UnitedHealthcare Accident and Critical Illness FAQs: Answers on AccidentWise, Accident Pro and CriticalGuard
These answers cover the questions people ask most about UnitedHealthcare accident and critical illness plans. Licensed Vivna agents wrote each one in plain English. Because rules change by state, every answer shows where it applies. Call 888-730-6001 anytime for free help.
Vivna Insurance is an appointed, authorized broker for UnitedHealthcare. We are an independent agency, not UnitedHealthcare. Accident and critical illness plans are supplemental coverage, not major medical insurance. Plans and availability vary by state.
Choosing an Accident or Critical Illness Plan
Start here to compare UnitedHealthcare accident and critical illness options. Then see where each plan is sold.
β How is CriticalGuard different from the critical illness benefit in Accident ProGuard?
CriticalGuard is standalone critical illness coverage up to $100,000 for most ages, issued through age 90.
By contrast, ProGuard bundles accident coverage with critical illness up to $50,000. It is issued to ages 18 to 64.
π Where this applies: States where both plans are sold
β Which UnitedHealthcare supplemental plans are guaranteed issue?
AccidentWise, Accident ProGap and Accident ProGuard GI are guaranteed issue.
In addition, CriticalGuard offers guaranteed issue at certain amounts and ages.
π Where this applies: Varies by plan and state
β Which UnitedHealthcare supplemental plans pay a lump sum and which reimburse expenses?
AccidentWise and CriticalGuard pay stated amounts regardless of your bills.
By contrast, the Accident Pro accident benefit reimburses actual charges. Its critical illness benefit, however, pays a lump sum.
π Where this applies: Varies by plan and state
β Which states offer AccidentWise?
AccidentWise is offered in every state except Massachusetts, New Jersey, New Mexico, New York and Vermont.
π Where this applies: Most states Vivna serves, except New Jersey and New Mexico
β Which states offer Accident ExpenseGuard?
Accident ExpenseGuard is offered in most states, with a few exceptions.
It is not available in Kentucky, Massachusetts, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Vermont or Washington.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Which states offer Accident ProGap?
Accident ProGap is offered in 34 states plus D.C.
However, it is not available in Colorado, Connecticut, Idaho, Kentucky, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Pennsylvania, Tennessee, Vermont, Virginia or Washington.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Which states offer Accident ProGuard?
Accident ProGuard is offered in the same states as Accident ProGap.
So, it is not available in Colorado, Connecticut, Idaho, Kentucky, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Pennsylvania, Tennessee, Vermont, Virginia or Washington.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Which states offer Accident ProGuard GI?
Accident ProGuard GI is offered in the same states as Accident ProGuard.
So, it is not available in Colorado, Connecticut, Idaho, Kentucky, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Pennsylvania, Tennessee, Vermont, Virginia or Washington.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Which states offer CriticalGuard?
CriticalGuard is offered in every state except Massachusetts, New Jersey, New Mexico, New York and Vermont.
π Where this applies: Most states Vivna serves, except New Jersey and New Mexico
AccidentWise Basics
These answers explain how AccidentWise works, who can apply and what it costs. Also, see how renewals and claims work.
β What is UnitedHealthcare AccidentWise?
AccidentWise is accident insurance that pays lump-sum cash benefits when you get treatment for a covered accidental injury.
Golden Rule Insurance Company, a UnitedHealthcare company, underwrites and administers it.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Is AccidentWise health insurance or an ACA plan?
No, AccidentWise is accidental injury only coverage with limited benefits.
It is not major medical coverage. Also, it does not count as minimum essential coverage under the ACA.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does AccidentWise cover illnesses like the flu or appendicitis?
No, AccidentWise pays only for accidental injuries.
It excludes sickness, disease, pregnancy and childbirth.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does AccidentWise pay based on my actual medical bills?
No, AccidentWise pays a fixed, stated amount for each covered service, no matter what the actual bill is.
π Where this applies: Most states Vivna serves, except New Jersey and New Mexico
β What can I spend AccidentWise cash benefits on?
You can spend AccidentWise cash benefits on anything you choose.
Common uses include deductibles, copays and coinsurance on your health plan. You can also use them for rent or mortgage, car payments, child care and everyday bills.
π Where this applies: Most states Vivna serves, except New Jersey and New Mexico
β Can AccidentWise replace my health insurance?
No, AccidentWise is meant to supplement health insurance, not replace it.
It pays limited, fixed benefits for accidental injuries only.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Can I pair AccidentWise with a high-deductible health plan?
Yes, AccidentWise is designed to complement your primary health coverage.
For example, its cash benefits can go toward your deductible, copays or coinsurance after an accident.
π Where this applies: Most states Vivna serves, except New Jersey and New Mexico
β Can I use AccidentWise alongside a short-term health plan?
The AccidentWise brochure does not name specific plan types.
AccidentWise is separate from any health coverage you have and pays its own fixed amounts. That said, a licensed agent can check how it fits with your plan.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Which states is AccidentWise available in?
The broker flyer lists 45 states plus DC, including Florida, Texas, Georgia, California and Pennsylvania.
Because the flyer lists availability state by state, check with a licensed agent for your state.
π Where this applies: Most states Vivna serves, except New Jersey and New Mexico
β What counts as an accidental injury on AccidentWise?
An accidental injury is sudden, unexpected bodily damage that is not gradual and needs immediate medical attention.
It cannot result from a sickness. Also, the injury must first happen after your coverage starts.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β If I get hurt in several ways in one accident, does AccidentWise count each injury?
No, all injuries from the same accident count as one injury.
Still, AccidentWise pays each covered service according to its own benefit.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Is an AccidentWise policy year the same as a calendar year?
No, a policy year is each 12-month period starting on your effective date.
As a result, per-year limits reset on that anniversary.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Will AccidentWise cover an injury that happened before I bought it?
No, AccidentWise excludes injuries before the effective date.
It also excludes injuries after the policy ends, or while coverage is not in force.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β How soon does AccidentWise coverage start?
AccidentWise coverage is available as soon as the next day.
However, your application must be approved and your first premium paid on or before the effective date.
π Where this applies: Most states Vivna serves, except New Jersey and New Mexico
β Who can buy AccidentWise?
The primary applicant must be 18 through 75 when the plan is issued.
A spouse or domestic partner can be 16 through 75. You can also add dependent children under 26.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Is there a maximum age to keep AccidentWise?
No, AccidentWise has no maximum age limit and no termination age.
