Personal Accident Insurance

Personal Accident Insurance

Personal Accident insurance provides a lump sum payment to help pay for expenses that medical insurance may not cover if you are injured in an accident outside of work.

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Take comfort knowing you have financial support for accidents

When unexpected injuries lead to unexpected expenses, your personal accident insurance can provide money to help pay for expenses such as medical bills, transportation costs and childcare expenses.

  • You’ll receive a lump sum payment to use as you see fit, paid directly to you
  • The plan pays no matter what your medical insurance covers
  • May cover accident-related events, such as: sports injuries, auto accidents, bicycle accidents, broken bones, knee injuries and falls

With group employee rates, you can get Personal Accident Insurance coverage for less than the cost of your daily medium cup of coffee.1

Here's how it works:

Kathy’s daughter, Molly, plays soccer. During a recent game, Molly collided with an opposing player, was knocked unconscious and taken to the local emergency room (ER) by ambulance for treatment. The ER doctor diagnosed a concussion and a broken tooth. He also ordered a CT scan. After thorough evaluation, Molly was released to her primary care physician for follow-up treatment, and her dentist repaired her broken tooth with a crown. Luckily Kathy has personal accident insurance!

Coverages2

Benefit Amount3

Ambulance (ground)

$300

Emergency Care

$100

Medical Testing

$200

Concussion

$400

Physician Follow-Up ($75x 2)

$150

BrokenTooth (repaired by crown)

$200

Kathy would get a lump-sum payment totaling $1,350 with MetLife Personal Accident
Insurance.

This example is for illustrative purposes only.
Benefits paid by MetLife Personal Accident Insurance

What is covered?

Here are some of the more utilized covered events/services. 

Benefit Type2 MetLife Personal Accident Insurance Pays YOU
Accidental Injury Benefits  
Fracture*
(depending on the fracture and type of repair)
$320 – $8,000
Dislocation*
(depending on the dislocation and type of repair)
$25 – $6,000
Second- or Third- Degree Burn
(depending on degree of burn and percentage of burnt skin)
$100 – $20,000
Concussion $200
Coma $10,000
Puncture Wound $75
Laceration
(depending on the length of the cut and type of repair)
$25 – $400
Broken Tooth Crown: $150 / Filling: $10 / Extraction: $50
Eye Injury $250
Accident - Medical Services & Treatment Benefits  
Ambulance Ground: $200 / Air: $1,000
Emergency Care
(depending on location of care)
$30 – $100
Physician Follow-Up $30
Therapy Services (including physical therapy) $15-$30
Medical Testing Medical Testing (MRI/MR, Ultrasound, NCV, CT/CAT, EEG) - $200
Medical Testing (X-Ray) - $125
Medical Appliances
(depending on the appliance)
$100
Transportation $300
Benefit Type Plan Benefits
Prosthetic Device One or More device: $500
Modification $5,000
Blood/Plasma/Platelets $100
Surgical Repair
(depending on the type of surgery)
$250-$1,000
Exploratory Surgery $250
Other Outpatient Surgery $100
Outpatient IV Infusion Therapy
(2 times per accident, 4 times per year)
$75
Hospital Benefits*  
Admission* $1,000 for the day of admission
Confinement*
(paid for up to 60 days per accident)
$200 per day
ICU Supplemental Confinement
(paid for up to 15 days per accident)
$200 per day
Inpatient Rehabilitation*
(paid for up to 15 days per accident)
$75 per day
Paralysis Benefits  
Paralysis
(depending on the number of limbs)
$5,000 - $10,000
Other Benefits  
Lodging Benefit* - for a companion of a covered person who is hospitalized
(30 days per calendar year)
$100 per day

* Notes Regarding Certain Benefits

  • Fracture and Dislocation benefits – Chip fractures are paid at 25% of Fracture Benefit and partial dislocations are paid at 25% of Dislocation Benefit.
  • Hospital Benefits – Hospital does not include certain facilities such as nursing homes, convalescent care or extended care facilities. See MetLife’s Disclosure Statement or Outline of Coverage/Disclosure Document for full details.
  • Lodging Benefit – The lodging benefit is not available in all states. It provides a benefit for a companion accompanying a covered insured while hospitalized, provided that lodging is at least 50 miles from the insured’s primary residence.


