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Frequently Asked Questions

What is the purpose of this coverage?

A. The Personal Accident Insurance Plan was designed to protect you and your family from financial hardship if a serious accidental injury occurs.

A. The minimum amount of coverage for which you can enroll is $10,000. The maximum amount is $500,000. There are 10 levels of coverage in all. Click here for a list of coverages and premium.

A. All active and retired federal employees are eligible to enroll at any time. Evidence of insurability is not required.

A. The coverage pays benefits for accidental loss that results from an accident. “Loss” means the person’s:

  1. loss of life;
  2. total and permanent loss of sight;
  3. total and permanent loss of speech;
  4. total and permanent loss of hearing;
  5. loss of hand or foot by severance at or above the wrist or ankle;
  6. loss of thumb and index finger of the same hand by severance at or above the point at which they are attached to the hand;
  7. loss due to quadriplegia, paraplegia, or hemiplegia;
  8. loss due to coma;
  9. total and permanent disability (members only). You can find a complete description in the Personal Accident Insurance Summary Plan Description.

A. A “loss” is not covered if it results from any of these:

  1. suicide or attempted suicide, while sane or insane;
  2. intentionally self-inflicted injuries, or any attempt to inflict such injuries;
  3. sickness, whether the loss results directly or indirectly from the sickness;
  4. medical or surgical treatment of sickness, whether the loss results directly or indirectly from the treatment;
  5. most bacterial or viral infections (see Summary Plan Description for exceptions);
  6. taking part in any insurrection;
  7. war, or any act of war. War means declared or undeclared war, and includes resistance to armed aggression;
  8. an accident that occurs while the person is serving on full-time active duty for more than 30 days in any armed forces (does not include Reserve or National Guard active duty for training);
  9. commission of or attempt to commit a felony, assault, or illegal action;
  10. travel or flight in any vehicle used for aerial navigation;
  11. being legally intoxicated or under the influence of any narcotic unless administered or consumed on the advice of a doctor.

A. Contact SAMBA for instructions as soon as possible at 1-800-638-6589.

A. The amount payable depends on the type of loss, as shown here:

  • 100% of covered amount paid for loss of: life, sight of both eyes, speech and hearing in both ears, both hands, both feet, one hand and one foot, one hand and sight of one eye, and quadriplegia.
  • 75% of covered amount paid for: paraplegia.
  • 50% of covered amount paid for loss of: sight of one eye, speech, hearing in both ears, one hand, one foot, and hemiplegia.
  • 25% of covered amount paid for loss of: thumb and index finger of the same hand, and hearing in one ear.
  • 1% of covered amount paid per month, up to 100 months for: total and permanent disability, and coma.

Unless otherwise stated, benefits are paid as lump-sum.

The following Preventive Services are covered (see Section 5a of the official Plan brochure for a complete listing):

Adult Preventive Care:

  • One routine physical exam per year, including certain lab tests and screenings
  • One annual routine gynecological visit for women age 18 or over, including Pap smears
  • Routine screenings, such as:
    • Fecal occult blood test
    • Double contrast barium enema
    • Total blood cholesterol
    • Chlamydial infections
  • Routine Prostate Specific Antigen (PSA) test
  • Osteoporosis screenings
  • Sigmoidoscopy screening
  • Routine screening colonoscopy
  • Adult routine immunizations endorsed by the Centers for Disease Control and Prevention (CDC)
  • Routine mammograms
  • BRCA screening for women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes 
  • Preventive care and screening services recommended under the U.S. Preventive Services Task Force (USPSTF)

Children Preventive Care:

  • Childhood immunizations recommended by the American Academy of Pediatrics
  • Office visits for well child care examinations (up to age 18)
  • Preventive care services recommended under the U.S. Preventive Services Task Force (USPSTF)

A. No, you may carry your PAI coverage into retirement. Please be aware that at age 70, your coverage amount may not exceed $50,000; at age 75, coverage may not exceed $10,000.

A. Click here to access the Enrollment Center.

Issued by The Prudential Insurance Company of America

Personal Accident Insurance

Summary of Benefits
Eligibility Requirements
Choose the amount and level of coverage that is right for you:

– $10,000 to $500,000

– Member only or Member and Family

Plan Benefits

Available Coverage Amounts

You can select from $10,000 to $500,000.

Add Family Coverage

Cover your spouse and unmarried children up to age 26.

Additional Benefits

Safe Driver, Education, Child Care, and other benefits included at no additional cost.

Permanent Coverage

You can continue this plan, even if you change agencies, retire, or leave your federal employment.

Premiums

– Biweekly premium
– Monthly premium

Resource Center

This coverage is not health insurance coverage (often referred to as “Major Medical Coverage”).

Group Insurance coverages are issued by The Prudential Insurance Company of America, a Prudential Financial company, Newark, NJ. The Booklet-Certificate contains all details, including any policy exclusions, limitations, and restrictions, which may apply. Contract Series: 83500

This policy provides ACCIDENT insurance only. It does NOT provide basic hospital, basic medical, or major medical insurance as defined by the New York State Department of Financial Services.

IMPORTANT NOTICE – THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS.

THIS IS AN EXCEPTED BENEFITS POLICY. IT PROVIDES COVERAGE ONLY FOR THE LIMITED BENEFITS OR SERVICES SPECIFIED IN THE POLICY.

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