Comprehensive Guide to National Accident Insurance: Coverage, Benefits, and FAQs

What is national accident insurance. How does accident insurance work. What does accident insurance cover. Who is eligible for accident insurance. Why do you need accident insurance if you have medical insurance. How to enroll in accident insurance without a medical exam. Are accident insurance benefits paid directly to you. Can you take accident insurance coverage with you if your employment status changes. How can you use accident insurance benefit payments.

Table of Contents

Understanding National Accident Insurance: A Comprehensive Overview

National accident insurance is a valuable financial tool designed to provide support in the event of unexpected injuries. This type of coverage offers a lump sum payment to help cover expenses that may not be fully addressed by traditional medical insurance. Let’s delve into the specifics of accident insurance and explore its benefits.

The Mechanics of Accident Insurance: How Does It Work?

Accident insurance operates on a straightforward principle: it provides financial assistance when you suffer injuries due to an accident. Here’s a breakdown of how it functions:

You pay a monthly premium for coverage
If you experience a covered accident, you receive a lump sum payment
The payment is made directly to you, not to healthcare providers
You can use the funds as you see fit, whether for medical bills or other expenses
Benefits are paid regardless of what your other insurance plans may cover

This flexibility allows you to address various financial needs that may arise following an accident, providing an additional layer of security beyond your regular medical insurance.

Comprehensive Coverage: What Does Accident Insurance Protect Against?

Accident insurance covers a wide range of injuries and accident-related events. While specific coverage may vary depending on the plan, here are some common scenarios that are typically included:

Sports injuries
Auto accidents
Bicycle accidents
Broken bones
Knee injuries
Falls
Dislocations
Concussions
Dental injuries (such as broken teeth)

Is accident insurance limited to these specific injuries? No, many plans offer coverage for a variety of accident-related medical services, including emergency care, medical testing, physician follow-ups, and even ambulance transportation.

Eligibility and Enrollment: Who Can Get Accident Insurance?

Accident insurance is typically available to a wide range of individuals. Here are the key points regarding eligibility and enrollment:

Employees can enroll themselves and eligible family members
Enrollment is usually possible during designated enrollment periods
The primary requirement is that you’re actively at work
No medical exam is required for enrollment
Coverage is guaranteed, regardless of your health status

How simple is the enrollment process? Remarkably so. There are no health questions to answer, making the process straightforward and accessible to most employees.

The Importance of Accident Insurance: Why It Matters

You might wonder why accident insurance is necessary if you already have medical insurance. Here’s why it’s a valuable addition to your financial safety net:

It covers expenses that medical insurance may not, such as deductibles and copays
Provides financial support for out-of-network care costs
Offers coverage for services not included in standard medical plans
Gives you the flexibility to use the funds as needed, whether for medical bills or other expenses

In essence, accident insurance acts as a financial buffer, helping you manage unexpected costs that can arise from accidents without depleting your savings or incurring debt.

Financial Benefits: How Accident Insurance Payments Work

Understanding the payment structure of accident insurance is crucial for appreciating its value. Here are the key aspects of how benefits are paid:

Payments are made directly to you, not to healthcare providers
The check is made payable to you for your convenience
Benefits are paid regardless of what other insurance plans may cover
You have the freedom to use the payment as you see fit

Can you use the benefit payment for any purpose? Absolutely. Whether you need to cover medical insurance deductibles, copays, household bills, or any other expenses, the choice is yours.

Portability: Taking Your Coverage with You

One of the significant advantages of accident insurance is its portability. But what does this mean for you?

You can take your coverage with you if your employment status changes
Coverage continues as long as you keep paying your premium
The only exceptions are if you stop paying or if your employer offers similar coverage with a different carrier

This portability feature ensures that you maintain your financial protection even if you change jobs or leave your current employer, providing long-term peace of mind.

