I saw this insurance offer several times before I finally signed up for it back in October. It's primary insurance for the entire vehicle and is $19/$25 per rental, not per day.
The appealing part to me is that the coverage extends to some higher end vehicle rentals so I don't have to worry about the stipulations my auto insurance carrier has on luxury and exotic vehicles.
Also comparatively speaking, the $19 per rental is ok with me instead of paying a $500 or $1000 deductible if something happens to the vehicle.
Accidents do happen.