For additional details or to confirm benefits under your plan, consult your member certificate or Outline of Coverage on MetLife’s MyBenefits site.

Benefit Payment Example

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The example below illustrates an employee who elected the Family Accident plan.

Kathy’s daughter, Molly, was riding her bike to school. On her way there she fell to the ground, was knocked unconscious, and was taken to the local emergency room (ER) by ambulance for treatment. The ER doctor diagnosed a concussion and a broken tooth. He ordered a CT scan to check for facial fractures too, since Molly’s face was very swollen. Molly was released to her primary care physician for follow-up treatment, and her dentist repaired her broken tooth with a crown. Depending on her health insurance, Kathy’s out-of-pocket costs could run into hundreds of dollars to cover expenses like insurance co-payments and deductibles. MetLife Group Accident Insurance payments can be used to help cover these unexpected costs.

Covered Event3 Benefit Amount
Ambulance (ground) $200
Emergency Care $100
Physician Follow-Up ($30 x 2) $60
Medical Testing $200
Concussion $200
Broken Tooth (repaired by crown) $150
Benefits paid by MetLife
Group Accident Insurance
$910


Benefit amount is based on a sample MetLife plan design. Actual plan design and benefits may vary.

All Benefit Levels include Social Security Disability Advocacy and Advisory Service (DAS)1, which can be initiated regardless of the outcome of a submitted Critical Illness claim filed with MetLife. To determine if your critical illness and disability qualify for Disability Advocacy Services through SSDC, call SSDC Services Corp. at 866-587-2853.7

Insurance Rates

MetLife offers group rates and payroll deduction, so you don’t have to worry about writing a check or missing a payment!
Your employee rates are outlined below.

Accident Insurance Monthly Cost to You
Coverage Options Plan Benefit
Employee $3.77
Employee & Spouse $7.50
Employee & Child(ren) $8.66
Employee & Spouse/Child(ren) $10.45

Personal Accident Insurance

You can’t always plan for accidents, but you can be better prepared financially.

Is Personal Accident Insurance Right for Me?

1 Covered services/treatments must be the result of a covered accident or sickness as defined in the group policy/certificate. See your Disclosure Statement or Outline of Coverage/Disclosure Document for full details.

2 Availability of benefits varies by state. See your Disclosure Statement or Outline of Coverage/Disclosure Document for state variations.

3 Benefits and amounts are based on sample MetLife plan design. Plan design and plan benefits may vary.

4 Coverage is guaranteed provided (1) the employee is actively at work and (2) dependents to be covered are not subject to medical restrictions as set forth on the enrollment form and in the Certificate. Some states require the insured to have medical coverage. Additional restrictions may apply to dependents serving in the armed forces or living overseas. Children may be covered to age 26.

5 Eligibility for portability through the Continuation of Insurance with Premium Payment provision may be subject to certain eligibility requirements and limitations. For more information, contact your MetLife representative.

6 Social Security disability advocacy services are provided by SSDC Services Corp. SSDC Services Corp. is not affiliated with MetLife, and the services and benefits they provide are separate and apart from the insurance provided by MetLife.

7 The Social Security Disability Advocacy and Advisory Service (DAS) Benefit is provided to employees enrolled in the Critical Illness or Personal Accident insurance you purchase. These services are provided by SSDC Services Corp., and DAS is a subscription service available in all 50 states and is not subject to insurance regulations. Coverage is guaranteed provided the employee is actively at work as set forth on the enrollment form and in the Certificate. Some states require the insured to have medical coverage. Additional restrictions apply to dependents serving in the armed forces or living overseas.

METLIFE’S PERSONAL ACCIDENT INSURANCE IS A LIMITED BENEFIT GROUP INSURANCE POLICY. The policy is not intended to be a substitute for medical coverage and certain states may require the insured to have medical coverage to enroll for the coverage. The policy or its provisions may vary or be unavailable in some states. Like most group accident and health insurance policies, policies offered by MetLife may include waiting periods and contain certain exclusions, limitations and terms for keeping them in force. For complete details of coverage and availability, please refer to the group policy form GPNP12-AX or contact MetLife.

Benefits are underwritten by Metropolitan Life Insurance Company, New York, NY. Hospital does not include certain facilities such as nursing homes, convalescent care or extended care facilities. See MetLife’s Disclosure Statement or Outline of Coverage/Disclosure Document for full details.