Bruce Harmon
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Mike:
Well said. I hope everyone reads your explanation very carefully.
Bruce Harmon
From: mike.m-@obra.org
Reply-To: mike.m-@obra.org
Date: Sun, 9 Nov 2003 05:30:35 -0800
To: OBRA Remailer <ob-@topica.com>
Subject: [OBRA Chat] OBRA medical insurance
We have recently been contacted by an injured rider looking to collect for
their injuries under the OBRA insurance plan. It seems that it is time for
me to again explain how this works.
First, OBRA does not carry a health insurance policy for participants. You
need to have your own policy. At the very least you should purchase a major
medical plan with a large deductible so that you will not be bankrupted by
common and unavoidable illness or injury. Although it is commonly done, it
is irresponsible to race you bike, or do anything else, without health
insurance. The risk is simply to great. I think people do this because
they wildly underestimate the cost of medical care and also the risk that
they will need to get care. Medical care is VERY expensive, in part because
the person who pays for their medical care with private money pays full
sticker price. They bear the cost of providing care for the people who
don't pay at all and for the discounts negotiated by insurance plans. Since
collections in medicine often run less than 50% of what is billed the
private pay patient is paying 2-3 times the actual market value for the
product.
OBRA does carry a medical rider on the liability insurance that we need to
have in order to run bike races. The medical rider is purchased solely
because it is impossible to purchase liability insurance without also
purchasing a medical rider. Basically this plan is the "trip and fall" type
of insurance that businesses purchase. The idea is that it is less likely
that there will be a liability claim if some of the medical losses are
covered should someone injure themselves on the insured property. Whether
this is true any longer in this era of increased litigiousness is a
debatable point. Regardless, the companies that sell liability insurance
require a medical rider. In order to keep costs down we try to keep this
medical coverage at the minimum amount acceptable to the liability insurance
company. A significant downside of this is that all the claims we have had
against the OBRA policy have been against the medical rider. We have never
had a claim against the liability insurance directly. Unfortunately, for
the past several years the amount paid out under the medical rider has
exceeded the premium paid in. Clearly the insurance companies will not
tolerate this very long. It is likely that this situation is in great part
because the number of people covered by personal health insurance plans
continues to decrease. People without personal health coverage who sustain
high cost medical injuries are forced to look wherever they can to cover
these costs. OBRA is on the verge of having a situation where we will be
unable to purchase the medical rider, at least at a reasonable cost, and
therefore will be unable to purchase liability insurance. If we are unable
to purchase liability insurance then we will be unable to have bike races.
It would be a great thing if OBRA could offer health care coverage at group
rates to members or, alternatively, offer participant health care coverage
that would at least cover them while riding their bike. This, of course,
would need to be charged to the member directly. In many ways this would be
a more fair thing since the individual would then be bearing the cost of the
coverage. At the present time, riders who make medical claims are
essentially asking that the race organizer to bear the cost of providing
their health insurance during the course of the event. It would be more
reasonable if this cost were borne by the individual rather than by the race
organizer. Clearly the cost of this coverage would not be met by the $5
single event membership or the $15 annual membership. Unfortunately, we
have, as yet, been unable to get any companies to provide us with quotes for
such an insurance plan. It would be great if someone on the list could help
us with finding a company to provide a quote.
The medical rider we currently have is secondary insurance. This means that
it will only pay off after your primary insurance pays the claim. Only the
amount in excess of your primary coverage is paid. If there is no primary
insurance then it pays at 80% of the claim. There is a significant
deductible and a fairly low limit.
If you are injured it is important that you present to the first aid
provider or at least the officials at the race. They should complete forms
to document that the injury occurred at the race. If you make a claim you
will need to complete a form required by the insurance company. You should
not submit this until all expenses have been incurred and all other
insurance payments have been made. We forward to the insurance agent who
will forward to the insurance company. Payments are not made quickly. It
has been our experience in thee past that the insurance company will take a
long time investigating the claim and payment will not be made for several
months. Obviously I would like to discourage people from making claims under
the OBRA liability insurance policy as any claims will compromise OBRA's
ability to purchase this insurance in the future.
Please feel free to contact me if you have any questions about this issue.
Mike Murray
To respond to the whole group send to ob-@topica.com.
