What does Unum accident coverage cover?

Unum accident insurance pays a fixed, lump-sum cash benefit directly to you for medical treatments and injuries resulting from a covered accident.

Covered Injuries and Medical Care

• Common Injuries: Fractures (broken bones), dislocations, second- and third-degree burns, concussions, lacerations, and torn knee cartilage.
• Medical Services: Emergency room visits, urgent care visits, physician office visits, diagnostic imaging (X-rays, MRIs), and surgeries.
• Hospitalization: Initial hospital admission, daily hospital confinement, and intensive care unit (ICU) stays.
• Recovery and Therapy: Follow-up visits, physical therapy, occupational therapy, speech therapy, chiropractic care, and rehabilitation unit confinement.
• Transportation & Lodging: Ambulance services (including air ambulance) and lodging for family members during a hospital stay.

Expanded and Special Benefits

Depending on your specific employer-sponsored plan, newer Unum policies also include coverage or incentives for:

• Annual Wellness: A cash reward for getting routine annual health screenings.
• Support Services: Benefits that help cover organized sports injuries, behavioral health visits, pet boarding, and personal safety provisions.
• Dismemberment/Loss: Loss of sight, hearing, or specific fingers, toes, hands, or feet.

What It Does Not Cover

• Illnesses, infections, or diseases resulting from general sickness rather than a physical accident.
• Injuries sustained while intoxicated, under the influence of illegal narcotics, or participating in illegal activities.
• Standard cosmetic surgery (unless required as reconstructive surgery following an accident).

You can review specific payout schedules and file claims by logging into your Unum Employee Benefits Account.

Unum accident insurance can be worth it if you have an active lifestyle, a high-deductible health plan, or limited savings to cover sudden out-of-pocket medical costs.

How It Works

• Lump-sum cash: You receive a direct cash payout based on the specific injury or treatment needed (like ER visits, broken bones, or physical therapy).
• Flexible spending: You can use the money for anything, including co-pays, deductibles, rent, or groceries.
• Low cost: Premiums are usually low (often just a few dollars per paycheck) because it is a voluntary group workplace benefit.

When It Is Worth It

• High-deductible health plans: If a major injury would wipe out your savings before your health insurance kicks in, the extra cash helps.
• Active lifestyle or kids: If you play contact sports, have accident-prone children, or commute in heavy traffic, the odds of filing a claim increase.
• Tight emergency funds: If you lack a robust rainy-day fund, it acts as a low-cost safety net.

When It Might Not Be Worth It

• Strong savings: If you already have a fully funded emergency account that can easily absorb a $1,500 or $3,000 medical bill, you can skip paying the monthly premium.
• Strict exclusions: Plans do not pay out for injuries resulting from high-risk activities like skydiving or illegal actions.
• Narrow coverage: It only covers accidents, not illnesses or general medical care. You can learn more about how payouts work from resources like GoodRx on Accident Insurance or watch a breakdown on YouTube's Unum Guide.

Unum pays varying lump-sum amounts depending entirely on the specific injury sustained and the medical treatments received, as payouts are determined by a fixed schedule of benefits rather than a percentage of your bills. Because employers select different coverage levels (e.g., low, medium, or high schedules), the exact amount you receive can vary based on your specific employer-sponsored plan.

Payments are made directly to you and can be used for any expenses. Below is a breakdown of the typical payout ranges across Unum Accident Insurance policies:

Hospitalization & Emergency Care

• Ambulance: $100 to $675 for ground; $500 to $3,200 for an air ambulance.
• Emergency Room Visit: $150 to $200.
• Doctor or Urgent Care Visit: $50 to $170.
• Hospital Admission: $500 to $2,000 (per admission).
• Hospital Confinement / Daily Stay: $100 to $400 per day (up to 365 days).
• Intensive Care Unit (ICU) Stay: An additional $200 to $1,000 per day.

Common Injuries & Procedures

• Fractures (Broken Bones): $100 to $5,000 for closed fractures; up to $10,000–$12,800 for open fractures requiring surgery.
• Dislocations: $2,000 to $4,000 for closed dislocations; up to $8,000 for open/surgical repairs.
• Concussion: $100 to $250.
• Lacerations (Cuts): $25 to $400 depending on the size and need for stitches.
• Burns: $750 up to $25,600 depending on the severity (2nd or 3rd degree) and percentage of body surface covered.
• Surgery (Open Abdominal/Thoracic): $1,000 to $2,550 ($100 to $250 for exploratory procedures).

