When Texans are looking at health insurance alternatives, they typically do so by turning one of three ways.
Each of those come with their pros and cons, but we have found that families working with Direct Primary Care doctors for their immediate needs tend to utilize the Catastrophic Health Insurance policies. They make an amazing partnership to provide the highest quality healthcare while still providing appropriate protection from the major events that can cause one to go bankrupt.
A catastrophic health insurance policy has three core pieces, critical illness coverage, hospital indemnity provisions, and an accident policy. Today we will focus on the accident policy in depth to make sure that the provisions are clear and understood, as a trip to the ER for a broken leg can be quite catastrophic!
Accident Policy Definition
As the name implies, these health insurance policies are set up to take care of your needs when you have an acute situation that was created by an accident of some sort. This could be falling off of a ladder while you are painting your home, crashing while riding your bicycle, or even an auto accident. The policy provisions will take care of the financial aspect of the bills from the accident so that you can focus on healing. The accident can happen anywhere really, so the coverage can extend world wide.
Accident Policy Components
In a fashion that was similar to the critical illness policy, there are four main components to the accident policy. They include the deductible, covered amount, coinsurance, and maximum benefit.
- Deductible - This is the amount of money that the covered participant/insured will need to pay first so that the policy benefits can kick in. This amount of money will range from $0 to $2,500 and is deducted from any benefit settlement when it is confirmed that the total bill is more than the deductible amount.
- Covered Amount - This is the amount of money that is paid by the policy after the confirmation of the accident that caused the insured to require care and that the total bill exceeds the deductible. This is often a percentage of your total claimable amount ranging between 70% and 100%.
- Coinsurance - This is the portion of the covered amount that the insured will be responsible for paying on covered accidents. If the covered amount is 80% of the claim, your coinsurance would be 20%.
- Benefit Maximum - This will be the maximum amount of coverage that the covered amount will pay per the plan guidelines. Most accident policies have a per accident maximum rather than a policy maximum.
What these terms mean for you once an accident happens, is that you will receive care while the healthcare provider, location, and/or system submits the bills to be paid. The health insurance company will then sort them into the claim and pay those submitting the bills what they are owed less the deductibles and coinsurance. You will then be responsible for paying those amounts from the balance bill that you will receive.
Accident policies can be written on an individual basis, but are best when bundled with the other pieces of a major medical/catastrophic health insurance policy. They protect you from being financially ruined if you're skiing in the ALPS, working from a ladder on your roof, or simply walking down the street. We can't plan for them, but we can plan for the monetary side of it.
If you would like to learn more about your healthcare options, speak with a qualified agent at Insurance For Texans today. We will gladly show all of your options as we work for you and not some big company.