The Fig Leaf of Excess Medical Coverage

Jay PaulApr 09 · 3 min read

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Ever wonder what is actually “covered” by those excess accident medical insurance programs that are provided by event directors or various associations that are never explained to you? Bet you’ve never asked, and if you did, the event organizer or group leader couldn’t explain how the coverage worked. While it’s great that organizations provide this benefit, many of these plans don’t fill the coverage gap the way you’d think.

In this post, We’ll explain how these plans work, how they coordinate with your health insurance, and what you might still owe if you get in an accident while participating in a covered event.

To get started, let’s suppose you are participating in a bike race sponsored by a local race director. You’ve signed the liability waiver required by their insurer, acknowledging that you won’t hold the event director responsible if something bad happens to you during the event. You’re pumped when informed you are “covered” if injured while participating in the race. Because, who wouldn’t be? It’s like a golden ticket. You’re safe and can go all out

Things start out fine, but halfway through your second lap, you wreck. Something’s happened to your shoulder and you bike frame is cracked. Leaving your bike on the side of the trail, you begin the two-mile walk to the race start. Once there, you convince your non-racing buddy to take you to the emergency room, where he drops you off and waves goodbye with a half-hearted smile. It’s only a shoulder, for crying out loud!

Over the course of the next five hours, you’re pricked, probed, robed, and even dosed, in no particular order, and finally diagnosed with a broken collarbone, separated shoulder, and a sprained wrist. You are sent home and told to see an ortho specialist the first of the week. Monday, you see the ortho, who puts you in a sling and wrist brace and tells you not to exert either for the next three months. In about a month, you receive separate invoices from Smiling Angel General Hospital and Dr. Seymour Paine looking for a total of $4,800 for services rendered while under their care. You curse softly under your breath and think, “How can this be? I was told I have good health insurance. This can’t be right.”

You reach out to your insurance carrier and learn that before your accident your deductible had not been met. In addition, you have 20% co-insurance and that the $4,800 you owe is, in fact, correct. Remembering that you were “covered” by the event itself, you reach out to the director and get a claim started.

You soon learn that their excess accident medical policy coordinates with your health insurance and that their policy has a limit of $10,000. This sounds great until you learn that it also has a deductible equal to your health insurance policy. You quickly realize that even with this event coverage you still owe at lea 2,000 bucks, and that doesn’t include other things like lost time from work or your damaged bike that your buddy had to retrieve from the woods.

Be aware. The average individual deductible today is over $4,000. Almost all excess accident medical plans have deductibles themselves and coordinate with your health insurance carrier. On top of that, these excess accident medical plans only cover you while in a covered event. Most of us do the majority of our training on our own and not as part of an association or event-sponsored activity. As such, we are covered only by our personal health insurance. Do a quick inventory, check your deductibles and copayments. Curious what your health insurance would pay if you were involved in an accident? Check out our Benefits Calculator.

At Buddy, we are committed to helping our customers live their lives more fearlessly. Maybe you know someone this happened to. Maybe you have questions. We have answers and we’d love to make it easier for you. Or, if we can help you navigate the labyrinth of health insurance and how it pays. Just ask. Every adventure needs a Buddy.

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