New York private passenger automobile insures who have Personal Injury Protection (PIP) coverage have the option to purchase one of the following Added Personal Injury Protection packages. Simply check the appropriate box(s) below and return this form to us.
The benefits indicated under each option for income and essential services are the aggregate of the Basic and Added PIP benefits. The benefits are maximum benefits per person, per accident basis, rather than a per year basis. All of the options include a $2,000 maximum funeral expense benefit and $10,000 death benefit.
Please call to obtain any additional coverage information you may need.
(1) Two-Year Benefits: Income Continuation/Survivor and Essential Services Benefits
Income/Survivor Essential Services
A B C D
Option Weekly Total Per Day Total
1 { } $100 $10,400 $12 $ 8,760
2 { } $125 $13,000 $20 $14,600
3 { } $175 $18,200 $20 $14,600
4 { } $250 $26,000 $20 $14,600
5 { } $400 $41,600 $20 $14,600
6 { } $500 $52,000 $20 $14,600
7 { } $600 $62,400 $20 $14,600
8 { } $700 $72,800 $20 $14,600
(2) Extended Income Continuation Benefits: Two-Year Survivor and Essential Services Benefits
Income Essential Services
A B C D
Maximum
Survivor Per
Option Weekly Total Benefits Day Total
9 { } $100 Unlimited $10,400 $12 $ 8,760
10 { } $125 Unlimited $13,000 $20 $14,600
11 { } $175 Unlimited $18,200 $20 $14,600
12 { } $250 Unlimited $26,000 $20 $14,600
13 { } $400 Unlimited $41,600 $20 $14,600
14 { } $500 Unlimited $52,000 $20 $14,600
15 { } $600 Unlimited $62,400 $20 $14,600
16 { } $700 Unlimited $72,800 $20 $14,600
(3) Approximate Additional Annual Costs
Please note the approximate additional annual cost of each of the following options:
Option 6 -- $7.00 per private passenger vehicle
Option 7 -- $11.00 per private passenger vehicle
Option 14 -- $54.00 per private passenger vehicle
Option 15 -- $69.00 per private passenger vehicle
Option 16 -- $82.00 per private passenger vehicle
Also note that resident relatives can be added if named, at an additional annual cost of $8.00.
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