident insurance plan that works for you?

If you are shopping around for accident insurance, there are a few common considerations to think about before signing up. Some of the questions that you might ask are:

  • Can I sign up without a medical exam? – You want to find a plan that doesn’t require you to get a medical exam if possible. This saves you the time and hassle of going to the doctor, as well as any fees associated with a doctors’ visit.

  • Is it easy to file a claim? – Accident insurance is only useful if you can use it. When an injury occurs the last thing that you want to think about is jumping through hoops to file a claim. When shopping for accident insurance look for companies that offer online, no-hassle, claim filing.

  • What is and is not covered by the plan? – Not all plans will cover the same injuries and treatments. It is important that you understand what your plan covers and what it does not, before committing to a plan.

  • How quickly will I receive my benefit? – Having an accident policy does you no good if you cannot get funding in a timely manner. You should look for a plan that has a quick turnaround when it comes to getting funds out.

  • How will the benefit be paid out? – It is important to know how your benefits will be paid out. Some benefits are paid as a lump sum and others are paid out on a monthly basis. Understanding how funds are distributed can help you to plan out your finances in case of an accident.

Employer Voluntary Accident Insurance

It is also important to check with your employer before signing up for accident insurance, some employers offer voluntary accident plans. These plans are different from individual accident insurance because they are offered directly through your employer as a group plan rather than individual plan but paid for by employees, via payroll deduction. In a group plan you typically get a lower premium for the same coverage because your premium cost is shared by others in the group.

Family Accident Insurance Coverage

With Guardian Direct® you can sign up either as an individual or you can extend your coverage to cover your whole family. No two families are alike, and it is important to consider your family’s health coverage and injury risk before signing up. Covering your family will typically increase your premium but it also provides gap coverage for you whole family, meaning that if there is an accidental injury you are covered.

Accident insurance is especially useful if you are a parent and your children are active. Kids are accident prone, in fact almost 1 in 5 children will visit the emergency room each year.⁵ Covering your children with accident insurance can help ensure that you are not stuck with large bills.

Accident insurance policies & Insights

For people who need more coverage than offered by a single plan it is possible to purchase multiple accident insurance policies. This could be particularly useful if your employer offers a voluntary accident plan and you need more coverage. You could purchase a supplementary accident policy, on top of the voluntary plan, giving you a higher cash benefit overall and more flexibility.

Making sure that you and your family are covered in case of an accidental injury is important to maintain and help reduce financial stress. However, purchasing insurance can seem complicated. With Guardian Direct® resource library you have the ability to make an informed decision when buying a supplemental accident insurance policy.

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Sources

  1. https://www.cdc.gov/nchs/fastats/emergency-department.htm (2021) accessed 3/5/2021

  2. https://healthcareinsider.com/why-ambulances-are-so-expensive-263386 (2021) accessed 3/5/2021

  3. https://www.thebalance.com/average-cost-of-an-er-visit-4176166 (2021) accessed 3/5/2021

  4. https://www.healthcare.gov/why-coverage-is-important/protection-from-high-medical-costs/#:~:text=The%20average%20cost%20of%20a,hundreds%20of%20thousands%20of%20dollars accessed 3/5/2021

  5. https://hcup-us.ahrq.gov/reports/statbriefs/sb242-Pediatric-ED-Visits-2015.jsp (2018) accessed 3/5/2021

Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice.(exp.03/23)

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