So you can keep it as long as you pay premiums, subject to the policy provisions.
π Where this applies: Most states Vivna serves, except New Jersey and New Mexico
β Do I have to answer health questions to get AccidentWise?
No, AccidentWise plans are guaranteed issue and are not medically underwritten.
Still, incorrect or incomplete application information can void coverage or lead to denied claims.
π Where this applies: Most states Vivna serves, except New Jersey and New Mexico
β Can I add my spouse and kids to AccidentWise?
Yes, you can add a spouse or domestic partner, as defined by your state.
You can also add eligible children under 26. Children include natural, adopted, placed-for-adoption and guardianship children.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β In Florida, how long can my child stay on AccidentWise?
In Florida, an unmarried child can stay on until age 31 if not covered by another health plan.
Foster children are also eligible.
π Where this applies: Florida
β Can grandchildren be covered on AccidentWise?
Some states let AccidentWise cover certain grandchildren.
Texas, Louisiana, Maryland, Minnesota and DC expand eligible children to include certain grandchildren. However, each state has its own conditions.
π Where this applies: Washington, D.C., Louisiana, Maryland, Minnesota and Texas
β What affects the price of AccidentWise?
Factors include your state of residence, the number of people covered, and the benefit level you choose.
Also, premiums are based on where you live on the effective date.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Can AccidentWise raise my rate because I filed a claim?
No, premiums will not change solely because of claims or a change in anyone's health.
Rate changes come with at least 31 days' notice, longer in some states.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Can AccidentWise rates change in my first year?
In Kentucky, Louisiana and North Carolina, rates will not change during the first 12 months.
After that, they can change no more than once in any 12-month period.
π Where this applies: Kentucky, Louisiana and North Carolina
β Is AccidentWise guaranteed renewable?
Yes, AccidentWise is guaranteed renewable in most states, as long as you pay premiums.
However, coverage can end if you cancel, the plan is discontinued statewide, or there is claim fraud. It also ends if you leave the U.S.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Which states have conditionally renewable AccidentWise plans?
In Delaware, Iowa, Maryland, North Dakota and Tennessee, AccidentWise is conditionally renewable, subject to the policy provisions.
π Where this applies: Delaware, Iowa, Maryland, North Dakota and Tennessee
β What happens to my family's AccidentWise coverage if the primary insured dies?
If other people are on the policy, continuation provisions apply so their coverage can continue.
However, a policy covering only the primary insured ends at death.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Can I cancel AccidentWise and get a refund?
Yes, you can get a refund if you cancel during the free look period.
You have 10 days after the policy is issued to return it for a premium refund. However, some states allow 30 days.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Which states give a 30-day free look on AccidentWise?
Connecticut, Indiana, Iowa, Louisiana, New Hampshire, South Carolina and Utah give a 30-day right to examine period.
This window is also called a free look period.
π Where this applies: CT, IN, IA, LA, NH, SC, UT
β How soon do I need to file an AccidentWise claim?
Notify Golden Rule within 30 days of the loss, or as soon as reasonably possible.
Then, send written proof of loss within 90 days. However, Golden Rule will not accept proof submitted more than a year late.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Do some states allow more time to file an AccidentWise claim?
Yes, Kentucky, Wyoming, Montana and North Carolina allow more time for certain claim steps.
For example, Kentucky and Wyoming allow 60 days for notice of claim. Montana allows 6 months instead. Meanwhile, North Carolina allows 180 days for proof of loss.
π Where this applies: Kentucky, Montana, North Carolina and Wyoming
AccidentWise Benefits
Here you can see what AccidentWise pays after a covered accident. Plus, learn how benefit amounts work.
β What AccidentWise plan levels can I choose from?
There are three levels: Plan 10000, Plan 15000 and Plan 20000.
Higher levels pay larger amounts for each covered service.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β How much does AccidentWise pay for a hospital admission after an accident?
AccidentWise pays $10,000, $15,000 or $20,000 for a hospital admission, depending on your plan level.
The admission must happen within 30 days of the injury. Also, the benefit pays once per policy year.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β What counts as a hospital admission on AccidentWise?
A hospital admission is a covered hospital stay, under a doctor's advice, of at least 24 consecutive hours.
Observation stays of 24 hours or more also count.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β How much does AccidentWise pay for an ER visit?
AccidentWise pays $1,000, $1,500 or $2,000 by plan level for ER treatment within 72 hours of the injury.
It pays once per day, up to 4 times per policy year.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β How much does AccidentWise pay for urgent care after an accident?
AccidentWise pays $200, $300 or $400 by plan level for urgent care within 72 hours of the injury.
It pays once per day, up to 4 times per policy year.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does AccidentWise pay for an MRI or CT scan after an injury?
Yes, the Major Diagnostic Exam benefit pays $1,000, $1,500 or $2,000 by plan level.
It covers a CT scan, MRI or EEG in a hospital or urgent care center. However, the exam must be within 30 days of the injury, and the benefit pays once per policy year.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does AccidentWise pay for follow-up visits or physical therapy?
Yes, AccidentWise pays $100, $150 or $200 per visit by plan level.
It covers up to 5 visits each per policy year. Visits must be within 30 days of the injury. Also, follow-up care must come after ER or urgent care treatment.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Can AccidentWise pay for a follow-up visit and physical therapy on the same day?
No, a follow-up treatment and a physical therapy visit on the same day receive only one benefit.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β How much does AccidentWise pay for outpatient surgery after an accident?
AccidentWise pays $1,000, $1,500 or $2,000 for outpatient surgery, by plan level.
Surgery must be within 30 days of the injury, and the benefit pays once per policy year.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does AccidentWise include accidental death or dismemberment coverage?
Yes, the Accidental Loss of Life, Limb or Sight benefit pays $10,000, $15,000 or $20,000 by plan level.
The loss must happen within 90 days of the injury. Also, the benefit pays once per lifetime.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Can AccidentWise pay twice for the same service on the same day?
No, AccidentWise pays only one benefit per day for the same or similar service.
If two benefits overlap, it pays the larger one.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does AccidentWise pay for an ambulance ride?
Ambulance is not on the standard AccidentWise benefit list.
However, Connecticut plans add a $500 emergency ambulance benefit per accidental injury.
π Where this applies: Every AccidentWise state, plus Connecticut
β Are AccidentWise benefits per person?
Yes, the benefit amounts apply to each covered person on the policy.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does AccidentWise include wellness or checkup benefits?
No, AccidentWise pays only for treatment of accidental injuries.
