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Your guide to accident insurance coverage

Accident insurance pays a cash benefit that helps cover the costs of treating an accidental injury.

Accidents happen. Sometimes they’re serious, sometimes they’re minor – but no matter what, treatment usually isn’t cheap. From broken bones to burns, the cost of treating an accidental injury and restoring you or a family member to good health can be expensive. Health insurance is designed to help you cover health related costs. But with high deductible in health insurance plans becoming increasingly common, even the out-of-pocket costs of health insurance alone can deal your finances a serious blow. Accident insurance can help you minimize the costs of treating an accidental injury so you’re able to afford the treatment you need. Cash benefits for supplemental insurance can be used in any way you choose.

What is accident insurance?

Accident insurance is a type of insurance that pays a cash benefit if you or a covered family member experiences an accidental injury. It helps with the unexpected expenses that often accompany an accidental injury that medical insurance alone doesn’t fully cover. Benefits paid are based on the type of injury, the severity of the injury, and the type of treatment you receive.

Accident insurance is a type of supplemental insurance, meaning it’s meant to support (not replace) your major medical insurance plan to help you cover unexpected expenses resulting from accidental injury.

How is accident insurance coverage different from health insurance coverage?

Accident insurance coverage and health insurance coverage both help you cover the costs of medical treatment. However, there are a few key differences between accident insurance and health insurance. Understanding them can help you make an informed decision about how much accident insurance you need.

Health insurance is a contract that requires your insurer to pay for some or all your health care costs directly to your healthcare provider in exchange for a premium, typically paid monthly or annually1. Under the Affordable Care Act (ACA) marketplace, all medical insurance plans cover at least 10 essential health benefits, including treatment for, emergency services, prescription drugs, pediatric services, and more2. As of 2018, nearly half of the American population get health insurance through their employer3. The average cost of private health insurance being $462/month for one person, without a subsidy4

Accident insurance pays out benefits in the event of an accidental injury. For example, if you’re admitted to the hospital for an accidental injury such as a broken leg, you could receive health insurance benefits under your health insurance and accident insurance benefits if you have supplemental accident insurance – but if you’re admitted for an illness, you’d only receive health insurance benefits. Supplemental accident insurance benefits are paid out in cash directly to you. 

Does accident insurance replace my major medical insurance plan?

Accident insurance is not designed to replace your major medical insurance plan. Rather, it’s designed to supplement your health insurance plan and help you cover out-of-pocket expenses associated with accidental injuries 

Do I need accident insurance if I have health insurance?

Depending on the terms of the applicable medical insurance plan, many with health insurance can still benefit from accident insurance coverage. Especially if your health insurance plan has a high deductible or you’re concerned about how you might cover out-of-pocket costs from an accidental injury.

Three in five people don’t have the funds to cover a $3,000 medical bill5– and the average deductible for high-deductible insurance plans is $2,3496 for single coverage. If you’re concerned that your current finances may not be enough to cover the costs of an accidental emergency, consider purchasing accident insurance. 

How does accident insurance work?

Like other types of insurance products, to receive accident insurance coverage, you pay a premium. If you or a covered family member is injured, you receive a cash benefit. Accident insurance pays that cash benefit directly to you. This benefit can be used in any way you choose whether to offset deductibles or co-pays or even to cover expenses such as your mortgage or groceries. The amount you receive will depend on the type of injury, the severity of the injury, and the treatments prescribed.

3 common steps to using accident insurance

  1. Submit your claim – Visit any doctor or hospital you choose to treat your accidental injury, then send a claim to your insurance provider for verification. Be sure to include all details of the injury and injury-related treatments.
  2. Receive your cash benefit – Once they've verified your claim, your insurance provider will pay a cash benefit directly to you—not to doctors or hospitals.
  3. Pay your bills – Once you’ve received your cash benefit, you can use it to pay any bills you choose, including deductibles, co-pays, coinsurance, ambulance charges, crutches, and wheelchairs, as well as non-medical bills like your mortgage, groceries, or childcare expenses.

Who needs accident insurance?

Accidents happen to everyone, and there’s no way of knowing when or where they might occur. 

Of course, certain people are especially good candidates for accident insurance. If you have a high-deductible health insurance plan, accident insurance can benefit you even more since your out-of-pocket costs of treating an accidental injury will may be higher. If you want to avoid using savings or even going into debt to cover the unexpected costs of an accidental injury, accident insurance can help.

Accident insurance can also be useful for people with children since kids can be accident-prone. On average, about 8,000 children visit the hospital emergency room for fall-related accidents every single day7. Accident insurance can help cover you as well as your children, helping to minimize the cost of treating your child’s accidental injury. And don’t worry – there's no limit to how many times your children can be covered by your accident insurance plan, no matter how accident-prone they may be.