Real-World Application: A Case Study of Accident Insurance in Action

To illustrate how accident insurance works in practice, let’s consider a hypothetical scenario:

Kathy’s daughter, Molly, is injured during a soccer game. She’s taken to the emergency room by ambulance, where she’s diagnosed with a concussion and a broken tooth. The ER doctor orders a CT scan, and Molly is later released to her primary care physician for follow-up. Her dentist repairs the broken tooth with a crown.

With a MetLife Accident Insurance High Plan, Kathy would receive a lump-sum payment totaling $1,350, broken down as follows:

Ambulance (ground): $300
Emergency Care: $100
Medical Testing: $200
Concussion: $400
Physician Follow-Up ($75 x 2): $150
Broken Tooth (repaired by crown): $200

This example demonstrates how accident insurance can provide substantial financial support for a range of medical services and treatments resulting from an accident.

Cost-Effectiveness of Accident Insurance

How affordable is accident insurance? With group employee rates, you can often secure coverage for less than the cost of a daily medium cup of coffee. This relatively small investment can provide significant financial protection in the event of an accident.

Frequently Asked Questions About Accident Insurance

To address common queries about accident insurance, let’s explore some frequently asked questions:

Why do I need accident insurance if I have medical insurance?

Accidents can happen unexpectedly and can be costly. Even comprehensive medical plans may leave you with expenses for services that aren’t covered, such as plan deductibles, copays, out-of-network care costs, or non-covered services. Accident insurance provides additional financial support to help manage these expenses.

Can I enroll for accident insurance without a medical exam?

Yes, your accident coverage is guaranteed regardless of your health status. There are no medical exams to take or health questions to answer. The only requirement is that you’re actively at work to be covered.

Are benefits paid directly to me or to my healthcare provider?

Payments are made directly to you, not to doctors, hospitals, or other healthcare providers. The check is made payable to you, giving you the flexibility to use the funds as needed.

Can I take my coverage with me if my employment status changes?

Yes, this coverage is portable. You can take it with you wherever you go. Your coverage will only end if you stop paying your premium or if your employer offers you similar coverage with a different insurance carrier.

Can I use the benefit payment for anything I need?

Yes, you have complete freedom to use the payment as you see fit. You can use it to help cover medical insurance deductibles, copays, household bills, or any other expenses you may have.

Accident insurance provides a valuable safety net for unexpected injuries and their associated costs. By offering direct payments, flexible usage, and guaranteed coverage, it complements your existing medical insurance and helps ensure you’re financially prepared for life’s unforeseen events. Whether you’re dealing with sports injuries, auto accidents, or other accidental injuries, this type of insurance can provide the additional support you need to focus on recovery without financial stress.

Accident Insurance | National Grid

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.

Accident Insurance

Take comfort knowing you have financial support for accidents

When unexpected injuries lead to unexpected expenses, your 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 Accident Insurance coverage for less than the cost of your daily medium cup of coffee. ¹

View plan details

Accident Insurance Outline of Coverage

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 accident insurance!

Covered Event2	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 Accident Insurance High Plan.

This example is for illustrative purposes only.

Benefits paid by MetLife Accident Insurance HighPlan

Accident Insurance FAQs

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Am I eligible to enroll for this coverage?

Yes, you can enroll both yourself and eligible family members. All you need to do is enroll during your enrollment period, and be actively at work.

I have medical insurance, so why do I need accident insurance?

Accidents can happen anytime, anywhere and always when you least expect them. What’s more they can be costly.

Even the best medical plans can leave you with expenses for services that just aren’t covered. Things like plan deductibles, copays, extra costs for out-of-network care, or non-covered services. Many people aren’t prepared to handle these costs, so having this additional financial support when the time comes may mean less worry for you and your family.

Can I enroll for this insurance without having a medical exam?

Yes. Your accident coverage is guaranteed⁴, regardless of your health. You just need to be actively at work to be covered. There are no medical exams to take and no health questions to answer, so the whole process might be easier than you first thought.

Are benefits paid directly to me or to my health care provider?

