Voya accident insurance covers a defined list of accidental injuries and the medical care that follows them, paying a set cash amount for each covered event directly to the policyholder. The benefit schedule includes fractures, dislocations, concussions, burns, lacerations, paralysis, coma, hospital stays, emergency room and urgent care visits, surgery, ambulance transport, follow-up care, diagnostic tests, medical equipment, and accidental death or dismemberment. It does not cover anything caused by illness, and it carries a specific list of exclusions ranging from work injuries to extreme sports.
What Qualifies as a Covered Accident
Voya defines an accident as an unforeseen event that results in a bodily injury. For benefits to apply, the injury has to occur on or after the coverage effective date, while the policy is in force, and independently of any sickness, disease, or bodily infirmity. If an illness caused or contributed to the injury, it is not covered. Property damage, such as a wrecked vehicle, is also outside the policy.
Many Voya accident plans cover injuries that happen outside of work, since on-the-job injuries fall under workers’ compensation. The exact scope varies by employer group, so the certificate of insurance issued at enrollment is the governing document.
Injuries and Treatments That Pay a Benefit
The benefit schedule is broad. Dollar amounts depend on the plan tier the employer selected, but the categories of covered events are consistent. The figures below come from representative plan schedules and give a sense of how the policy pays out.
Fractures
Broken bones pay by the bone involved and whether the repair was a closed reduction (set without surgery) or an open reduction (surgical). A closed hip fracture pays $5,000 and an open hip fracture pays $10,000. A broken leg pays $2,700 closed or $5,400 open. A broken finger or toe pays $300 closed or $600 open. Chip fractures pay 25% of the closed-reduction amount for that bone.
Dislocations
Dislocations work the same way. A hip joint dislocation pays $4,000 closed or $8,000 open. A dislocated knee pays $2,500 or $5,000. A dislocated shoulder pays $2,000 or $4,000. Partial dislocations pay 25% of the closed-reduction benefit.
Hospital, Emergency, and Urgent Care
Hospital admission pays a lump sum, with a daily benefit on top of it for each day of confinement. One schedule shows $1,750 for admission, $375 per day for standard confinement, and $600 per day in a critical care unit. Rehabilitation facility stays pay roughly $200 to $225 per day, typically for up to 90 days.
An emergency room visit pays a flat benefit of about $250 to $350 depending on the plan, and urgent care treatment pays a similar amount. Ground ambulance transport pays around $400; air ambulance pays $2,000 or more.
Surgery and Anesthesia
Open abdominal or thoracic surgery pays up to $1,500. Outpatient surgery pays around $250. Specific orthopedic repairs have their own amounts: torn knee cartilage pays $900, a ruptured disk pays $900, and tendon, ligament, or rotator cuff repairs run from $600 for an exploratory procedure to $1,400 for two or more repairs. General anesthesia administered by a physician for a covered surgery pays about $250.
Other Injuries and Conditions
- Concussion: roughly $275 to $450 depending on tier.
- Traumatic brain injury: up to $2,500 on higher-tier plans.
- Burns: second-degree burns covering 36% or more of the body pay around $1,500; third-degree burns pay $8,500 to $20,000 depending on area affected; skin grafts pay 50% of the burn benefit.
- Lacerations: $50 for a cut not requiring sutures, up to $750 for a laceration over six inches.
- Coma lasting 14 or more days: $18,500.
- Paralysis: $18,000 for paraplegia, $27,000 for quadriplegia.
- Emergency dental: about $400 for a damaged crown, $125 for an extraction.
- Eye injuries: $110 for removal of a foreign object, $400 for eye surgery.
Follow-Up Care and Therapy
Benefits continue after the initial treatment. Doctor follow-up visits pay $100 to $150 each. Physical, occupational, speech, chiropractic, and accident-related mental health therapy pay roughly $60 to $175 per session, with session limits of six to ten per accident depending on the plan. Home health care visits pay $75 to $100 each.
