Health insurance and skydiving acidents?

[DougH 270]

Do most health insurance plans cover acidents that occur doing "high risk" activities like skydiving?

I am sure each plan is different but I wondered if there was an industry trend.

I was just thinking back to a conversation I had with some one from the DZ. The person had as much medical industry experince as I have, nada, but they thought that almost every medical insurance company out there is going to deny the claim if you screw up jumping?

Another question is for those of you who ended up with expensive metal upgrades, how did you medical insurance company treat you?

"The restraining order says you're only allowed to touch me in freefall"
=P

[peregrinerose 0]

My injury was pretty minor (wicked whiplash after hard open) and the insurance covered the ER visit.

Do or do not, there is no try -Yoda

[Remster 24]

If you medical coverage is through a group plan, I was told they cannot limit the coverage like that.

We went through a busted femur, and didnt have any issues at all, except incompetance with the people following up the paper work (ie double billing, etc...) but that gets straightened out. They even paid for the rod removal once the doctor recommended it due to chronic pain from it.

Remster

[DougH 270]

A group plan is an insurance policy that you would get through your employer right?

I just graduated school so I have been on my parents plan until now because it was cheaper and easier for me so some of the terminology is lost on me.

"The restraining order says you're only allowed to touch me in freefall"
=P

[tdog 0]

I asked my health insurance company over the phone a series of questions.

The lady on the other end finally got frustrated and said, "even if you try to kill yourself skydiving, on purpose, we still have to cover the claim."

All insurance companies are different. Call your company and ask.

Actually the line I remember the best from that call. "We don't exclude stupidity either."

(In their defense, I used the question, "Say I do something real stupid, so stupid that everyone says it was stupid, will you still pay?")

[Remster 24]

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All insurance companies are different. Call your company and ask.

I forgot to say that...

Remster

[kelpdiver 2]

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Do most health insurance plans cover acidents that occur doing "high risk" activities like skydiving?

I am sure each plan is different but I wondered if there was an industry trend.

I suspect most do, but it's not always easy to get the full information in the materials commonly given out. Quickest way would be HR or the insurance co directly.

In filling out my benefits package at a new job, I couldn't even find an exclusion list for AD&D insurance, but have read that they often exclude the high risk sports they know about.

Hyperbaric medicine seems to be commonly excluded, so divers get insurance from DAN or PADI.

[kmfenaughty 0]

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Do most health insurance plans cover acidents that occur doing "high risk" activities like skydiving?[/Reply]

Hmmmmm .... everything look's good so far and I'm not going to call them right now and look for trouble

I attempted a tendem a number of years back and when my wife found out about it she was "concerned" about what would happen if .. so I did call and I WAS covcerd including my life insurance and accidential death.

She felt better when I told her she would get about 800k cause the assidential death would kick in. She seemed relieved


[Reply]Another question is for those of you who ended up with expensive metal upgrades, how did you medical insurance company treat you?

Funny you should ask .... I'm about 6 weeks post op (Tibia Plateau Fracture w/ 5 screws) and I just recieved the attatched from Ingenix Subrogation Services

Instead of filling it out .. with all the details I decided to call, the rep said all they were really looking for is if a 3rd party was involved

I told them .. nope no 3rd party it was just a stupid accident and absloutley NOTHING about the details.

The rep said I didn't have to send the questioneer back .... he had filled in the info while we were on the phone.

99% of the people on this earth are sheep ... dare to be different

[kmfenaughty 0]

Here is the attachment

99% of the people on this earth are sheep ... dare to be different

[bigdad510 1]

That's an interesting question, even in the military. When I was in the Army, there wasn't anything more dangerous then Airborne Infantry, so nobody cared what we did and everything we did, no matter how stupid, was covered.

now I'm in the Air Force, and they have a little twist on the rules (not sure how they get away with it, since it's the same insurance, you have to have a high risk activity briefing documented in order for incidents to be covered. Luckily you can have an "annual" briefing, instead of "instances". It's still pretty stupid in my opinion.

I'm not sure if the other branches are the same, I would be interested in hearing about them.

Brad

[tombuch 0]

In the United States...

Group medical insurance policies are permitted to exclude hazardous activities under federal law. That change happened in Congress about eight years ago and was discussed in depth either here, or on rec.skydiving, but there was very little action from the skydiving community in opposition.

State law may prohibit exclusions. Some states regulate the insurance industry with an objective of inclusiveness, and some target lower premiums. Many states are actively looking at ways to increase coverage and reduce costs, and exclusions are always on the table.

It's an interesting political issue because excluding specific sports activities (i.e. scuba diving, skiing, skydiving) can be very harmful to a local/state/regional economy, and those injured without insurance coverage can become a financial burden to the rest of us through cost shifting as uninsured patients. So either the costs of care are covered through a more expensive insured risk pool, or the uninsured patients get care anyway and the costs are shifted within the medical community and among taxpayers. It's a thorny political problem in the United States that is probably being discussed in Speakers Corner, and will certainly get at least peripheral sound bites in the presidential campaign.