Payments will be paid directly to you, not to the doctors, hospitals or any other health care providers. And to make things even easier, the check is made payable to you. There’s no need to work it around any other insurance you may have. Benefits are paid no matter what your other insurance plans may cover.

If my employment status changes, can I take my coverage with me?

Yes. This coverage is portable, meaning you can take it wherever you go. Your coverage will only end if you stop paying your premium or if your employer offers you similar coverage with a different insurance carrier. ⁵

Can I use the benefit payment on anything I need?

Yes, you can use your payment as you see fit. Use it to help cover your medical insurance deductibles, copays, household bills, and more.

Accident Insurance – What Is It

How Accident Insurance Works

Accident insurance pays cash benefits for injuries resulting from an accident. You pay a monthly premium for coverage, so you are prepared when those unexpected life events come your way. Even if your health insurance covers 100% of your medical costs from the accident, you may still receive benefits from your accident insurance plan.

What Does Accident Insurance Cover?

Every accident insurance plan differs based on the injuries covered in your plan, the severity of the injury, and treatments for recovery. Here are some of the injuries that may be covered by accident insurance:

Accident-related injuries such as broken bones or dislocations, burns, dental and eye injuries
Ambulance services
Emergency room care or urgent care
Diagnostic testing such as X-rays and CAT scans
Hospital treatment and surgical care for your injuries
Physical therapy and rehabilitation

Understanding the details of your plan’s coverage can help ensure that you have protection in place for you and your family.

Questions To Ask When Deciding On Accident Insurance Coverage

What injuries are covered by the plan?
What injuries are not covered?
How quickly do you receive your payment when an accident occurs?
Will you receive a lump sum or monthly payments?
Is a medical exam required to qualify for the plan?

How To Use Accident Insurance Benefits

Most accident insurance plans typically become effective within days of application and the payment is made directly to you. There are no deductibles, copays, or coinsurance. Once you receive your benefits, you can use the cash to cover many of the costs incurred while recovering from your injury.

Cost-of-living expenses while recovering
Home care for you
Day care for your children while you recover
Transportation to rehab or treatment centers
Medical costs not covered by health insurance
Deductibles and out-of-pocket expenses from your health insurance plan

Is Accident Insurance Worth It?

The monthly premiums of most accident insurance plans are typically low in cost, which make them cost-effective add-ons to your health insurance coverage. You may want to think about accident insurance if you and your family lead an active lifestyle, your health insurance offers only limited coverage, or if out-of-pocket expenses from an accident would be costly with your current health insurance plan.

Rounding Out Health Insurance With Supplemental Insurance Coverage

Accident insurance is just one of many supplemental insurance plans that can complete your health insurance coverage. Serious illness and hospitalization are some of the “what ifs” you may also want to consider when supplementing your health insurance plan.

Critical illness insurance pays cash benefits when diagnosed with a serious illness, helping you pay bills and afford essential services you may need like home care while recovering from an illness.

Hospital indemnity insurance pays cash benefits that may cover inpatient hospital stays due to injury or illness as well as expenses while you are recovering at home.

Choosing The Right Accident Insurance Plan

Anthem can assist you in selecting an accident insurance plan that compliments the lifestyle of you and your family. Learn more about how supplemental insurance and your health insurance plan can work together to help you stay protected from the unexpected.

For more information, call us at 888-811-2101 (TTY: 711), Monday through Friday, from 8 a.m. to 5 p.m. ET.

Work accident insurance

How work accident insurance is carried out in 2019. Working in any company can be dangerous. And an accident can happen to any of the workers. That is why it is extremely important to know how insurance against industrial accidents is carried out in 2019. After all, the guarantee of receiving payments for treatment and compensation from the employer depends on this procedure.

General points:
Insurance is a mandatory procedure that every employer must complete in relation to an employee.
Thus, the system of Russian legislation provides for the payment of an insurance fee for each employee. Starting from January 1, 2019, the tax service of Russia begins to deal with all such fees.
It is she who will monitor the correctness of the calculations of these contributions and their payment on time.
There are several types of insurance – compulsory, social and voluntary. In all types, the amount of payment and insured events will differ. And this should be taken into account when drawing up a document.