It has no wellness, screening or sickness benefits.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
AccidentWise Exclusions and State Rules
Every accident plan has exclusions, and some states change the rules. So check these limits before you buy.
β What does AccidentWise not cover?
AccidentWise excludes sickness, stroke, self-inflicted harm, war, riots, felonies and incarceration.
It also excludes cosmetic treatment, most dental care, and care from an immediate family member. However, some state rules vary.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does AccidentWise cover a stroke?
No, AccidentWise excludes any cerebrovascular accident, also known as a stroke.
However, in Virginia, the exclusion applies only to a stroke unrelated to an accidental injury.
π Where this applies: Every AccidentWise state (Virginia differs)
β Does AccidentWise cover infections?
Generally no, AccidentWise does not cover infections, with two narrow exceptions.
First, it covers a bacterial infection caused directly by an accidental cut or wound. Accidentally swallowing a contaminated substance also qualifies.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Are sports injuries covered by AccidentWise?
Most sports injuries are covered, but AccidentWise excludes some sports and activities.
For example, it excludes injuries from professional, semi-pro or intercollegiate sports. However, the exclusion does not apply to intramural sports. The plan also excludes several high-risk activities.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Which risky activities does AccidentWise exclude?
AccidentWise excludes skydiving, hang gliding, bungee jumping, parakiting and motor racing.
It also excludes scuba diving 60 feet or deeper. In addition, it excludes paid horseback riding, climbing, skiing or non-motorized racing.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does AccidentWise cover on-the-job injuries?
No, not if you have, or must have, workers' compensation coverage for that work.
In that case, workers' comp should pay instead.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does AccidentWise cover dental injuries?
AccidentWise excludes dental care, except as covered for an accidental injury to sound, natural teeth.
That said, check the policy for the specifics.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does AccidentWise cover military service injuries?
No, AccidentWise excludes injuries during active service in any armed forces, National Guard or reserve.
However, Arkansas and Texas refund premiums pro rata for that service on written request.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does AccidentWise cover injuries while flying a private plane?
No, not if you are the pilot, crew, in training, or have duties aboard a non-commercial aircraft.
However, riding as a regular passenger is not part of this exclusion.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Do any states remove the AccidentWise sports and hazardous activity exclusion?
Yes, five states do not apply the AccidentWise high-risk activity and sports exclusion.
These states are Connecticut, Illinois, Oklahoma, Utah and Virginia. By contrast, Idaho applies it only to paid professionals.
π Where this applies: CT, ID, IL, OK, UT, VA
β What extra AccidentWise benefits come with Connecticut plans?
Connecticut plans add three extra AccidentWise benefits.
First, there is a $500 emergency ambulance benefit. Plus, home health care pays $50 per day, up to 80 visits a year. Finally, a $500 benefit covers accidental ingestion of a controlled drug.
π Where this applies: Connecticut
β Does AccidentWise in Maryland pay for a second opinion?
Yes, Maryland plans pay $100 if a hospital requires a second opinion during an inpatient stay.
However, this benefit pays only once per person per policy year.
π Where this applies: Maryland
β In Indiana, how long do I have to get treatment for AccidentWise to pay?
Indiana gives you 180 days after the injury to get treatment.
The 180-day window applies to hospital admission and diagnostic exams, plus follow-up care, physical therapy and outpatient surgery.
π Where this applies: Indiana
β Does Virginia AccidentWise allow more time for the loss of life, limb or sight benefit?
Yes, in Virginia the loss must occur within 180 days of the injury.
By contrast, the standard AccidentWise window is 90 days.
π Where this applies: Virginia
β How is AccidentWise different in Pennsylvania?
In Pennsylvania, accidental death does not have to occur within 90 days.
Also, the plan can pay both follow-up treatment and physical therapy. In addition, the stroke and felony exclusions do not apply.
π Where this applies: Pennsylvania
β Does AccidentWise in South Dakota require a 24-hour hospital stay?
No, a South Dakota hospital admission does not have to last 24 hours to qualify.
π Where this applies: South Dakota
β How does the AccidentWise loss of life, limb or sight benefit work in New Hampshire?
New Hampshire splits it into four separate benefits.
These cover loss of life, double dismemberment, single dismemberment and loss of sight. However, only one benefit pays for the same injury.
π Where this applies: New Hampshire
Accident Pro Basics
These answers compare Accident ProGap and Accident ProGuard. In addition, see who can apply and what affects the price.
β What is the UnitedHealthcare Accident Pro Series?
It is a group of accident plans from Golden Rule Insurance Company.
The broker flyer lists three options: Accident ProGuard, Accident ProGuard GI and Accident ProGap. In addition, a separate brochure covers Accident ExpenseGuard.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β What is Accident ExpenseGuard?
Accident ExpenseGuard is supplemental accident medical expense coverage with an accidental death and dismemberment (AD&D) benefit.
It pays for covered accident-related expenses directly to you.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β What is Accident ProGap?
Accident ProGap combines accident expense coverage, a critical illness lump sum and AD&D.
It also adds a $2,500 hospital admission benefit for sickness. Plus, payments go directly to you.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β What is Accident ProGuard?
Accident ProGuard combines accident expense coverage, a critical illness lump sum and AD&D.
It comes in two versions: ProGuard with simple medical questions, and ProGuard GI with guaranteed issue.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Are Accident Pro Series plans major medical insurance?
No, these plans are limited-benefit supplements to health insurance, not a substitute for major medical.
Also, they do not count as minimum essential coverage.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β What can I use Accident ProGap or ProGuard money for?
You can use Accident ProGap or ProGuard money as you see fit.
For example, the brochures mention deductibles and coinsurance, lost wages, rent or mortgage, utilities, food and gas.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Can I pair an Accident Pro plan with a high-deductible health plan?
Yes, Accident Pro plans can help with costs like high deductibles.
These plans are designed to supplement health insurance. Plus, they pay in addition to what your health plan pays.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Can I use an Accident Pro plan with a short-term health plan?
The Accident Pro brochures do not name specific plan types.
However, Accident Pro plans pay benefits even if you have other medical coverage. A licensed agent can help check the fit.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Which Accident Pro plan includes a hospital admission benefit?
Only Accident ProGap includes a hospital admission benefit.
It adds a $2,500 lump sum for a sickness hospital admission each calendar year.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Do preexisting conditions affect Accident ProGap and ProGuard?
Yes, preexisting conditions affect the critical illness and ProGap hospital admission benefits.
