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.
What does first-party medical benefits coverage do?
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 add all three optional coverages to your first-party benefit-medical insurance, it’s called a 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 medical benefits as part of your car insurance policy. The Pennsylvania Insurance Department says motorists must have a minimum of $5,000 in 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.
First-party benefit-medical may be unnecessary if you have adequate health insurance and your state doesn’t require this coverage.
— Michelle Megna contributed to this story.
Ask the Insurance Expert
Laura Longero
Executive Editor
Laura Longero is an insurance expert and Executive Editor at CarInsurance.com, where she specializes in helping consumers navigate the complexities of the financial and insurance industries. She has 15 years of experience educating people about finance and car insurance. Prior to joining CarInsurance.com, she worked as a reporter and editor at the USA Today Network. Her expertise provides readers with practical guidance, helping them make informed choices about their financial and insurance needs.
Ask the Insurance Expert
John McCormick
Editorial Director
John is the editorial director for CarInsurance.com, Insurance.com and Insure.com. Before joining QuinStreet, John was a deputy editor at The Wall Street Journal and had been an editor and reporter at a number of other media outlets where he covered insurance, personal finance, and technology.
Ask the Insurance Expert
Leslie Kasperowicz
Executive Editor
Leslie Kasperowicz is an insurance educator and content creation professional with nearly two decades of experience first directly in the insurance industry at Farmers Insurance and then as a writer, researcher, and educator for insurance shoppers writing for sites like ExpertInsuranceReviews.com and InsuranceHotline.com and managing content, now at CarInsurance.com.
Ask the Insurance Expert
Nupur Gambhir
Managing Editor
Nupur Gambhir is a content editor and licensed life, health, and disability insurance expert. She has extensive experience bringing brands to life and has built award-nominated campaigns for travel and tech. Her insurance expertise has been featured in Bloomberg News, Forbes Advisor, CNET, Fortune, Slate, Real Simple, Lifehacker, The Financial Gym, and the end-of-life planning service.