Per-occurrence accidentA simple plan design offering financial protection against the unexpected Our simple, easy-to-use, per-occurrence accident insurance plan pays 100% of eligible services and supplies related to an accidental injury, up to the plan maximum.
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Overview
Plans can be customized between $300 and $10,000 per accident, and cover one or three accidents per insured per year. Employees can use this 24/7 coverage to fill the gaps of high-deductible health plans. For example, if a group’s deductible is $2,000 and the per-occurrence accident benefit is $2,000, employees can meet their deductible without paying out of pocket if they experience a covered accident. |
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Eligible expenses Benefits are paid for the following eligible expenses related to an accident: |
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X-rays, MRIs, and CT Scans
Inpatient prescription drugs Benefits are provided when:
Surgery
Medical Benefits are provided for the following services and supplies when they are provided or prescribed by a licensed physician or other licensed health care provider:
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Dental Benefits are provided for treatment performed by a licensed physician or licensed dentist in connection with the following:
Inpatient hospital Benefits are provided when all of the following conditions are met:
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Compare our products
The following products, features, terms and conditions may vary by state and may not be available in all U.S. states or any U.S. territory. Please contact your Symetra representative for more information on state availability.
Product | Differentiators | Industry-specific features | Pairs well with: |
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Critical illness | Symetra considers any stage of breast cancer (even Stage 0) as invasive cancer in terms of benefit payouts. Optional benefits for mental illness, infertility treatments, sudden cardiac arrest, mini stroke (TIA) and more. Broad diagnosis requirements for medical conditions make it easy for employees to qualify for claims. Pays the organ transplant benefit when the need for a transplant identified, not after it's completed, so that more insureds qualify for claims. |
Benefits are available for diagnoses that health care workers may experience more frequently, like occupational HIV, TB and hepatitis, as well as for many community- and hospital-acquired infectious diseases that result in hospitalization. | Group disability: Serious illnesses often require time away from work. Having both plans helps employees recover from their medical bills and lost income. Stop loss: A $5,000 step-down deductible may be available for groups who offer Symetra Critical illness along with their Symetra Stop Loss policy. |
Scheduled benefit accident | An initial accident benefit is paid with every approved claim to help cover incidentals such as travel, parking and over-the-counter medication. Benefits for sprains, accidental poisoning, gunshot wounds, animal bites and other frequently seen injuries. Optional benefits to support parents, pet owners, organized sport participants, multigenerational households, first responders and health care workers. |
Health care workers can receive additional benefits if they’re injured while performing their job duties, including injuries resulting from workplace aggravated assaults and occupational HIV/HEP/TB exposures or diagnoses. They can also receive an increased benefit amount when they choose to visit a hospital or facility within their group’s system. First responders who sustain a covered injury while performing their standard occupational duties receive an additional benefit payout. They also receive benefits for gunshot wounds, workplace aggravated assault, occupational HIV/HEP/TB exposure or diagnosis and a line of duty death. |
Critical illness: Provide coverage for major illnesses as well as injuries—big and small—with both plans. Hospital indemnity: Serious accidents can lead to time in the hospital. Provide benefits for the injury, follow-up treatment and hospital stay with both plans. |
Per-occurrence accident | Option to cover one or three accidents per year, up to $10,000 per accident. Easy claims filing process. |
Simple, easy-to-understand product. |
Critical illness: Provide coverage for major illnesses as well as injuries—big and small—with both plans. Hospital indemnity: Serious accidents can lead to time in the hospital. Provide benefits for the injury, follow-up treatment and hospital stay with both plans. |
Hospital indemnity | Pays daily benefits to the employee or their covered spouse for routine childbirth, up to a specified number of days per year, with no preexisting condition limitation for pregnancy. No separate maximum for the number of times we’ll pay the higher initial day confinement benefit (admission benefit). Automatic coverage for newborns or newly adoptive children for 31 days, even with routine, uncomplicated births. |
Health care workers receive an increased benefit amount when they choose to visit a hospital or facility within their group’s system. Optional, HSA-compatible coverage for inpatient mental health, substance abuse and nursing facilities. Optional benefits for an observation unit, ambulance transport, surgical procedures and anesthesia. |
Group disability: Serious illnesses often require hospitalization. Having both plans helps employees recover from their hospital bills and lost income. Symetra Health: While hospital indemnity can pay for major medical events, including childbirth, Symetra Health can pay for over 13,000 moderate, severe and catastrophic diagnoses that may occur throughout the year. |
Symetra Health | Pays benefits solely based on diagnosis codes to the insured's Venmo, PayPal or bank account. Multiple diagnoses within the same year are covered, with no maximum number of payouts for moderate and severe conditions. |
Benefits for over 13,000 covered illnesses or injuries, including common conditions that may occur in active workforces, like concussions, dehydration and migraines. |
Hospital indemnity: This combination provides broad coverage of injuries and illnesses, while also providing substantial benefits for the most common reason for hospitalization—childbirth. |
FAQ
What's the maximum benefit allowed for each accident?
$10,000. An employer can choose to offer between $300-$10,000 per accident, for either one or three accidents per year.
What kind of groups would be a good fit for this type of accident plan?
This is especially helpful for groups with high-deductible health plans who are trying to reduce the impact of deductible, copay and coinsurance requirements. It's also often recommended for groups that don't already have accident coverage in-force, and it's a great way to provide simple, valuable coverage for employees who are new to accident insurance. If your group prefers benefits based on the type of injury and treatment, as well as specific options for health care workers, first responders and parents, you may want to consider our scheduled benefit accident insurance.
What documentation is required to submit a claim?
Any medical documentation that is related to the accident can be submitted. Our digital claims process is simple and can be completed in minutes.
Is this plan HSA-compatible?
Yes.
Broker resources
Video: Per-occurrence accident insurance |
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Product guide (PDF) |
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Marketing materials |
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Video library |
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Forms library |
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Find your local Symetra representative |
Want to learn more? Contact your Symetra representative today.
Per-occurrence accident coverage, insured by Symetra Life Insurance Company, 777 108th Ave NE, Suite 1200, Bellevue, WA 98004, is not available in all U.S. states or any U.S. territory. It pays benefits up to a preselected, per occurrence amount and does not cover losses due to sickness, nor does it cover the cost of all hospital and medical services. It is not a replacement for major medical or other comprehensive coverage and does not satisfy the minimum essential coverage requirements of the Affordable Care Act. Base policy form number is LGC-10011P 10/11. Coverage may be subject to exclusions, limitations, reductions and termination of benefit provisions.
THIS POLICY IS ISSUED AS AN ACCIDENT ONLY POLICY. IT DOES NOT PAY BENEFITS FOR LOSS CAUSED BY ILLNESS.
WEB-1370 10/25