Almost Everything to know about the Aflac Accident Plan

We offer four Aflac plans: Whole Life, Critical Illness, Accident, and Hospital Indemnity. While you might have a good guess at what each plan covers from the title alone, each one has their own set of benefits that you might not notice from a quick glance at the cover of a brochure. 

When it comes to the accident plan, yes, it pays you if you’re injured, but did you know it’ll also pay you for riding in an ambulance or if your doctor determines you need a transportation aid (like a cane, wheelchair, or crutches)? And that’s just the tip of the iceberg! There’s a lot more that you might not expect, check out the brochure by clicking here.   

It’s also important to know that while the accident plan pays for injuries, its only injuries that can be tracked to a single event. Why make that distinction? Well, it doesn’t cover “wear-and-tear.” If you slowly develop carpal-tunnel after years of labor, you might not get coverage. But if you slip and fall and tear your rotator cuff, then you’ll receive a payout. Basically, the event needs to have a “timestamp,” meaning you should be able to tell Aflac exactly when it happened.  

The reason this plan is so important (especially for people who have a very physical job or a job that requires a lot of moving around) is because Aflac payouts go directly in your pocket. When you end up with a broken bone or a torn Achilles your health insurance (hopefully) will be the main way you’re paying your doctor bills. But that insurance doesn’t help with babysitters to watch your kids, or the amount of money you might be missing because you can’t go to work! Aflac’s insurance payouts do. It’s entirely your choice what you do with the money. 

A common misconception is that the accident plan only pays out for on-the-job injuries, but that’s not true. Most of the claims we assist with at SDPEBA are for accidents outside of work, e.g., slipping on the stairs, participating in rec-sports, and even car accidents. If you’re clumsy, spend a lot of time outdoors, or have very active children, then you should consider this plan!  

Employee Only Rates

Low: $5.70

High $9.95

Employee + Spouse

Low: $8.83

High $15.43

1 Parent Family

Low: $9.89

High $17.83

2 Parent Family

Low: $13.02

High $23.30

Rates are per pay period.

We offer a high and a low plan. The high plan offers additional coverage and higher payouts than the low plan, but also costs more.  

The payout difference between the high and low plan varies, but is usually about two times as much! For example, if you’re admitted into a hospital for an injury, you receive a $625 payout on the low plan, but a $1,250 payout on the high plan.

The High plan also offers two additional riders, the gunshot rider and the recreational sports rider. The gunshot rider offers a payout for being shot and the recreational sports rider gives you a 10% higher payout when the injury is sports related. If you’re a police officer or an avid soccer fan, we recommend you consider the high plan! 

How does it Pay Out? 

Payouts require a visit to the doctor or the hospital. Once you receive initial treatment, you’re able to then file a claim for that event.  

As a member of SDPEBA, we have a team of benefit representatives that are dedicated to helping you with your claims! Once you’ve been treated and you’re ready to begin filing all you have to do is give us a call (888-315-8027) or email us [email protected]

When you email us be sure to include the following information: 

  1. The policy holder’s name and date of birth 
  2. Date of the Injury and Date when care was received  
  3. Diagnosis of the injury  
  4. How the injury occurred e.g., did you slip? Did you roll your ankle playing a game of pickup basketball? Were you on a cruise ship and did you overestimate your dance skills on the open seas and wind-up tripping into a waiter carrying a large swan made of ice?   
  5. Name of the hospital/doctor’s office (this can be generic, such as: Sharp Grossmont) 
  6. Additionally, please note: was this injury work related?  
  7. Pharmacy Ledger for any prescriptions filled.  

Wellness Benefit 

The Aflac Accident plan offers a $50 annual wellness benefit to policyholders who are actively taking steps to stay healthy! To put it in plain English, you can get paid for just going to the doctor! Check this link for a list of the most common tests that will qualify you for a one-time $50 benefit.

You can apply for these the same way you would for a normal Aflac claim, just know you can only get one $50 payout per calendar year, and that’s per enrolled dependent. By just submitting a simple claim after getting my COVID Vaccine I got $50! That money went straight into paying my premiums for Aflac, basically giving me 25% off my annual premiums!   

For more on Wellness Benefits, click here

Signing Up and Important Notes 

Aflac Enrollment is open April 1st to June 30th for active City employees. It has an effective start date of August 1st. During that time, you can call us at 888-315-8027  in order to sign up.

REMINDER. Aflac is not like a traditional health plan. You need to file a claim in order to receive benefits. No worries though, we’ll act as a mediary between you and Aflac so it’s as simple as sending us a couple of emails. You can find a guide we put together to help you through that process by clicking here

Additionally, if you have any questions about what is or isn’t covered under the Aflac Accident plan (or any of our other plans) feel free to email us at [email protected] or give us a call at 888-315-8027.