Recovery & Ongoing Therapy

• Physical Therapy: $25 to $115 per treatment session (typically capped at 6 to 15 visits per accident).
• Medical Appliances (Crutches, Braces): $100 to $150.
• Prosthetic Devices: $500 to $1,300 for one device; up to $2,600 for multiple.
• Lodging & Transportation: $100 to $200 per night for lodging (if traveling for care); up to $300–$675 for transportation costs.

Severe Losses & Accidental Death

• Dismemberment / Loss of Sight: $750 to $2,000 for a finger or toe; $7,500 to $20,000 for a single hand, foot, or eye; and up to $40,000 for catastrophic multiple losses.
• Accidental Death: Typically ranges from $20,000 to $100,000 for the employee (often doubling if the accident occurs while riding as a fare-paying passenger on a common carrier like a plane or train).

Note: Many plans also feature an Organized Sports Benefit that bumps up the injury and treatment payouts by 15% if the injury happens during a sanctioned sporting event. To view your specific plan's coverage tiers, you should log into your employee benefits portal or request the Schedule of Benefits document from your HR department.

Accident insurance does not cover illnesses, chronic medical conditions, or injuries resulting from intentional self-harm, illegal acts, or high-risk activities.

Common Exclusions

• Illnesses and Diseases: Conditions like cancer, heart attacks, strokes, or infections are not covered because they are health-related, not caused by a sudden accident.
• Intentional Self-Harm: Injuries from suicide attempts or deliberate self-inflicted harm are completely excluded.
• Illegal Activities: Injuries sustained while committing a crime, participating in a riot, or engaging in illegal substance abuse are not eligible for payouts.
• Intoxication: Claims resulting from being under the influence of illegal drugs or driving over the legal alcohol limit are typically denied.
• High-Risk or Extreme Sports: Dangerous hobbies—such as skydiving, BASE jumping, auto racing, or flying in private aircraft—are often excluded unless you purchase a specialized rider.
• Acts of War or Terrorism: Injuries or death caused by active military conflict, acts of war, or terrorism are standard exclusions in most policies.
• Pre-Existing Conditions: While accident insurance generally focuses on new injuries, complications stemming directly from a pre-existing physical defect or prior chronic injury may be denied.
• Work-Related Injuries (in some cases): Certain policies exclude injuries covered by workers' compensation if they happen on the job, though this varies by plan.

To learn more about supplemental options, you can review details on Assurity or check out plans like UHOne.com.

An accident for accident insurance is a sudden, unexpected, and external physical event that results in bodily injury or death.

What Qualifies as an Accident

For an event to qualify under an Accident Insurance policy, it typically must meet these core criteria:

• Sudden and Unforeseen: It happens unexpectedly at a specific time and place, rather than developing over a long period.
• External Cause: The injury is caused by physical force from the outside (like a fall, crash, or impact) rather than an internal medical condition.
• Accidental Bodily Injury: The event directly causes physical harm, such as fractures, lacerations, burns, or concussions.

Common Covered Events

Policies generally pay out benefits for injuries sustained during everyday mishaps or active events, including:

• Car accidents
• Slips, trips, and falls
• Sports and recreational injuries (e.g., playing basketball)
• Severe cuts or lacerations in the kitchen or workplace

What Does NOT Qualify

Insurers explicitly exclude certain events from the definition of a covered accident. You generally cannot claim benefits for:

• Illnesses and Sickness: Infections, diseases, or medical conditions that develop naturally.
• Pre-Existing Conditions: Injuries or complications related to a health issue you already had before purchasing the policy.
• Self-Inflicted Harm: Intentional injuries or suicide attempts.
• Risky or Illegal Activities: Injuries sustained while committing a crime, driving under the influence of drugs or alcohol, or participating in hazardous prohibited sports.
• Natural Causes and Disasters: In many standard supplemental policies, acts of God or broad weather-related natural disasters are excluded.