If you or your children lead an especially active lifestyle, accident insurance is worth considering. Accident insurance covers most sports-related injuries related to children organized sports. In fact, Guardian Direct® accidental injury benefits can increase by 20% if your child is injured while participating in an organized sport8

What does accident insurance cover?

Accident insurance can cover unexpected expenses resulting from different types of accidental injuries. You can purchase accident insurance for just you or for your entire immediate family. Exact coverage areas and amounts will vary depending on your plan and provider. Here’s a comprehensive list of over 25 injury and treatment types Guardian Direct accident insurance covers: 

  • Injuries – accident-related concussions, lacerations, fractured or broken bones, surgery, coma, dislocations, burns, loss of limbs, and death
  • Ambulance services – traditional ambulance rides and even air ambulances
  • Emergency care – urgent care doctor visits, emergency room visits, and follow-up doctor visits
  • Diagnostic tests – X-rays, CT or CAT scans, MRIs, and EEGs
  • Hospital treatment – hospital and ICU admission and stays
  • Restorative treatment – prescribed prosthetics, appliances, injury-related eye surgery or object removal, and injury-related dental crowns or extractions
  • Rehabilitation treatment – rehabilitation center stays and physical therapy sessions

If you or a covered family member experiences one of these injuries or treatment types, you may be entitled to receive a cash benefit. If your child (18 and younger) was participating in an organized sport when the accident occurred, the entire cash benefit paid may increase by 20%.

What is not covered by accident insurance?

Every plan is different, but most l accident insurance doesn’t pay out benefits for the following types of injuries: 

  • Injuries caused by disease or illness
  • High-risk recreational sports injuries (including, skiing, scuba diving, bungee jumping, etc.)
  • Injuries caused by dangerous or reckless activities
  • Self-inflicted injuries, including suicide
  • Injuries that occur while under the influence of drugs or alcohol
  • Injuries incurred while committing a crime
  • Injuries incurred prior to purchasing accident insurance

Remember – though health insurance may pay out benefits to treat these sorts of injuries as well as other conditions, such as illness or disease, accident insurance only pays out benefits in the case of an accidental injury. 

How much accident insurance do I need?

Finding the right accident insurance plan for you depends on how much you will need to cover deductibles, co-pays, and other unexpected expenses if you or a family member has an accident. Before choosing an accident insurance plan, review your health insurance plan, including deductibles and co-pay amounts. 

You'll also want to review your finances to decide how much you want to or can afford to pay each month. This will largely depend on whether you want to pay more upfront through a premium or more when you or a family member is injured. The larger premium you pay upfront, likely the less you’ll pay if you or a family member experiences an accidental injury. 

It’s also important to consider what specific injuries and treatment types are covered under an accident insurance plan. 

How to pay hospital bills for an accidental injury

Accident insurance can help cover any bills or costs  related to covered accidental injuries from deductibles to hospital and intensive care unit admission and stays. Accident insurance can also help cover ambulance rides or even the rent you may be unable to pay due to the missed workdays.

Is accident insurance worth it?

Accident insurance can be worth it for anyone who would prefer not to have to drain their savings to cover the cost of treatment for an accidental injury. It can help offer you comfort to know that if you or a family member is injured, your finances will be protected and you’ll be able to focus on recovery. 

How to get accident insurance

Some employers offer supplemental accident insurance as a voluntary employee benefit, but it isn’t especially common. If you’d like to obtain  accident insurance for you and your family, you can purchase it directly from an insurance provider online. You can get approved for an accident insurance plan in a matter of minutes.

If you suffer a serious accidental injury, the last thing you’ll want to worry about is how you’ll afford the treatment you need to recover. 

 

Links to external sites are provided for your convenience in locating related information and services. Guardian, its subsidiaries, agents and employees expressly disclaim any responsibility for and do not maintain, control, recommend, or endorse third-party sites, organizations, products, or services and make no representation as to the completeness, suitability, or quality thereof.

This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist's office.

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Sources:

1. https://www.healthcare.gov/glossary/health-insurance, accessed September 2020
2.https://www.healthcare.gov/coverage, accessed September 2020
3. https://www.kff.org/other/state-indicator/total-population, 2018
4. https://www.healthmarkets.com/content/health-insurance-cost-per-month, accessed September 2020
5. The Guardian Workplace Benefits Study, Fourth Annual, https://www.guardianlife.com/benefits-administration/study/benefits-in-the-workplace, 2016
6. https://www.cnbc.com/2019/09/26/your-health-insurance-costs-are-about-to-go-up-in-2020.html, 2019
7. https://www.stanfordchildrens.org/en/topic/default?id=accident-statistics-90-P02853, accessed October 2020
8. https://www.guardiandirect.com/products/accident-insurance/guardian-accident-protection-plus-gold-most-states, accessed October 2020

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.
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