To respond to the list manager send to ob-@teleport.com
To unsubscribe send to obra-uns-@topica.com
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<TITLE>Re: [OBRA Chat] OBRA medical insurance</TITLE>
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<FONT FACE="Arial">Mike:<BR>
<BR>
Well said. I hope everyone reads your explanation very carefully.<BR>
<BR>
Bruce Harmon<BR>
</FONT><BLOCKQUOTE><FONT FACE="Arial"><BR>
<B>From: </B>mike.m-@obra.org<BR>
<B>Reply-To: </B>mike.m-@obra.org<BR>
<B>Date: </B>Sun, 9 Nov 2003 05:30:35 -0800<BR>
<B>To: </B>OBRA Remailer <ob-@topica.com><BR>
<B>Subject: </B>[OBRA Chat] OBRA medical insurance<BR>
<BR>
</FONT></BLOCKQUOTE><FONT FACE="Arial"><BR>
</FONT><BLOCKQUOTE><FONT FACE="Monaco"><TT>We have recently been contacted by an injured rider looking to collect for<BR>
their injuries under the OBRA insurance plan. It seems that it is time for<BR>
me to again explain how this works.<BR>
<BR>
First, OBRA does not carry a health insurance policy for participants. You<BR>
need to have your own policy. At the very least you should purchase a major<BR>
medical plan with a large deductible so that you will not be bankrupted by<BR>
common and unavoidable illness or injury. Although it is commonly done, it<BR>
is irresponsible to race you bike, or do anything else, without health<BR>
insurance. The risk is simply to great. I think people do this because<BR>
they wildly underestimate the cost of medical care and also the risk that<BR>
they will need to get care. Medical care is VERY expensive, in part because<BR>
the person who pays for their medical care with private money pays full<BR>
sticker price. They bear the cost of providing care for the people who<BR>
don't pay at all and for the discounts negotiated by insurance plans. Since<BR>
collections in medicine often run less than 50% of what is billed the<BR>
private pay patient is paying 2-3 times the actual market value for the<BR>
product.<BR>
<BR>
OBRA does carry a medical rider on the liability insurance that we need to<BR>
have in order to run bike races. The medical rider is purchased solely<BR>
because it is impossible to purchase liability insurance without also<BR>
purchasing a medical rider. Basically this plan is the "trip and fall" type<BR>
of insurance that businesses purchase. The idea is that it is less likely<BR>
that there will be a liability claim if some of the medical losses are<BR>
covered should someone injure themselves on the insured property. Whether<BR>
this is true any longer in this era of increased litigiousness is a<BR>
debatable point. Regardless, the companies that sell liability insurance<BR>
require a medical rider. In order to keep costs down we try to keep this<BR>
medical coverage at the minimum amount acceptable to the liability insurance<BR>
company. A significant downside of this is that all the claims we have had<BR>
against the OBRA policy have been against the medical rider. We have never<BR>
had a claim against the liability insurance directly. Unfortunately, for<BR>
the past several years the amount paid out under the medical rider has<BR>
exceeded the premium paid in. Clearly the insurance companies will not<BR>
tolerate this very long. It is likely that this situation is in great part<BR>
because the number of people covered by personal health insurance plans<BR>
continues to decrease. People without personal health coverage who sustain<BR>
high cost medical injuries are forced to look wherever they can to cover<BR>
these costs. OBRA is on the verge of having a situation where we will be<BR>
unable to purchase the medical rider, at least at a reasonable cost, and<BR>
therefore will be unable to purchase liability insurance. If we are unable<BR>
to purchase liability insurance then we will be unable to have bike races.<BR>
<BR>
It would be a great thing if OBRA could offer health care coverage at group<BR>
rates to members or, alternatively, offer participant health care coverage<BR>
that would at least cover them while riding their bike. This, of course,<BR>
would need to be charged to the member directly. In many ways this would be<BR>
a more fair thing since the individual would then be bearing the cost of the<BR>
coverage. At the present time, riders who make medical claims are<BR>
essentially asking that the race organizer to bear the cost of providing<BR>
their health insurance during the course of the event. It would be more<BR>
reasonable if this cost were borne by the individual rather than by the race<BR>
organizer. Clearly the cost of this coverage would not be met by the $5<BR>
single event membership or the $15 annual membership. Unfortunately, we<BR>
have, as yet, been unable to get any companies to provide us with quotes for<BR>
such an insurance plan. It would be great if someone on the list could help<BR>
us with finding a company to provide a quote.<BR>
<BR>
The medical rider we currently have is secondary insurance. This means that<BR>
it will only pay off after your primary insurance pays the claim. Only the<BR>
amount in excess of your primary coverage is paid. If there is no primary<BR>
insurance then it pays at 80% of the claim. There is a significant<BR>
deductible and a fairly low limit.<BR>
<BR>
If you are injured it is important that you present to the first aid<BR>
provider or at least the officials at the race. They should complete forms<BR>
to document that the injury occurred at the race. If you make a claim you<BR>
will need to complete a form required by the insurance company. You should<BR>
not submit this until all expenses have been incurred and all other<BR>
insurance payments have been made. We forward to the insurance agent who<BR>
will forward to the insurance company. Payments are not made quickly. It<BR>
has been our experience in thee past that the insurance company will take a<BR>
long time investigating the claim and payment will not be made for several<BR>
months. Obviously I would like to discourage people from making claims under<BR>
the OBRA liability insurance policy as any claims will compromise OBRA's<BR>
ability to purchase this insurance in the future.<BR>
<BR>
Please feel free to contact me if you have any questions about this issue.<BR>
<BR>
Mike Murray<BR>
<BR>
To respond to the whole group send to ob-@topica.com.<BR>
To respond to the list manager send to ob-@teleport.com<BR>
To unsubscribe send to obra-uns-@topica.com<BR>
<BR>
<BR>
<BR>
</TT></FONT></BLOCKQUOTE><FONT FACE="Monaco"><TT><BR>
</TT></FONT>
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