Accident Prone? Get a Plan to Cover your Deductible!

If you are accident prone, often get injuries, or simply participate in activities where you could get hurt this is a great plan for you!

Many people often use up their Health Insurance Deductible and this is a way to get those bills covered. But it’s not magic, it’s a simple way to get reimbursed once you have had medical expenses due to ONLY an accident.

By now you already know if this plan is a good fit for you, or someone in your family. So give us a call after giving this blog a quick read.

Call for a Quote at 425-802-2783 or

Click here to Email health@achieve-alpha.com

This Accident Plan is a direct reimbursement plan that is linked to a health insurance plan, so it will pay up to the Max Out of Pocket in your Health Insurance policy per year!

Due to the increasing prices of health insurance more people are getting a Bronze plan, yet being exposed to a $6,000 Deductible is a bit scary. This is a way to help ensure that wouldn’t be as big of a bite. However, it will not cover ongoing illnesses, sicknesses, medications, or cancer. It’s only for those NEW acute injuries or accidents.

To be very honest, this Accident Plan with AIG is the best bang for the buck, yet not an immediate payout structure like Aflac. They pay out quicker, yet often their coverage is more limited and more expensive (yes you read that correctly). They have more overhead from TV ads. If that is what you want then go right ahead. There is no such thing as one best company, it’s which one works best for you!

Example AIG Accident Policy Quote

Accident Plan Coverage Examples

Sporting events are another activity where an accidental injury may occur. A baseball pitcher who develops a rotator cuff injury during the act of pitching would not qualify as an accidental injury. However a batter who is hit on the wrist by a pitch, which causes a fracture, has sustained an accidental injury. Joggers who develop ligament strain and tears during the course of their running routine have not suffered an accidental injury. However, if they misstep off a curb and fracture their ankle they have suffered an accidental injury. Clearly the demonstration of the “accidental” event within the course of normal participation in an activity can be made and an injury associated with that event would be covered if “care” as defined within the terms of the policy contract is provided.

Dollar-for-dollar reimbursement for:
• Emergency Room
• Hospital
• Urgent Care Center
• Surgery
• Diagnostic Exams
• X-rays
• Physical Therapy

Here is an overview of the rules:

  • Initial care must be received within 72 hours (3 days) of the accidental injury.
  • Accident Emergency Care Benefit: such treatment or attention must be received from an Emergency Room, Hospital, Urgent Care Center or Physician’s office and in the United States.
  • Accident Follow-up Care Benefit is also covered, up to three visits which must be completed within 30 days of the accidental injury or discharge from the hospital. Outpatient surgery is covered as one of the three visits under the Follow-Up Care Benefit.
  • Fractures sustained as a result of a covered accidental injury must be diagnosed within 14 days of the accidental injury.
  • One Major Diagnostic Exam per accidental injury will be covered if completed within 14 days of the accidental injury. Major diagnostic Exam is limited to: CT Scan, MRI, or EEG (electroencephalogram).
  • Physical Therapy visits received as a result of an accident as prescribed by a physician, rendered by a physical therapist must begin within 30 days of the accidental injury or discharge from the hospital.
  • X-ray covered due to an accidental injury if completed within 14 days of the accidental injury.

 CLICK HERE FOR SIGNIFICANTLY MORE DETAILS

Talk to you soon!

Below are our areas of expertise:

Gary Franke, Tamara Chandler, Justin Cross
Independent Broker
Achieve Alpha Insurance, LLC 
12507 Bel-Red Rd, Ste 103
Bellevue, WA 98005
(425) 802-2783
health@achieve-alpha.com
www.achieve-alpha.com

Details about Accident Plan

Below are additional details that is good to know about the Accident Plan…

Click here to return to the Main Page on the Accident Plans.

Technical Details of the Accident Plan

An ACCIDENT means the unforeseen occurrence of an event that results in an accidental injury to an insured person wholly independent of disease, bodily infirmity, illness, infection or any other physical condition.

An ACCIDENTAL INJURY means a bodily injury to an insured person as the result of an accident, after coverage under this policy takes effect and while this policy is inforce, which results in care within 72 hours (3 days) after the injury is sustained. The following are examples that help describe the difference between an injury and an accidental injury.

How to File an Accident Expense Claim

The claims process begins when you contact the Customer Service Center to request health claim forms. This may be done via their Customer Service phone number (800) 811-2696. You MUST complete the form and submit it, along with any documentation, including Explanation of Benefits (EOB), to the address provided. After receiving all required documentation, they will begin review of the claim. Normal processing time is 10 business days from receipt of all required documents.

Accident & Health Claims – 800-811-2696

ACCIDENT FOLLOW UP CARE BENEFIT: Follow-up treatments are limited to three follow-up treatments per month. The follow-up treatments must occur within one year of the Accidental Injury or discharge from the hospital, and must be furnished by a Physician in a Physician’s Office or in a Hospital on an outpatient basis. Benefit NOT payable for the same visit that the Physical Therapy Benefit is payable or on the same day for which the Accidental Emergency Care Benefit is payable.