General aspects

Based on the fact that all cases have now been transferred to the Russian Federal Tax Service, a more thorough review of all contributions will be carried out.
And fines for violations are also quite large. All mandatory payments for accident insurance are made by production.
When calculating wages, the employer deducts a fee from the Federal Tax Service of the Russian Federation from it. If an insured event occurs, then the following is carried out:
• provision of social protection;
• compensation in full for the harm caused;
• Prevention of injury and illness in the course of work.
It should be understood that without fail the victim is paid the amount necessary for the treatment. Moreover, he receives treatment absolutely free of charge.
If the worker has other types of insurance, he can claim payment from other places of insurance.

About the parties to the agreement

There are several parties involved in this insurance process. The first is the insurer.
In the case of accidental charges, the Social Insurance Fund acts as an insurance agent.

The Social Insurance Fund carries out procedures such as:

• registration of all enterprises that insure their employees;
• accept reporting on contributions;
• control the payment of insurance premiums.
Both Russian and foreign organizations act as insurers – all those who work in Russia or employ citizens of the Russian Federation.
Individuals must also pay this insurance premium. This happens in those conditions when an individual hires those citizens who have insurance.
As for the insured persons themselves, these are exclusively natural persons. They may work on the basis of:
• an employment contract;
• civil law agreement.
In this case, in the latter case, it is necessary to place in the document a clause stating that it is the insured who pays all the contributions.

Legal framework

Federal Law No. 125-FZ “On Compulsory Social Insurance against Occupational Accidents and Occupational Diseases” provides all the conditions and provisions for the full insurance procedure for employees of enterprises.
Therefore, the employee has every right to claim insurance from his employer. The amount of the insurance payment is determined as a percentage of the amount of the insurance fee.
In this case, a special tariff scale is used. It is constantly updated and requires the payment of amounts corresponding to the costs of treatment.
This is discussed in chapter 2. All points of payments and insurance coverage are indicated here. All contributions are determined according to the risks of working in a particular area.
Decree of the Government of the Russian Federation No. 713 contains rules according to which it is necessary to determine the risks in the profession, and allow calculating the tariff fee for insurance.
But both discounts and surcharges on tariffs are approved by law. This is stated in more detail by the Decree of the Government of the Russian Federation No. 524.
How to calculate this indicator is stated in the order of the Ministry of Labor and Social Protection of the Russian Federation No. 39n.
The administration of insurance premiums has also been transferred to the Tax Service of the Russian Federation. To do this, Article 24 appeared in the Tax Code in part 2. She talks about insurance premiums and the features of working with them.

Procedure for provision in Russia

In order to receive an insurance payment, you need to perform a number of simple steps:

Seek medical attention To report the injury
Notify the insurer This must be done within 30 days. The usual form of notification is a statement. It should be sent along with supporting documents to the insurer
Wait for review Usually this procedure takes from 10 to 60 days. If litigation arose during the injury, then the payment is made only after the end of this process

It is worth noting that the heir of the insured or another person specified in the contract may claim to receive payment in the event of the death of the insured.
The amount of the insurance payment can be disputed. This is done by submitting an application to the Central Bank of the Russian Federation.

Drawing up a contract

The only document that regulates the provision of insurance benefits is an insurance contract.
It must be concluded with the insurance company in paper form – only with the help of such a document can you protect your rights in court and demand a change in the amount of compensation in case of disagreement.
The insurance company draws up the contract document on its own. Since in most cases a standard form is used.
Only numbers can change in it – depending on the amount of deductions that will be made.
The contract is made in duplicate – so that one can be received by the insured, and the other is given to the insured.
In the event of an accident, this document is provided to receive payment. When concluding a transaction, you should familiarize yourself with all the clauses of this document and read it carefully in order to understand all the features of the agreement.
Since not all insured events can be taken into account in this document.
Main types
There are several types of insurance that an employee can take out in an accident plan. Thus, the legislation provides for mandatory, social and voluntary registration of insurance.
All these types are distinguished only by the fact that voluntary insurance is the type of insurance that an employee receives at his own request and in any insurance agency.
Plus, you need to understand that insurance may not cover all the costs of treatment and rehabilitation.
Therefore, you need to prepare to protect your rights in any case. This is the only way you can expect to receive the greatest compensation.