These benefits do not pay for a preexisting condition during the first 12 months. In fact, that 12-month period includes the waiting period.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β What is a preexisting condition on Accident ProGap and ProGuard?
A preexisting condition is based on the 12 months before your coverage starts.
First, it includes any condition you got advice, care, treatment or prescriptions for in that period. It also includes symptoms that would lead a prudent person to seek care then.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Do any states have shorter preexisting condition rules on ProGap and ProGuard?
Yes, several states shorten or change the ProGap and ProGuard preexisting condition rules.
For example, Maine and Utah use 6 months for critical illness. Meanwhile, Nevada and Wyoming use a 6-month look-back. California, Montana, North Carolina and Wyoming drop the symptoms-only test.
π Where this applies: CA, ME, MT, NC, NV, UT, WY
β Is a preexisting condition ever covered for critical illness on Accident ProGuard?
Yes, after 12 months, a critical illness from a preexisting condition is covered unless otherwise excluded.
However, Maine and Utah use 6 months instead.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Who is eligible for Accident Pro Series plans?
The primary insured and spouse must be 18 to 64 when applying.
Also, you can cover children from birth until their 26th birthday, or as your state requires.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β How long can I keep an Accident Pro plan?
Accident Pro plans are renewable until the primary insured's 70th birthday or death.
After that, a covered spouse, or otherwise a covered child, may continue the policy.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Do I have to answer health questions for Accident ProGap?
No, Accident ProGap is guaranteed issue, with no health questions to answer.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Is Accident ProGuard medically underwritten?
Yes, Accident ProGuard asks simple medical questions and is subject to health underwriting.
By contrast, ProGuard GI is guaranteed issue, with no health underwriting.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Who is Accident ProGuard GI designed for?
Accident ProGuard GI is a guaranteed issue plan.
Per the broker flyer, it may suit people who have had trouble getting coverage due to health issues.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Can I get Accident ProGuard if I already have a fixed indemnity plan?
Yes, the broker flyer says ProGuard's higher critical illness options suit people wanting more support.
For example, that includes people who already have a Health ProtectorGuard fixed indemnity plan.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β What affects the price of an Accident Pro plan?
Age, gender, tobacco use, and coverage type and level are among the pricing factors.
Also, you get at least 31 days' notice before a premium change.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β What if I misstate my age or tobacco use on an Accident Pro application?
Golden Rule may adjust benefits or premiums to match the correct information.
If the correct age would have made you ineligible, coverage is void. In that case, Golden Rule also refunds premiums minus benefits paid.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β When does an Accident Pro policy end?
It ends at the primary insured's 70th birthday or death, unless a covered spouse or child continues it.
The policy also ends for nonpayment, cancellation, or fraud or misrepresentation.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β How do I file an Accident Pro accident claim?
Submit a claim form with the Explanation of Benefits (EOB) from your other insurance.
The EOB shows the provider's actual charges after discounts and adjustments.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β How soon must I report an Accident Pro claim?
Notice of claim is due within 30 days of the loss, or as soon as reasonably possible.
However, some states allow longer.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β How do Accident ProGuard, ProGuard GI and ProGap differ?
Accident ProGuard has the highest critical illness options and asks simple medical questions.
By contrast, ProGuard GI is guaranteed issue with lower amounts. ProGap is also guaranteed issue, plus it adds a hospital admission benefit.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Which Accident Pro plan has the highest critical illness benefit?
Accident ProGuard has the highest, with up to $50,000 per qualified illness.
By contrast, ProGuard GI tops out at $7,500 and ProGap at $10,000.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β How is Accident ExpenseGuard different from Accident ProGuard?
ExpenseGuard covers accident expenses and AD&D only, with no critical illness benefit.
It also offers accident amounts up to $20,000. By contrast, ProGuard adds critical illness, with accident amounts up to $10,000.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β How is AccidentWise different from the Accident Pro plans?
AccidentWise pays fixed cash amounts for each covered service.
By contrast, Accident Pro plans reimburse actual charges after a $250 deductible, up to a yearly maximum. ProGap and ProGuard also add critical illness.
π Where this applies: Most states Vivna serves, except New Jersey and New Mexico
β Which has broader ages, AccidentWise or the Accident Pro plans?
AccidentWise has broader ages, issuing from 18 through 75 with no termination age.
By contrast, Accident Pro plans issue from 18 to 64 and renew to age 70.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Do AccidentWise and Accident Pro plans reset benefits the same way?
No, AccidentWise limits reset each policy year from your effective date.
However, Accident Pro accident maximums reset each calendar year.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Does AccidentWise have a deductible like the Accident Pro plans?
No deductible appears in the AccidentWise benefit schedule.
By contrast, Accident Pro plans have a $250 accident deductible per person, except in California.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Which UnitedHealthcare accident plans also cover critical illness?
Accident ProGap and Accident ProGuard include a critical illness lump sum.
However, AccidentWise and Accident ExpenseGuard do not.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
Accident Pro Benefits
Here you can see what Accident Pro pays for injuries, hospital stays and accidental death. Then compare benefit levels.
β How does the Accident Pro accident benefit pay?
It reimburses actual accident-related charges after a $250 deductible, up to your chosen yearly maximum.
The plan bases charges on your other insurance's EOB. If there is no EOB, it uses reasonable and customary charges instead.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β What is the deductible on Accident Pro plans?
Accident Pro plans have a $250 deductible per covered person.
Also, each family pays no more than two deductibles per calendar year. However, California plans have no deductible.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β How much accident coverage can I get on Accident ExpenseGuard?
You choose $5,000, $7,500, $10,000, $15,000 or $20,000 per covered person, per calendar year.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β How much accident coverage does Accident ProGap offer?
Accident ProGap lets you choose $2,500, $5,000 or $10,000 per covered person, per calendar year.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β How much accident coverage does Accident ProGuard offer?
Accident ProGuard offers $5,000 or $10,000 per covered person, per calendar year.
By contrast, ProGuard GI offers $5,000 or $7,500.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Does the Accident Pro accident maximum reset every year?
Yes, the accident benefit is an annual maximum that starts over each calendar year.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Which accident treatments must happen within 48 hours on Accident Pro plans?
Burns or cuts, a diagnosed concussion, ER visits and urgent care visits must happen within 48 hours.
However, in Utah, the rule is 48 hours or as soon as reasonably possible.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Which accident treatments are covered within 30 days on Accident Pro plans?
Ambulance, anesthesia, doctor visits, fractures, hospital or ICU stays, labs and X-rays qualify within 30 days.