Diagnostics, Equipment, and Medication
X-rays pay around $90, and major imaging such as MRI, CT, or PET pays about $300 per scan. Lab services pay around $90. Medical equipment like crutches or braces pays $275 to $750. Prosthetic devices pay $1,250 to $1,500 for one or $2,000 to $2,400 for two or more. Blood, plasma, and platelet transfusions pay around $625 when administered within 90 days of the accident. Accident-related prescription medication pays about $20.
Accidental Death and Dismemberment
Most Voya accident plans include an accidental death and dismemberment benefit. If the insured employee dies in a covered accident, the benefit runs from $30,000 on a lower-tier plan to $50,000 on a higher one. Death on a common carrier such as a commercial airline pays more, up to $100,000 on the high tier. Loss of a hand or foot pays $7,500 to $12,500 depending on the plan level.
Extras Built Into the Policy
A sports accident rider, included on many plans, increases the benefit amounts for hospital care, accident care, and common injuries by 25%, up to an additional $1,000, when the injury occurs during an organized sporting activity. The activity has to be an amateur competition or supervised practice with written rules, a certified official, oversight by a legal entity such as a school or conference, and a regulation playing surface.
A wellness benefit is bundled at no extra cost. It pays a fixed amount once per year when a covered person completes an eligible health screening, regardless of whether the screening cost anything out of pocket. The payment is typically $50 for the employee and $50 for the spouse, with $25 per covered child up to $100 total for children. Eligible screenings include annual physicals, routine dental and eye exams, mammograms, colonoscopies, blood panels, immunizations, bone density screenings, and COVID-19 tests. If the employee also carries Voya critical illness or hospital indemnity coverage, the wellness benefit can be claimed separately under each product for the same screening.
Travel assistance is included through Europ Assistance USA, at no additional charge, when a covered person is traveling more than 100 miles from home. Services include pre-trip visa and immunization information, urgent message relay, lost luggage help, medical referrals and case monitoring, and emergency medical evacuation to the nearest adequate facility, subject to a $150,000 maximum. The service has to be arranged through the provider at the time of the event.
What Voya Accident Insurance Does Not Cover
Benefits are not paid for losses caused by:
- Sickness or disease, or any condition not caused by an accidental injury.
- Injuries that occur during work for pay, profit, or gain, under many plans.
- Participation or attempted participation in a felony or other illegal act.
- Operating a motor vehicle with a blood alcohol level at or above the legal limit.
- Suicide, attempted suicide, or intentionally self-inflicted injury.
- Alcoholism or drug misuse not under a doctor’s direction.
- War, or injury sustained while on active military duty (premiums for that period are refundable).
- Driving or riding in a vehicle during a race, stunt show, or speed test.
- Operating, crewing, or jumping from an aircraft or hot air balloon. Flying as a paying passenger on a commercial flight is fine.
- Hang gliding, bungee jumping, parasailing, parakiting, kite surfing, and similar extreme activities.
- Practicing for or competing in semi-professional or professional athletic events for compensation.
Exclusions can vary by state, and some optional riders carry pre-existing condition limitations. Where a pre-existing condition clause applies, it generally defines the condition as one for which the covered person received medical treatment in the 12 months before the coverage effective date, with benefits for related claims becoming payable after the first 12 months of coverage.
Who Can Be Covered
The employee has to be actively employed and enrolled. A legal spouse and dependent children are also eligible. Dependent children — natural, step, adopted, or under legal guardianship — can stay on the plan until age 26. Coverage is guaranteed issue, so no health questions or medical exams are required at enrollment.
How Benefits Are Paid Out
Voya accident insurance pays a fixed dollar amount to the policyholder, not to a doctor or hospital, based on the type of injury or treatment and regardless of what the actual medical bill is. The cash can be spent on anything: medical costs, deductibles, copays, rent, groceries, or any other expense that comes up after an accident. The policy is designed to sit alongside a health plan, not replace one. It does not meet the Affordable Care Act’s minimum essential coverage requirement, and it will not do the work of major medical insurance.
Because employers choose the tier and plan design, two employees at different companies can hold Voya accident policies that pay different amounts for the same injury. The certificate of insurance delivered at enrollment lists the exact benefit amounts and any state-specific terms, and controls over any summary description.