Mandatory

Compulsory social insurance is the type of payment provided by the Social Insurance Fund.
It is through this organization, at the expense of the employer’s deductions, that the state pays funds for insurance.
Payments can be made both in the form of a one-time compensation and monthly insurance payments. In some cases, you can expect to receive payments for additional expenses.
Insurance of this type includes not only payment in the course of temporary inability to work, but is also provided for a complete loss of ability to work.
Even in the event of the death of the insured, his relatives can count on receiving compensation under the insurance.
It should be taken into account that all payments will be made in accordance with the indicators for the amounts that are set on the day when the payment is calculated.
Compulsory insurance must be issued to military personnel, police and judicial officials, the Ministry of Emergency Situations and several other categories of citizens. They are the most likely to be at risk of injury at work.

Social

Social insurance is the same compulsory insurance. There are no differences between them and they are one and the same insurance option. Therefore, all functions and features are the same for them.
And in the case of registration of compulsory social insurance, the insured person receives a policy, based on which he can apply for compensation and insurance payments.

Voluntary

In the situation with voluntary insurance, the whole situation is much simpler. A person has the opportunity to independently choose an insurer company, depending on their needs and preferences.
In addition, it should be understood that this type of insurance may not be issued. This is an additional guarantee of receiving a payment. And it can concern not only an accident.
The peculiarity of this insurance is that the opening of an insurance account occurs in accordance with the application submitted by an individual or a legal entity – if it is corporate insurance.
Another aspect is the fact that the individual will pay insurance premiums on his own, and not the company will automatically collect fees from him.

Contributions for insurance against industrial accidents and occupational diseases

Industrial accident insurance rates 2019 are based on the indicator of which occupational risk class the position of the insured person belongs to.
It is in accordance with them that the amount of payment is formed, which the employer must transfer to the FSS.
There are 32 classes in total – the amounts increase by 0.1 percentage point in each class step. So, at the beginning – at the first stage, the tariff rate will be equal to 0.2%.
The increase of 0.1% will last until grade 14 and amount to 1. 5%. Then the increase from 15th to 19th grade will be 0.2% each, from 20th to 23rd – 0.3%.
And further in this algorithm:

Class Tariff, %
24 4.1
25 4.5
26 5
27 5.5
28 6.1
29 6.7
30 7.4
31 8.1

But the last class – the 32nd will be 8.5%.

How the fund is formed

The Social Insurance Fund of the Russian Federation is formed at the expense of several income items:
1. Mandatory contributions from those who are insured – deductions from wages.
2. Fines and penalties resulting from late filing of fees or payment of fees.
3. Capitalization of liquidated policyholders.
This is the main block, but in some cases, the FSS may receive funds from other legal sources.
Insurance in Russia is well developed, so each employee can be protected from an accident at the place of work or a disease associated with the profession.
Therefore, the state provides compulsory insurance for all employees.

National insurance – איתן זבולון ושות’

Indeed, the National Insurance Institute is responsible for the provision of services and social assistance to citizens, but the bureaucratic labyrinths and confusion that a citizen has to face require skills, knowledge and extensive experience in this area, especially when the relevant laws and issued on their basis The regulations are numerous and very cumbersome and are updated every year. There are many cases where people do not get all they are entitled to and in full, if at all, from the National Insurance Institute, and the main reason for this is that people go to this huge and bureaucratic institution alone, without any – any experience and without a lawyer who specializes in this area, which leads to the rejection of his claims by the institution or does not achieve a fair and appropriate result in the circumstances of the case.