MRI and CT scans, prescriptions, prosthetics and surgery also qualify. Indiana, however, allows 6 months for fractures and surgery.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Will Accident Pro plans pay if my health insurance already paid the claim?
Yes, Accident Pro plans have no coordination of benefits for accidents.
Instead, the plan pays based on the provider's actual charges, regardless of what other insurance pays.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Can you show an example of how the Accident ExpenseGuard accident benefit pays?
In the brochure's fictional example, a child's accident costs $8,507.
After the $250 deductible, the plan pays $8,257. Plus, the rest of that year's benefit stays available.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Who receives the Accident Pro benefit payments?
Accident Pro plans pay benefits directly to you, the insured.
For death benefits, the plan pays your beneficiary instead. Also, you decide how to use the money.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β What does reasonable and customary mean on Accident Pro plans?
Reasonable and customary is the most common local charge for similar services, medicines or supplies.
Here, local means the area where you got care. Also, the plan uses this charge when no EOB is available.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Is there an extra cost to add dependents to Accident ExpenseGuard?
Yes, adding dependents to Accident ExpenseGuard requires additional premium.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Do Accident Pro plans include accidental death and dismemberment coverage?
Yes, every Accident Pro plan includes AD&D equal to your chosen accident benefit amount.
Also, this AD&D amount is a per-person lifetime maximum.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β How much does the Accident Pro AD&D benefit pay for each loss?
Accidental death, loss of two or more limbs, or two or more hands or feet pays 100%.
By contrast, loss of one limb, hand or foot pays 50%. Finally, loss of the thumb and index finger on the same hand pays 25%.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β How soon after an accident must a loss occur for Accident Pro AD&D to pay?
In most states, the loss must occur within 30 days of the accident.
However, Arkansas, Illinois, Maryland, Maine, Oklahoma and Texas allow 90 days. Utah, by contrast, allows 180 days.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Are there AD&D timing differences for Accident ExpenseGuard in Pennsylvania and Virginia?
Yes, Pennsylvania and Virginia both have different Accident ExpenseGuard AD&D timing rules.
In Pennsylvania, the 30-day limit does not apply to accidental death. Virginia, by contrast, uses a 90-day window. However, it extends to one year if you become totally disabled within 30 days.
π Where this applies: Pennsylvania and Virginia
β Does Accident Pro AD&D pay on top of the accident medical benefit?
Yes, AD&D pays in addition to the accident benefit for other injuries from the same accident.
However, AD&D is limited to its lifetime maximum.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β How does the Accident ProGap hospital admission benefit work?
It pays a $2,500 lump sum for a hospital admission due to sickness.
The stay must last at least 24 hours. Also, it pays once per covered person per calendar year.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Does the ProGap hospital admission benefit cover accident hospital stays?
No, the ProGap hospital admission benefit is for sickness only.
Instead, hospital care after an accident falls under the accident expense benefit.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Does each family member get the ProGap $2,500 hospital benefit?
Yes, a covered spouse and children are each eligible for the same $2,500 benefit.
However, each person can receive it only once per calendar year.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Is there a waiting period for the ProGap hospital admission benefit?
Yes, most states have a 30-day waiting period for the ProGap hospital admission benefit.
However, in Illinois, Missouri and Utah, an admission within 30 days pays up to $500. Maryland, by contrast, has no waiting period.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Does South Dakota require a 24-hour stay for the ProGap hospital benefit?
No, the minimum 24-hour stay requirement does not apply in South Dakota.
π Where this applies: South Dakota
Accident Pro Critical Illness and Exclusions
Some Accident Pro plans also pay for a covered critical illness. Still, review the exclusions before you rely on a plan.
β How much critical illness coverage does Accident ProGuard offer?
Accident ProGuard offers $10,000, $20,000, $30,000 or $50,000 per illness.
By contrast, ProGuard GI offers $5,000 or $7,500, matching the accident amount you choose.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β How much critical illness coverage does Accident ProGap offer?
ProGap pays $2,500, $5,000 or $10,000 per illness, matching the accident amount you choose.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Which illnesses pay 100% on Accident ProGap and ProGuard?
Heart attack, stroke, invasive cancer, coma, paralysis, and major organ or tissue failure pay 100%.
So do third-degree burns, end-stage renal failure, and loss of hearing, speech or vision.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Which conditions pay 25% on Accident ProGap and ProGuard?
Non-invasive cancer, a benign brain tumor, and listed heart procedures pay 25%.
The listed heart procedures include bypass, angioplasty, stent placement and heart valve surgery.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β If I have more than one heart procedure, does ProGuard or ProGap pay for each one?
No, the listed heart illnesses are grouped together as one benefit.
As a result, it pays once, even if you have more than one listed procedure.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β What is the lifetime maximum for critical illness on Accident ProGap and ProGuard?
The critical illness lifetime maximum is three times the amount you choose.
For example, a $10,000 benefit has a $30,000 lifetime maximum.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Can Accident ProGuard pay for the same critical illness twice?
No, each listed condition pays once per covered person per policy.
Also, at least 180 days must pass between qualifying diagnoses.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Are my spouse and children covered for critical illness on ProGap and ProGuard?
Yes, spouses and children are covered at 50% of the primary insured's critical illness benefit.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Does the Accident ProGuard critical illness benefit drop at age 65?
Yes, the benefit per covered illness automatically drops by 50% at age 65 or older.
In fact, the Pro Series flyer notes this reduction for critical illness benefits across the series.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Is there a waiting period for critical illness on Accident ProGap and ProGuard?
Yes, most states have a 30-day critical illness waiting period.
However, in Illinois and Missouri, a diagnosis within 30 days pays up to $500. Maryland, by contrast, has no waiting period.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β How does Accident ProGuard pay for cancer diagnosed early in the policy?
Accident ProGuard covers cancer after 90 days.
Before that, a cancer diagnosis 31 to 90 days after the effective date pays 10% of the benefit. However, in Utah, a diagnosis after 30 days pays 100%.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Does the Accident Pro accident benefit pay for a stroke?
No, stroke appears in the Accident Pro general exclusions.
However, on ProGap and ProGuard, stroke is a covered critical illness. It pays 100% after the waiting period.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β What do Accident Pro plans not cover?
Exclusions include care that is not medically necessary, stroke, war, self-inflicted harm and riots.
The plans also exclude felonies and military service. In addition, they exclude intoxication, infections, experimental or cosmetic treatment, and expenses outside the U.S.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Do Accident Pro plans cover injuries at work?