With all that said, most group medical policies in the United States still do cover skydiving. Many life policies may exclude coverage. Group policies tend to be more inclusive than individual policies. The trend is for more companies to exclude more activities. In some cases a rider may be available to cover your activity for an additional premium.

Your best bet when shopping for individual coverage is to talk with the insurance agent and ask very specific questions.

If you work for a company that provides group coverage it is well worth calling the HR department and speaking directly with the person who negotiates insurance purchasing. Human Resources departments are always looking for ways to reduce their insurance costs and insurance companies can offer may tools including higher deductibles and co-pays, reduced provider groups, containment caps, or exclusions. Your HR department should know of your concern. That's true for skydivers, but also true if you are a skier, or participate in motor sports, or any other hazardous activity.

We often think of politics as irrelevant to our daily lives, but this is an obvious case where the political process is important to us all, regardless of which side of the insurance issue you are on. Not only is it a critical social issue, but the costs of care are a growing burden on every one of us. I know it sometimes feels like Congress is a mess and isn't responsive, but health insurance is also handled at the state level, and your voice will have more power there. If you don't know who your state legislators are, find out, and then give them a call. If you don't fully understand the issue, ask your state representatives for a briefing on their perspective, and on the opposition view point.

Tom Buchanan
Instructor Emeritus
Comm Pilot MSEL,G
Author: JUMP! Skydiving Made Fun and Easy

[kelpdiver 2]

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Group medical insurance policies are permitted to exclude hazardous activities under federal law. That change happened in Congress about eight years ago and was discussed in depth either here, or on rec.skydiving, but there was very little action from the skydiving community in opposition.

Tom, that wasn't a change in policy. The bill was intended to ban exclusions, particularly on company plans that didn't cover motorcyclists. But between passage and the end of the rule making phase, the end result somehow got totally reversed as to the intent.

[white_falcon 0]

Credentials: 12 +/- yrs as a Licensed Property, Life & HEALTH insurance agent in FLORIDA

In my experience, if the policy does not SPECIFICALLY exclude coverage, you ARE covered.

I know specifically that United Health Care, Golden Rule Insurance Company, and Capital Health Plan (may not be available statewide) ALL would cover skydiving injuries. The only exception would be if a question regarding you participation in skydiving was asked and you indicated you DID NOT skydive.

Other than that, you would be OK. Also, As Tom stated (I think he knows everything about everything) :-) If you are on a GROUP policy (thru your employer) you are in a MUCH better position. ( I would be VERY surprised to find a limitation on ANY group policy as to recreational activities.

SOME companies may up-rate your policy for skydiving but my guess is that it won't make a difference (again, thats been MY experience)

As far as Life insuranace is concerned. you will generally pay a "surcharge" for being a skydiver but you can still purchase quality coverage.

Hope this Helps

Scott

[monkycndo 0]

The policy I recently had only excluded coverage if the activity was intercollegiate or as a profession. As a sport skydiver, they covered my broken leg.

50 donations so far. Give it a try.

You know you want to spank it
Jump an Infinity

[darwin143 0]

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The only exception would be if a question regarding you participation in skydiving was asked and you indicated you DID NOT skydive.

What if they don't ask? Does the company need to know if you are a skydiver in order for them to cover any skydiving-related injuries?

I don't intend on telling my insurance company that I skydive unless they ask.

[kelpdiver 2]

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The only exception would be if a question regarding you participation in skydiving was asked and you indicated you DID NOT skydive.

What if they don't ask? Does the company need to know if you are a skydiver in order for them to cover any skydiving-related injuries?

I don't intend on telling my insurance company that I skydive unless they ask.

What he was saying that if you lie as part of their rate setting, they can cancel out on you for fraud. Same would be true of life insurance policies.

[aheavenlytiger 0]

Out of curiousity, if when I initially received my life insurance coverage I wasn't a skydiver yet, but now I am, would I be in default somehow if I went in? Would my family still be able to collect? I thought that there was some sort of time frame that after which any claims that may have been made when opening a policy cannot be refuted. I might be totally wrong in that, so please correct me if I am.

[fugozzie 0]

I have fallen off a ladder twice

[NWFlyer 2]

The answer that fits all circumstances is this:

1) Read your policy ... not the nice little summary your HR person gives you, but the full, detailed certificate of coverage.
2) Call your broker/agent/HR rep/customer service line to clarify anything that you don't understand in the policy.

The only issue I had with the one sky-diving related insurance claim I've made was an after-the-fact subrogation questionnaire. The insurance company is just doing their due diligence and trying to find out if the accident might be covered by some other policy such as an auto insurance, worker's comp, or accident insurance policy. I sent back the survey with details and nothing ever came of it.

"There is only one basic human right, the right to do as you damn well please. And with it comes the only basic human duty, the duty to take the consequences." -P.J. O'Rourke

[ChrisL 2]

I wouldn't take the chance :-)

If I could get myself to the ER and didnt need an ambulance ride,
I'd just lie about how I got injured :-)

__

My mighty steed