The law states that in order to receive a benefit or payment for the rights listed in the law, it is necessary to apply in advance to the National Insurance Institute. Some of the procedures are simple and can be done by filling out a special form such as an application for unemployment benefits and a lump sum for the birth of a child, and some are complex and require prior knowledge and understanding of what is being done from both a legal and practical point of view. .

Special services allowance – paid to an insured person aged 18 to retirement age who is heavily dependent on the help of others in daily household chores (eating, personal hygiene, moving around the house, bathing and dressing ), or the insured person needs supervision in order to prevent danger to himself or others. The benefit is also paid to patients undergoing chemotherapy, dialysis, ventilators and transplant patients.

It is important to note that the term “medical disability” refers only to the degree of medical disability to be determined by the results of examinations and tests, as defined in the National Insurance Regulations (Determination of the degree of disability in victims of industrial accidents) of 1956 . , and only after determining the degree of disability in %, if the degree of medical disability entitling to the allowance is established, the doctor of the Commission of the Office determines the degree of disability. The amount of the monthly allowance is calculated based on the percentage of disability, but if the insured person is able to return to full or part-time employment, according to the opinion of the commission doctor, the insured person will be invited to a meeting with a rehabilitation specialist so that he can give his opinion on this issue.

Insurance from accidents accidents at production – designed to compensate for loss of income to the insured to a person injured in an accident at work and to provide assistance for recovery and return to work . The purpose of the law is to provide lifelong free medical care and treatment in everything related to an accident at work, as well as vocational rehabilitation, financial compensation for loss of income, which is determined based on the income of the insured person at the time of the accident. If the victim becomes disabled as a result of an accident, a lump-sum payment or a lifetime allowance is paid. In the event of the death of the victim, the heirs are entitled to a lifetime benefit.

Accident at work/workplace – This definition refers to a wide variety of incidents and cases in which a person is suddenly and unexpectedly injured, and the injury occurs during (during work, at the place of work and in the process of work) of his work and as a consequence (because of the risks of the work, as a result of the performance of work) of his work for or on behalf of his employer. In fact, the law states that work-related activities such as: eating at work, taking breaks, using devices and amenities that the employer has provided to the employee, an accident on the way to and from work, corporate days, training days, at courses and parties will be considered an accident at work, for which you can file a claim for compensation with the National Insurance Institute.

Important! On a health condition violation in connection with work (accident at work or occupational disease), as a result of which a person died, or his condition requires medical assistance, or he lost his ability to work for at least 3 days, the insured person or his heirs must notify the National Insurance Institute as soon as possible. In addition, the information provided by the injured person in the emergency department is critical to the continuation of the process with the National Insurance Institute.

The National Insurance Institute Medical Board consists of a medical specialist and a secretary of the board meeting, whose responsibility is to keep records and ensure that rules and procedures are followed. The Medical Commission is relevant for any insured person who wants to fully exercise their rights in the National Insurance Institute. A medical examination by a doctor of the medical commission is carried out in order to study the complaints of the insured person and to establish defects, injuries and restrictions from which the insured person suffers.

Second stage — In the second stage, the commission doctor will conduct an examination of the health status of the insured person. The examination is intended to determine the degree of disability of the insured person in percentage terms. At this stage, the commission doctor must be presented with additional documents that were not presented in the case, if any, and the insured person, before the examination, must describe in detail to the commission doctor the diseases and / or disorders that he suffers from and how they affect his life expectancy and normal daily activities.

As part of your case with the National Insurance Institute, our office prepares the client for the medical examination, clearly and clearly explaining the violations, defects and limitations that the commission doctor will check, and the examination procedure. Our work does not end there, unlike various firms that send their clients alone to the medical commission, our bureau and lawyers specializing in this field accompany the client to the commission for as long as necessary in connection with the case.