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.

How much coverage can I have?

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.

Who is eligible to enroll in this plan?

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

What types of accidental injuries are covered?

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

loss of life;
total and permanent loss of sight;
total and permanent loss of speech;
total and permanent loss of hearing;
loss of hand or foot by severance at or above the wrist or ankle;
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;
loss due to quadriplegia, paraplegia, or hemiplegia;
loss due to coma;
total and permanent disability (members only). You can find a complete description in the Personal Accident Insurance Summary Plan Description.

What types of accidental injuries are not covered?

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

suicide or attempted suicide, while sane or insane;
intentionally self-inflicted injuries, or any attempt to inflict such injuries;
sickness, whether the loss results directly or indirectly from the sickness;
medical or surgical treatment of sickness, whether the loss results directly or indirectly from the treatment;
most bacterial or viral infections (see Summary Plan Description for exceptions);
taking part in any insurrection;
war, or any act of war. War means declared or undeclared war, and includes resistance to armed aggression;
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);
commission of or attempt to commit a felony, assault, or illegal action;
travel or flight in any vehicle used for aerial navigation;
being legally intoxicated or under the influence of any narcotic unless administered or consumed on the advice of a doctor.

How do I report an accidental injury?

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

How are benefits paid out?

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.

Do I lose the coverage if I retire?

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.