Emergency room insurance supplements in the United States are a form of accident medical coverage that covers accidental bodily injury. These plans have no health questions and no underwriting, which means everyone can qualify. Guaranteed acceptance is usually up to age 65. Since it is a form of accident insurance, the plans can be used with any licensed physician, emergency room, urgent care facility or medical clinic. Some sales brochures may refer to these plans as 24-hour accident coverage, accident medical expense benefit, personal injury insurance plan, accident medical insurance, or personal accident insurance. It should be dubbed “the most useful pound-for-pound plan” based on its practicality.
The add-ons that provide this form of emergency room coverage are a membership-based indemnity. A compensation plan makes up for a loss in cash payments to the member or health care provider. The plans pay part of the medical expenses collected by doctors or hospitals up to a benefit amount of $2,500, $5,000, $7,500 or $10,000 per accident. The plans are not marketed as insurance, but as a limited accident medical expense policy. The plans are linked to an association that offers its members this type of emergency room insurance coverage. Coverage is for bodily injury and not for illness-related emergency room visits. With a good plan, injuries sustained in little league sports like soccer, football, and baseball are covered. High school sports injuries are also covered in some plans. Professional or collegiate level sports injuries are not covered. Like any other health insurance plan, the injury must occur while coverage was in force and directly cause a loss to you covered by the policy. Therefore, benefits are only paid if the policy was active before the injury occurred. Children can stay on the family accident plan until age 26, when they will have to switch to an individual policy.
Since the plans are not insurance but an association, applications have no health concerns and acceptance is guaranteed. Emergency room coverage plans cannot have a strict set of “in or out of network” rules. The ER supplement I am writing about here can be used at any hospital, doctor, or clinic. The plans can also be used for travel insurance while outside of the United States. Most plans will only cover abroad for two consecutive months. Therefore, if your vacation outside the country is within the last 2 months, the plan will not cover any bodily injury claims. But who is really worried about health insurance during a 2-month vacation?
Personal injury insurance plans pay for all injuries from any accident up to the policy benefit of $2,500, $5,000, $7,500 or $10,000 less a $100 deductible. The deductible is the out-of-pocket expense (the insured) before the country of the accident plan. Put another way, members can choose $2,500, $5,000, $7,500, or $10,000 USD accident medical benefits with a $100 deductible per occurrence. Currently, most injury plans have a deductible of $100 or $250. Indemnity benefits reset after each accident and benefits are paid per injury or per accident with a new $100 deductible.
Emergency room coverage includes:
-Ambulance charges
-Hospital emergency room care
-Operating room costs (inpatient or outpatient)
-X-rays
-MRI
-Lab tests
– Doctor visits (inpatient or outpatient)
-Medical fees for surgery (inpatient or outpatient)
-Anesthesia expenses
-Physical therapy
-Prescription drug expenses
-Dental treatment for injuries to healthy natural teeth.
-Nursing expenses
-Several hospital expenses during the stay, outpatient surgery under general anesthesia.
-Room and food in the hospital
-General nursing care.
The lowest plan fee found so far. Note: Many insurance agencies sell these packaged accident plans with dental, vision, and other random discounts. Therefore, these prices are only the policies for direct accident coverage.
Individual: policy value of $5,000 – $22 per month.
Individual: policy value of $7,500 – $28 per month.
Individual: policy value of $10,000 – $34 per month.
Family: policy value of $5,000 – $35 per month.
Family: policy value of $7,500 – $41 per month.
Family: policy value of $10,000 – $47 per month.
(The monthly price of a family policy includes everyone. It is the same price if you have a family of 3 people or a family of 8 people).
Emergency room health insurance supplements in the United States are commonly used in conjunction with HDHPs (High Deductible Health Plans) to cover large deductibles. Typical PPO deductibles are up to $5,000 and $10,000 due to constant rate increases from insurance companies. The increase in the deductible each year offsets the increase in the annual rate. The problem people have with these large deductibles is that one visit to the ER for a broken bone or torn ligament will cover the deductible for the year. Many of HDHP’s deductibles are maxed out due to bodily injuries that required X-rays, MRIs, and eventually surgery. Emergency room insurance plans pay out of pocket for bills associated with accidents and may pay for the high deductible PPO plan. Combining an HDHP with an ER plan of the same amount will offset any claims resulting from bodily injury.
One specific benefit worth noting is the surgical benefit. Members can choose any doctor. Of course, the policy must be active before the injury occurs. For example, let’s use a common sports injury like a torn anterior cruciate ligament. This knee injury often requires a complete ligament replacement to return to an active lifestyle. The torn knee ligament is not going to heal itself and for people who play sports and move it is a must. In this example, no matter how the ACL was injured, the knee has buckled and then you will hear a click. The knee swells and doesn’t feel the same. At least that’s how my ACL went down. At this point, someone can go directly to an emergency room and have the MRI or X-rays done.
Or they can make an appointment directly with an orthopedic surgeon. Either way, the next step is diagnostic testing to see what the damage is. If the diagnosis is a torn ACL, you will have time to schedule outpatient surgery. Ask some physical therapists in your area who are the best orthopedic surgeons for ACL reconstructions. Physiotherapists know exactly who the best doctors are because they are the first people who see patients after the operation. Surgeons who do Sports Medicine and work with professional athletes are the elite. Contact the doctor’s office and get an ACL repair quote. In many common sports injuries, the emergency room insurance policy face value of $10,000 will pay for the entire surgery and post-op physical therapy. The total out-of-pocket expense would be the plan deductible ($100 or $200). Not to mention the best knee surgeon in the state took care of you.
