Accident health insurance supplements are being used to cover upfront injury related expenses for the ER. The plans can be used to supplement an existing health insurance policy or as a personal injury plan to pay for an unexpected ER visit or surgery.
Many Americans are concerned about insuring everyday accidents like bodily injury and emergency room coverage. Of course, it’s important to insure things like cancer and heart attacks, but for young adults, and especially children, emergency room visits are far more prevalent. Unfortunately, getting to the emergency room isn’t cheap and the process of recovering from a serious physical injury can be exhausting. Damaged body parts often need to be surgically fixed and post-operative physical therapy sessions feel like a Sylvester Stallone Rocky movie. I won’t lie, the Rocky Four soundtrack propelled me through my physical therapy workouts after ACL knee surgery.
Health insurance for the self-employed gets especially complicated when it comes to emergency room visits. In order to qualify for the Major Medical PPO plan the individual must undergo underwriting and be medically qualified. Assuming you’ve been approved, you’ll need to select a deductible and plan style. The most cost-effective PPO policies in the individual health insurance market are HDHP (high deductible health plan) plans. The deductible is the out-of-pocket expense that the insured has to pay before the health insurance policy is billed. PPO stands for Preferred Provider Organization and is a type of health insurance that allows you to choose any doctor. Picking any doctor isn’t necessarily true, their is a lot of fuzzy territory with PPOs being “in network or out of network”.
The deductible options for individuals in the PPO market are $1,500, $2,500, $3,500, and $5,000. Typical family deductible options are $3,000, $5,000, $7,000, and $10,000. You would like to opt for 100% co-insurance. Co-insurance is a shared expense between you and the insurance company after the deductible. Most people are familiar with 80/20% co-insurance. 100% co-insurance is popular because you won’t need to understand calculus to figure out any future hospital bills. The insurance plan picks up 100% of the bill after the deductible with this option. On the other hand, setting up a health savings account is a good idea. HSAs have some nice tax advantages and you can open an account equal to the deductible amount. So a $10,000 Health Savings Account can be associated with a $10,000 HDHP. The annual maximum contribution to a Health Savings Account is determined by your HDHP deductible. If you are self-employed, ask your CPA about health savings accounts.
High deductible health insurance plans tend to have lower monthly premiums. However, with that higher deductible comes the risk of paying more of that deductible if you use health insurance. A $5,000 deductible hospital bill is equivalent to a broken bone. Guess How Many Americans Pay That HDHP $5,000 Deductible? You guessed it, due to an accidental physical injury in the emergency room.
Accidental health insurance supplements have been doing a good job filling this ER gap for years. Other names used for this plan include personal accident insurance, emergency room insurance supplement, accident medical coverage, personal injury insurance plan, 24 hour accident coverage, and accident supplement benefit plan. In my opinion these plans are poorly marketed, and most licensed health insurance agents are doing their customers an injustice if they don’t bring this up. I say this because many people are paying insurance companies a lot of money every month, and could get stuck with a huge deductible bill if they actually use the insurance.
PPOs are guaranteed issue insurance products, unlike the health insurance industry. Emergency room insurance supplements fall into this category and have automatic approvals. Online applications have no health questions, but require a Social Security number and date of birth. This type of guaranteed issued accident medical expense coverage is an indemnity. Compensation compensates members with predetermined benefit amounts.
Personal injury insurance plans in this category are membership based associations. The membership organization helps individuals and families in the United States gain access to discount programs and is, in this case, the most practical emergency room insurance supplement I’ve seen pound for pound so far.
Each association member can choose a benefit level of accident coverage commensurate with their monthly budget or the amount of the HDHP deductible. The plans cover the HDHP deductible, giving high deductible health plans a virtual zero deductible effect. Remember, ER visits due to injuries cover HDHP’s maximum deductible. ER plans pay injury related expenses to pay for the PPO deductible. Again, plans only cover ER-related expenses due to the injury, not the illness itself.
Members can choose emergency room coverage levels of $2,500, $5,000, $7,500, or $10,000. Accident Compensation Benefit is paid per injury and there is no limit on its usage. Typically a person will receive a $100 dollar deductible per covered accident. ER policies pay up to $2,500, $5,000, $7,500, or $10,000 per accident, excluding a $100 deductible. In simple terms, you will pay $100 dollars for any covered injury, assuming the bill does not exceed the maximum of $2,500, $5,000, $7,500, or $10,000 of the policy benefit.
Here are some statistics on what the major personal accident insurance dues are. Indemnity plan rate hikes rarely happen as it is an association based health insurance product.
-$24 per month: $5,000 profit Personal plan.
-$29 per month: $7,500 profit Personal plan.
-$36 per month: $10,000 profit Personal plan.
-$35 per month: Family plan with $5,000 in benefits.
-$41 per month: $7,500 Advantage Family Plan.
-$47 per month: Family plan with $10,000 in benefits.
(Family policy prices are all inclusive, it is the same price for a family of 3 or a family of 12)
It doesn’t matter which accident health insurance plan brochure you pick up, all plan brochure EOB (Explanation of Benefits) pages state the same key benefit: Members can choose any doctor, hospital or emergency room. Since it is accident compensation, there is no restriction on the benefits to be chosen by the health care providers. Accidents are unpredictable and so it is important to know which emergency room you will end up in. I can’t imagine accident plans would sell if they came with some shoddy network provider handbook of acceptable doctors. This brand of accident coverage is 100% portable and can be used outside the United States for up to two months while traveling abroad.
Benefits of accident plan at a glance:
-hospital emergency care
Doctor’s fee for surgery (inpatient and outpatient)
-Laboratory test.
X-ray and MRI.
Ambulance expenses.
Registered Nurse.
-Hospital room and board.
Operating room cost.
-Anesthesia.
-prescription drugs.
-Physical therapy (very important after the operation)
-Doctors’ visits (inpatient and outpatient).
-Dental treatment for injury of natural teeth.
Splints, crutches, and casts.
Source by Adam Santi
