SAMBA’s Personal Accident Insurance Plan
Issued by The Prudential Insurance Company of America
Available to active and retired federal employees.
Coverage in the event of accidental death or dismemberment.
You cannot be denied coverage due to age or health.
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.
- Paper Enrollment and Change Coverage Forms
- Beneficiary Designation Form
- FAQs
- Summary Plan Description (under development)
- Limitations and Exclusions
- Termination Policy
- Payroll Allotment Form
- Direct Debit Application Form
- Authorized Representative Form (HIPAA)
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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