What does first-party medical benefits coverage do?

First-party benefits (FPB or MEDEX) can encompass several areas of insurance coverage; however, this definition is for first-party benefits-medical.

First-party benefit-medical insurance is similar to personal injury protection and medical payments coverage in that it covers medical expenses resulting from an auto accident, regardless of fault.  It covers the policyholder, drivers listed on the policy and relatives living in the same household as the policyholder.

First-party benefits, specific limits, and coverages vary by state but typically include:

  • Necessary medical and surgical treatment
  • Necessary dental, psychiatric, psychological, and optometric treatment
  • Essential rehabilitative services (physical therapy, speech pathology, etc.)
  • Ambulance and nursing service
  • Required medications, medical supplies, and prosthetic devices

Covered costs are subject to the particular coverages and maximum limits you choose at the inception of your first-party benefits policy.

Other optional first-party benefit coverages can be added, each separately, to your policy for work loss, funeral benefits, or accidental death.  If you choose to add all three optional coverages to your first-party benefit-medical insurance, then it’s called first-party benefit-combination package benefit (FPB CPB).

In Pennsylvania, there also is optional first-party benefits-extraordinary medical coverage.  Here, when you have selected first-party benefits- medical with a $100,000 limit, you can get additional (extraordinary) coverage that allows you to raise the limit even higher – up to $1 million.

Is first-party benefits medical coverage mandatory?

Pennsylvania is the only state that requires you to buy first-party benefits medical as part of your car insurance policy. The Pennsylvania Insurance Department says that motorists must have a minimum of $5,000 of medical benefits coverage, but higher limits are available.  In Pennsylvania, if you insure more than one car on your policy, all vehicles must carry the same limits on FPB medical coverage.

What happens if I don’t have first-party benefits medical coverage?

If this first-party benefits coverage is optional in your state, and you choose to go without, then to have your medical expenses paid for you when you are at fault in an accident or the at-fault party cannot cover your injuries, you will need to have coverage such as medical payments or personal injury protection on your policy, or you may end up paying out-of-pocket for your medical bills.

If you have adequate health insurance and your state doesn’t require this coverage, then first-party benefit-medical may be unnecessary. 

 — Michelle Megna contributed to this story.

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Contributing Writer

Prachi is an insurance writer with a master’s degree in business administration. Through her writing, she hopes to help readers make smart and informed decisions about their finances. She loves to travel and write poetry.