No, Accident Pro plans exclude any injury or illness arising from employment for wage or profit.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Are injuries while intoxicated covered by Accident Pro plans?
No, Accident Pro plans exclude losses while a covered person is intoxicated, as defined by state law.
ProGap and ProGuard also exclude voluntarily taking sedatives or drugs, or inhaling gas.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Do Accident Pro plans cover mental health or substance abuse treatment?
No, Accident Pro plans exclude services or confinement for mental health or substance use disorders.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Do Accident Pro plans pay for crutches, wheelchairs or other medical equipment?
No, Accident Pro plans exclude durable medical equipment.
However, the plans list prosthetics as a covered accident service.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Do Accident Pro plans cover physical, speech or occupational therapy?
Accident Pro plans exclude occupational therapy and outpatient speech therapy.
They also exclude vocational or recreational therapy.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Are sports injuries covered by Accident Pro plans?
Accident Pro plans exclude pro, semi-pro and intercollegiate sports injuries, but not intramural sports.
They also exclude skydiving, hang gliding, bungee jumping, racing, rodeo and deep scuba diving.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Do Accident ProGap and ProGuard exclude hazardous activities?
Yes, both ProGap and ProGuard exclude participation in hazardous activities.
In addition, they exclude the listed sports and high-risk activities.
π Where this applies: AL, AR, AZ, CA, DC, DE, FL, GA, IA, IL, IN, KS, LA, MD, ME, MN, MO, MS, MT, NC, NE, NV, OH, OK, RI, SC, SD, TX, UT, WI, WV, WY
β Are accidents outside the U.S. covered by Accident Pro plans?
No, Accident Pro plans exclude expenses incurred outside the United States.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
β Do Accident Pro plans include wellness or checkup benefits?
No, the Accident Pro brochures do not list a wellness benefit.
Also, for Wyoming residents, the brochures state the policy has no comprehensive adult wellness benefits.
π Where this applies: Most states Vivna serves, except Kentucky, North Dakota, New Hampshire, New Jersey and New Mexico
CriticalGuard Basics
These answers explain how CriticalGuard works, who can apply and when benefits start. Also, see how claims get paid.
β What is UnitedHealthcare CriticalGuard?
CriticalGuard is critical illness insurance that pays a lump-sum cash benefit.
It pays on the first diagnosis of a qualifying serious illness. In addition, Golden Rule Insurance Company underwrites and administers the plan.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Is CriticalGuard major medical insurance?
No, CriticalGuard is a limited-benefit supplement to health insurance.
It pays only for qualifying critical illnesses. Also, it is not minimum essential coverage under the ACA.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β How is a CriticalGuard lump sum paid?
CriticalGuard pays the benefit in full, directly to you, for a qualifying diagnosis.
The benefit is a stated amount, regardless of your actual medical expenses.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β What can I use CriticalGuard money for?
You can use CriticalGuard money for anything you need.
For example, it can go toward bills, living expenses, out-of-pocket medical costs, or expenses while you cannot work.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does CriticalGuard pay if I already have health insurance?
Yes, CriticalGuard pays benefits regardless of other insurance coverage.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Can I pair CriticalGuard with a high-deductible health plan?
Yes, CriticalGuard is designed to supplement health insurance.
For example, its lump sum can help with deductibles and other out-of-pocket costs after a serious diagnosis.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Can I use CriticalGuard with a short-term health plan?
The CriticalGuard brochure does not name specific plan types.
However, CriticalGuard pays regardless of other coverage you have. A licensed agent can help confirm the fit.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Can I get CriticalGuard if I have Medicare?
CriticalGuard issue ages run through 90, and benefits pay regardless of other coverage.
Also, the brochure notes the plan is separate from any health or Medicare Advantage coverage you have.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β What is Golden Rule's financial strength rating?
A.M. Best rates Golden Rule Insurance Company A (Excellent).
You can check ambest.com for the latest rating.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Which states is CriticalGuard available in?
The broker flyer lists CriticalGuard in 45 states plus DC.
These include Florida, Texas, Georgia and California. Still, check with a licensed agent for your state.
π Where this applies: Most states Vivna serves, except New Jersey and New Mexico
β What does First Diagnosis mean on CriticalGuard?
First Diagnosis means the first time in your lifetime the condition is diagnosed.
It must happen after the waiting period, while coverage is in force. However, some states do not use First Diagnosis.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Will CriticalGuard pay again if my cancer comes back?
Generally, it will not pay again for the same condition, since benefits are based on First Diagnosis.
However, if less than 100% was paid, the remaining category maximum can pay another Qualifying Event.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Will CriticalGuard cover a cancer I was diagnosed with before buying it?
No, CriticalGuard excludes a diagnosis made before your effective date.
Instead, benefits are based on a first diagnosis after coverage starts.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Who can make a qualifying CriticalGuard diagnosis?
A legally qualified physician must make the diagnosis, using generally accepted diagnostic criteria.
However, CriticalGuard excludes diagnoses by you or a family or household member. It also excludes diagnoses made outside the U.S.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Is there a waiting period on CriticalGuard?
Yes, all CriticalGuard plans have a 30-day waiting period after the effective date.
However, waiting periods may vary by state. For example, Maryland has none.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β What if I'm diagnosed during the CriticalGuard waiting period?
CriticalGuard excludes a diagnosis made during the waiting period.
However, in Missouri, the plan pays $250 per lifetime and ends benefits for that event. In Connecticut, by contrast, the insurer voids the policy and refunds the full premium.
π Where this applies: Every CriticalGuard state (Connecticut and Missouri differ)
β Does CriticalGuard cover preexisting conditions?
CriticalGuard does not cover preexisting conditions during the first 12 months.
After 12 months from your effective date, however, the preexisting condition limitation no longer applies.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β What counts as a preexisting condition on CriticalGuard?
It's a condition you received or were advised to get care for in the 12 months before coverage.
Screenings in that period that lead to later care also count. In addition, symptoms a prudent person would have checked count too.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Which states have a shorter CriticalGuard preexisting condition period?
Maine, New Hampshire and Utah limit the preexisting condition period to 6 months.
Also, Wyoming uses a 6-month look-back. In Texas, it lasts no more than 6 months for people 65 or older.
π Where this applies: Maine, New Hampshire, Texas, Utah and Wyoming
β Do preexisting conditions apply to CriticalGuard buyers 65 and older in North Carolina?
