Group Accident Medical
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Product Summary
Many organizations and clubs purchase a type of Accident & Health coverage called a Group Accident Medical policy. This policy provides medical expense coverage for members of a group who are injured by an accident while participating in group-sponsored activities.
When an organization sponsors a group activity, there is always the possibility that a participant may suffer an injury, perhaps something serious. If an accident occurs, the organization may want to help pay the medical expenses. In the case of a serious accident, the medical expenses could be substantial.
Buying an Accident Medical policy can be a prudent decision for the organization. Injured parties are less likely to bring suit against the organization if their medical bills are taken care of. Medical bills from heath care providers are paid quickly and easily. The coverage fosters good public relations for the organization.
The Accident Medical policy automatically includes Accidental Death & Dismemberment coverage.
Annual policies are available for youth and adult clubs, associations, and organizations. Policies can also be purchased on a short-term basis for an event, such as a fundraising drive, convention, or walkathon.
What's Covered?
Accident Medical Expense Coverage
Accident medical expenses are covered while participating in scheduled, sponsored and supervised activities of the insured group. Injuries sustained during direct travel to and from the covered activity are also covered. Covered expenses can include physician treatments, hospital services, LPN or RN services, use of an ambulance, ambulatory surgical or medical center services, home health care expenses, prescription medicines, and dentist visits. Expenses incurred within 52 weeks of the date of the accident are covered.
All participants / members of the insured group must be covered. New participants who join the group after the effective date are automatically included, without additional charge. No premium refunds are made for members who leave the group before the policy expires.
Coverage is available on either a primary or excess basis. Primary coverage responds to covered expenses regardless of other available insurance the individual may have. The expenses are subject to a small deductible. Excess coverage pays last. The medical bills must be first submitted to the individual’s other insurance plan, and then the excess Accident Medical policy will consider the unpaid balances, after a small deductible, up to the benefit limit.
Benefit limit options of $5,000, $10,000 and $25,000 are available. The benefit limit applies on a per accident basis. The policy has an aggregate limit of $250,000 per occurrence.
Accidental Death & Dismemberment (AD&D) Coverage
AD&D coverage pays a lump sum benefit for accidental loss of life, limb or sight. A limit of $5,000 is available.
What Isn't Covered?
Any injury or sickness covered by Workers’ Compensation or any occupational disease law is not covered. Occupational accidents are not covered. This is not disability insurance. Sporting activities are not covered unless specifically noted on the policy. This coverage is not to be considered a substitute for any type of health, medical or disability insurance.
What Affects the Cost of the Policy?
The premium is based on the number of participants in the group and the nature of the organization or event. Short-term policies are rated on a per day, per participant basis.