AMBULANCE BENEFIT: Benefit only payable if Accidental Emergency Treatment Benefit is payable
DRUG BENEFIT: Benefits for drugs administered in a Hospital or Urgent Care Center.
FRACTURE BENEFIT: Diagnosis of the Fracture must be within 14 Days of the Accidental Injury.
MAJOR DIAGNOSTIC EXAMINATIONS: Benefit is limited to one Major Diagnostic Exam per Year for each Insured Person. Major Diagnostic Exams are limited to a CT Scan, MRI or EEG (electroencephalogram).
PHYSICAL THERAPY BENEFIT: Physical Therapy must begin within 30 days of the Accidental Injury or discharge from the Hospital and must be completed within six months after the Accidental Injury. Benefit is limited to one Physical Therapy treatment per day, up to a maximum of ten treatments for each Accidental Injury.
PROSTHESIS BENEFIT: Benefit limited to a maximum of one Prosthetic Device received within one year of the Accidental Injury.
X-RAY BENEFIT: The x-ray or set of x-rays must be performed within 14 days of the Accidental Injury.

Insurance Company Legal Mumbo Jumbo
Here is a description from AIG about making sure actual accidents are covered and how they avoid fraudulent claims.

“We reserve the right to request that a Physician of our choice review any Diagnosis in the event of a dispute or disagreement
regarding the appropriateness or correctness of a Diagnosis. We also reserve the right to require that an Insured Person submit to
an examination to confirm a disputed Accidental Injury. We reserve the right to request that an independent and acknowledged
expert in the applicable field of medicine review the evidence used in making any disputed Diagnosis. We will pay for any such
requested examination or review.”

EXCLUSIONS
For any Insured Person:
(a) We will pay NO benefits under the policy if covered services provided are not related to a covered Accident.
(b) We will pay NO benefits for any Accident or any loss caused in whole or in part by, or resulting in whole or in part from the following:
i) the Insured Person’s suicide or attempt at suicide, or intentional self-inflicted injury or sickness, or any attempt at intentional
self-inflicted injury or sickness while sane or insane;
ii) the Insured Person’s alcoholism or drug addiction;
iii) the Insured Person’s commission of or attempt to commit an assault or felony;
iv) the Insured Person engaging in an illegal activity or occupation;
v) the Insured Person’s voluntary participation in any riot or civil insurrection;
vi) declared or undeclared war, or any act of declared or undeclared war; and
vii) any illness, loss, or condition specifically excluded from the definition of any Accident.

Below are our areas of expertise:

Gary Franke, Tamara Chandler, Justin Cross
Independent Broker
Achieve Alpha Insurance, LLC 
12507 Bel-Red Rd, Ste 103
Bellevue, WA 98005
(425) 802-2783
health@achieve-alpha.com
www.achieve-alpha.com

The Future of Health Insurance with Trump

health-insurance-changes-ahead-2017BOOKMARK THIS PAGE: We will Update as changes are made to Individual Health Insurance

We all know that due to the election of Donald Trump there are going to be many changes. One of the largest is regarding Individual Health Insurance. Especially since he has proclaimed to repeal “Obamacare”. 

Don’t be worried, as we are here to notify you of any changes as they occur! Our goal is to guide you through what happens next…

The 2017 Open Enrollment will continue as planned from Nov 1st 2016 to Jan 31st 2017.

(Click Here) for Information on 2017 Health Insurance Options

BOOK A MEETING to go over 2017 Plans!

It took 3.5 years from when the Affordable Care Act was passed on March 23rd 2010 until it was implemented on January 1st 2014. From speaking with many other professionals we are projecting that it would take about 2 years for any real structural change to occur. The soonest changes would be made are for 2018 plans since you are locked in. At least we can hope..

Changes to Expect:

Pre-Existing Conditions: There will be a waiting period for pre-exisiting conditions (there was a 9 month waiting period before the ACA). This would LOWER prices since people would not be able to “game the system” of getting coverage instantly for immediate medical issues occuring while uninsured. However if coming from a Group Plan they would waive the “waiting period” for having continuous coverage.

More Choices: With the ACA, the fully loaded Gold/Silver/Bronze policies currently cover “all” medical conditions. If you are able to choose a more “catastrophic only” policy this will result in cheaper policies for those that choose these and more expensive policies for those wanting the full coverage plans.

How to Enroll: It’s expected there will be no Open Enrollment period since the health insurance carriers will be able to underwrite and use waiting periods to “manage risk”. This means you will most likely be able to buy any time of the year.

Individual Mandate: Trump has proclaimed to end the manadate to buy health insurance and eliminate the tax penalty if you don’t.

Below is an independent article going over potential changes.

How Trump Might Change Health Insurance

Health Insurance carriers would not stand for any changes to simply drop coverage immediately since policies are locked in for a calendar year. Changes for the next year would move you to the next closest plan just like it did when the ACA was first implemented and you were moved to a new Gold/Silver/Bronze plan.

Give us a call at 425-802-2783 if you have any questions, as we want to ensure that you make an informed decision about your medical needs.

Below are our areas of expertise:

Gary Franke, Tamara Chandler, Justin Cross
Independent Broker
Achieve Alpha Insurance, LLC 
12507 Bel-Red Rd, Ste 103
Bellevue, WA 98005
(425) 802-2783
health@achieve-alpha.com
www.achieve-alpha.com

Achieve Alpha