No, in North Carolina, preexisting limits do not apply to people 65 or older on the effective date.
However, a rider can still exclude a condition.
π Where this applies: North Carolina
β How do CriticalGuard preexisting conditions work in Pennsylvania?
Pennsylvania looks back 5 years for advice, care or treatment.
However, the exclusion period is still 12 months.
π Where this applies: Pennsylvania
β Who can buy CriticalGuard?
The primary insured must be 18 to 90 when applying.
You can also cover a spouse or domestic partner, and children under 26.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Do I have to answer health questions for CriticalGuard?
It depends on your age and benefit amount.
Some amounts are guaranteed issue with no underwriting. However, others are simplified issue with some medical questions.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Which CriticalGuard amounts are guaranteed issue?
A $5,000 or $10,000 maximum can be guaranteed issue for certain ages and plans.
For example, $5,000 is guaranteed issue on every plan for ages 65 to 79.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β In Florida, how long can my child stay on CriticalGuard?
In Florida, your child can stay on CriticalGuard until their 31st birthday.
That said, the child must be unmarried and not covered by another health plan.
π Where this applies: Florida
β Is CriticalGuard guaranteed renewable?
Yes, CriticalGuard plans are guaranteed renewable for life, as outlined in the policy.
However, coverage ends if premiums are unpaid or you cancel. It also ends if the full maximum benefit has been paid.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β When does a CriticalGuard policy end?
A CriticalGuard policy ends when all category maximums and riders are paid out, or premiums go unpaid.
It also ends if you cancel or commit claim fraud. In addition, a single-person policy ends at the insured's death.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β What affects the price of CriticalGuard?
Your state, plan, benefit level and age on the effective date are among the price factors.
Premiums are based on where you live.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Can CriticalGuard rates go up after a claim?
No, premiums will not change solely because of claims or a change in health.
Rate changes come with at least 31 days' notice. In some states, however, the notice period is longer.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Can I cancel CriticalGuard and get my money back?
Yes, you can cancel for a refund during the 10-day free look period after your policy is issued.
However, Connecticut, Indiana, Iowa, Louisiana, New Hampshire, Oklahoma, South Carolina and Utah allow 30 days.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β How do I file a CriticalGuard claim?
Go to uhcmemberhub.com, print a claim form, and complete it.
Then send it with the required information. Benefits go directly to you.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β How soon do I need to report a CriticalGuard claim?
Report it within 30 days after the first diagnosis, or as soon as reasonably possible.
However, Kentucky and Wyoming allow 60 days, and Montana allows 6 months.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β What can I do in UHC Member Hub with CriticalGuard?
At uhcmemberhub.com, you can update contact information, manage billing, and submit claims.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
CriticalGuard Plans and Benefits
Here you can compare CriticalGuard plans, benefit amounts and optional benefits. Plus, see the extra services included.
β What CriticalGuard plans can I choose from?
CriticalGuard offers four plans: Cancer, Heart/Stroke, Cancer + Heart/Stroke, and Critical Illness.
The Critical Illness plan is the full suite. In addition, it adds other critical conditions.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β What does the CriticalGuard Cancer plan pay?
Life-threatening cancer pays 100% of your cancer maximum on the Cancer plan.
Cancer in situ and a benign brain tumor each pay 25%. Also, skin cancer pays $500.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β What does the CriticalGuard Heart/Stroke plan pay?
A heart attack or stroke pays 100% of your heart and stroke maximum.
In addition, a qualifying heart illness pays 25%, once per lifetime.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β What extra conditions does the CriticalGuard Critical Illness plan cover?
Beyond cancer, heart attack and stroke, the Critical Illness plan covers other critical conditions.
Advanced Alzheimer's, ALS, coma, end-stage renal failure and major organ transplant each pay 100%. Loss of independent living, by contrast, pays 50%.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does CriticalGuard cover Alzheimer's disease?
Yes, CriticalGuard covers Alzheimer's disease, but only on the Critical Illness (full suite) plan.
On that plan, advanced Alzheimer's disease pays 100% of the critical conditions maximum.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β What does a coma need to qualify for CriticalGuard?
The coma must last at least 7 consecutive days to qualify.
On the Critical Illness plan, it pays 100%.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β What is the CriticalGuard loss of independent living benefit?
This benefit pays 50% if you permanently cannot do 2 of 6 daily activities, like bathing or dressing.
However, the inability must last at least 90 days. Also, it pays once per lifetime, on the Critical Illness plan.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does CriticalGuard cover skin cancer?
Yes, CriticalGuard pays $500 for skin cancer, once per lifetime.
This benefit applies on the Cancer, Cancer + Heart/Stroke and Critical Illness plans.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Which CriticalGuard benefits pay only once per lifetime?
Cancer in situ, benign brain tumor, skin cancer and heart illness pay once per person, per lifetime.
Loss of independent living and the COVID benefit are also once per lifetime.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does CriticalGuard cover conditions not on its list, like diabetes?
No, CriticalGuard pays only for listed Qualifying Events.
It excludes other diseases, including complications caused by a Qualifying Event or its treatment.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β How much CriticalGuard coverage can I buy?
You pick a Benefit Lifetime Maximum Amount in $5,000 increments.
Maximums go up to $100,000 for most ages, depending on your age and plan.
π Where this applies: Most states Vivna serves, except New Jersey and New Mexico
β What CriticalGuard amounts are available if I'm under 50?
Ages 18 to 49 can choose $50,000 to $100,000 on the Cancer, Heart/Stroke and combined plans.
The Critical Illness plan, by contrast, ranges from $5,000 to $100,000.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β What CriticalGuard amounts are available at ages 50 to 64?
At ages 50 to 64, the Cancer, Heart/Stroke and combined plans range from $10,000 to $100,000.
By contrast, the Critical Illness plan ranges from $5,000 to $100,000.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β What CriticalGuard amounts are available after age 65?
Ages 65 to 74 can choose $5,000 to $75,000 on any plan.
Then, ages 75 to 90 can choose $5,000 to $50,000.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β How does the CriticalGuard lifetime maximum work?
You receive up to 100% of your chosen maximum for each category of Qualifying Events.
Plans with more than one category have a separate maximum for each.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β If CriticalGuard pays less than 100%, is the rest still available?
Yes, if a benefit is less than 100% of the category maximum, the remainder stays available.
It can then pay a later Qualifying Event in that category. However, total payments never exceed the maximum.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Can the CriticalGuard Cancer + Heart/Stroke plan pay for both cancer and a heart attack?
Yes, because each category has its own Benefit Lifetime Maximum Amount.
As a result, a qualifying cancer and a heart attack can each pay up to 100%.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does CriticalGuard pay extra if I'm diagnosed while pregnant?
Yes, a first Qualifying Event diagnosis during pregnancy pays an additional 50% of that benefit.
Plus, this extra amount does not count toward the lifetime maximum.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does CriticalGuard have a COVID benefit?
Yes, it pays $10,000 for an ICU stay with a positive COVID diagnosis, once per lifetime.
This benefit does not count toward the lifetime maximum. However, it is not available in Indiana.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Is CriticalGuard coverage per person?
Yes, benefits are per covered person for the plan you choose.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β What optional benefits can I add to CriticalGuard?
In most states, you can add Wellness, Outpatient Prescription Drug and Telemedicine riders.
These riders cost extra, and you must choose them at application. Also, they apply to everyone on the policy.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does CriticalGuard have a wellness benefit?
Yes, CriticalGuard offers a wellness benefit as an optional rider.
It pays $75 for one covered wellness exam per calendar year, after a 30-day waiting period. For example, covered exams include a physical, vaccine, colonoscopy or mammogram.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β In which states is the CriticalGuard wellness rider not available?
The wellness rider is not available in Colorado, Connecticut, Idaho, Michigan, Missouri, Pennsylvania or Virginia.
π Where this applies: CO, CT, ID, MI, MO, PA, VA
β How does the CriticalGuard outpatient prescription drug rider pay?
The rider pays $15 per generic fill and $50 per brand-name fill.
Combined, it pays up to $600 per calendar year. Also, a 30-day waiting period applies.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β How does the CriticalGuard telemedicine rider work?
The rider provides unlimited $0 general physician visits through HealthiestYou, 24/7 by app, web or phone.
However, behavioral health and dermatology visits cost extra. Plus, there is no waiting period.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Where is the CriticalGuard telemedicine rider not available?
The telemedicine rider is not available in Idaho, Maryland, Pennsylvania or Virginia.
π Where this applies: Idaho, Maryland, Pennsylvania and Virginia
β Do CriticalGuard riders reduce my lifetime maximum?
No, CriticalGuard riders do not reduce your lifetime maximum.
In fact, rider benefits are per person and do not count against the Benefit Lifetime Maximum Amount.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Can I add a CriticalGuard rider later?
No, CriticalGuard riders are only available when you apply.
Also, they cover everyone on the policy.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β What is the Optum Perks card included with CriticalGuard?
Optum Perks is a prescription discount card, not insurance, included at no extra cost.
It can save 30% to 80% off usual pharmacy prices, though savings vary. Also, you can print it or send it to your phone at perks.optum.com/uho.
π Where this applies: Most states Vivna serves, except New Jersey and New Mexico
β Does CriticalGuard include cancer support services?
Yes, cancer support services come with the Cancer, combined and Critical Illness plans.
Optum Cancer Resource Services offers an oncology nurse and guidance to quality providers. It also offers second opinions and clinical trial information.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does CriticalGuard include heart disease support?
Yes, heart disease support comes with the Heart/Stroke, combined and Critical Illness plans.
The Optum Heart Failure and Coronary Artery Disease Management Program helps you monitor symptoms and manage your condition.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Are the Optum programs available with CriticalGuard in every state?
No, the Optum programs are not available with CriticalGuard in every state.
Pennsylvania plans do not include Optum Perks or the cancer and heart programs. Similarly, Texas plans do not include the cancer and heart programs.
π Where this applies: Pennsylvania and Texas
CriticalGuard Exclusions and State Rules
CriticalGuard has exclusions, and some states change its rules. For that reason, each answer shows where it applies.
β What does CriticalGuard not cover?
CriticalGuard exclusions include war, self-inflicted harm, intoxication or illegal drug use, and felonies.
Riots, incarceration and AIDS-related events are also on the list. In addition, CriticalGuard excludes diagnoses outside the U.S. or before the waiting period ends.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does CriticalGuard exclude risky sports?
Yes, the Heart/Stroke, combined and Critical Illness plans exclude certain risky sports.
The excluded activities are pro or intercollegiate sports, skydiving, bungee jumping, motor racing, rodeo and deep scuba diving. However, the Cancer-only plan does not list these exclusions.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Does CriticalGuard cover an intentionally medically induced condition?
No, the Critical Illness plan excludes an intentionally medically induced critical condition.
However, a major organ transplant is the exception.
π Where this applies: Most states Vivna serves, except California, New Jersey and New Mexico
β Is there a total lifetime cap on CriticalGuard in Georgia?
Yes, Georgia caps two CriticalGuard plans at a $250,000 lifetime maximum per covered person.
These are the Cancer + Heart/Stroke and Critical Illness plans.
π Where this applies: Georgia
β How is the CriticalGuard Critical Illness plan different in Idaho?
In Idaho, loss of independent living and major organ transplant are not covered.
Also, no optional riders are available there.
π Where this applies: Idaho
β Does CriticalGuard require a first-ever diagnosis in Indiana?
No, in Indiana the diagnosis does not have to be the first in your lifetime.
Also, the COVID benefit is not available there.
π Where this applies: Indiana
β Does Maryland CriticalGuard have a waiting period?
No, Maryland CriticalGuard plans have no waiting period.
However, preexisting condition rules still apply. Also, Maryland plans do not offer the telemedicine rider.
π Where this applies: Maryland
π More Supplemental Insurance Guides
These answers cover the basics of each UnitedHealthcare accident and critical illness plan. When you want more depth, these guides from our licensed agents explain how supplemental coverage works. Then, if a question comes up, call 888-730-6001 anytime.
π Supplemental Insurance Guides
𧩠More UnitedHealthcare FAQ Libraries
π Questions About UnitedHealthcare Accident or Critical Illness Plans?
These answers cover the most common accident and critical illness questions, but every family is different. Therefore, our licensed agents compare UnitedHealthcare supplemental plans for free.
Best of all, our help costs you nothing. Request a free quote online, or call 888-730-6001 to speak with an agent today. You can also reach us through our contact page.
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Official resources: the UnitedHealthOne website, HealthCare.gov, and the National Association of Insurance Commissioners.
Vivna Insurance is an appointed, authorized broker for UnitedHealthcare. We are an independent agency, not UnitedHealthcare. Accident and critical illness plans are supplemental coverage, not major medical insurance. Plans and availability vary by state.