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Emergency Room Visit Coverage in Visitors Insurance for Fixed Coverage Plans

Emergency Room Visit Coverage in Visitors Insurance for Fixed Coverage Plans

The Emergency Department, also commonly referred to as the "Emergency Room" is where you should go to seek treatment for life threatening/urgent medical care. This article will help you understand the charges you are likely to receive during a visit to the Emergency Department. Regardless of what plan you purchase, it is important that you understand when you should utilize the hospital, and how your plan will pay for the charges incurred there. A hospital's outpatient department, also referred to as the Emergency Room (ER), should only be used in the event of an emergency which is considered to be a life threatening, urgent situation. If your injury/illness is not life threatening you should consider seeking treatment from a doctor's office or an urgent care facility. While the treatment may be the same, the cost is significantly less.

In this article, we will focus on the fixed coverage plans. These plans offer very little coverage and have strict requirements which must be met before the insurance company will pay the fixed amount for Emergency Room charges. Fixed coverage plans pay a fixed amount for each procedure and you are responsible for the rest. We will use the VisitorSecure plan with a $50,000.00 policy max and a $100.00 deductible as an example to help explain how a fixed coverage plan works in regards to outpatient Emergency Room services. Please keep in mind that you are responsible for your deductible before your plan will pay the fixed amount associated with a particular service (the deductible is per injury/illness in most fixed coverage plans).

In the event that you find yourself in a situation where you feel you should visit an Emergency Room for treatment, you will first be examined by doctors in the Emergency Room. During the initial treatment, depending on your injury/illness, you are likely to have multiple procedures done (diagnostic x-rays, lab services, surgery, etc.). All services are separate, meaning you will receive bills related to each service; for example, you may receive a bill from the doctor, another bill from the x-ray technician, a bill from the Emergency Department for the use of the room you were in, the medication they supplied to you and the list can go on, and on. The fixed coverage plans will ONLY pay the fixed amount listed in the schedule of benefits for ALL charges incurred in the Emergency Room.

For example, the VisitorSecure plan with a $50,000.00 policy maximum will only pay up to $355.00 (per injury/illness) for the use of a hospital Emergency Room and ALL EXPENSES INCURRED THEREIN. This means that regardless of how much everything totals up to for the room, the medication, the x-rays, the attending physicians charges, surgery (intensive or not), etc. the policy is only going to pay up to the fixed amount of $355.00 (this amount may be different depending on the plan and policy maximum you choose) and you are responsible for the remaining balance. The VisitorSecure plan indicates that if you are seen for an illness, you must be admitted in order for the Emergency Department charges to be paid. What this means is, if you go the Emergency Room for treatment related to an illness (Food poisoning, the Flu, Pneumonia etc.) and you are not admitted, the plan will pay NOTHING towards the bills related to that Emergency Room visit. If you go to the Emergency Room for an injury or accident (broken leg, dog bite etc.) the charges will be allowed for payment.

For example, if you go to the Emergency Room for a broken leg the plan will allow for payment regardless of whether or not you are admitted into the hospital. If you go to the Emergency Room because you have the flu and you are not admitted into the hospital the plan will pay NOTHING, and you will be responsible for all charges.

Example 1:

Let's say you were seen in the Emergency Room for an illness and you are admitted, in this instance the Emergency Department charges would be allowed for payment, (as long as it is an eligible expense) the payment would be as follows:

If the total charges add up to $1,500.00, you would be responsible to pay your deductible before the insurance company will pay anything which for this scenario is $100.00 (The VisitorSecure plan offers choices of $0, $50 and $100, if you are over age 70, you have the option to choose a $100 or $200 deductible). The plan would then pay up to the $355.00 which is the fixed amount related to the policy maximum of $50,000.00, after your $100.00 deductible the insurance company is actually only paying $255.00 ($355.00 - $100.00 = $255.00) and you would be responsible for the difference which would be $1,145.00. Your total patient responsibility would be $100.00 (your deductible) + $1,145.00 (remaining balance after insurance payment of $255.00) = $1,245.00.

Example 2:

Let's say you visited the Emergency Room for an illness and you were not admitted, the Emergency Room visit would not be paid.

If the total charges added up to $1,500.00 you would be responsible for the full amount of $1,500.00.

Note: The VisitorSecure plan does not participate in a PPO network, but if your plan does please understand that Network Negotiated Fees are only applied to charges that the insurance company considers payable.

It is important that you understand how your plan works, for more details on how your plan works please refer to your policy's certificate wording, brochure and benefits details. Emergency Room visits whether outpatient or inpatient are very expensive so if treatment can be provided at a doctor's office or an urgent care facility it is in your best interest to seek treatment there. While the decision is always yours, it is important that you understand how your plan works before the charges are incurred.

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To continue with the application please scroll down to confirm this notice

CALIFORNIA RESIDENTS SPECIAL NOTICE

1. THE INSURANCE POLICY THAT YOU ARE APPLYING TO PURCHASE IS BEING ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF CALIFORNIA. THESE COMPANIES ARE CALLED "NONADMITTED" OR "SURPLUS LINE" INSURERS.

2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY REGULATION AND ENFORCEMENT THAT APPLY TO CALIFORNIA LICENSED INSURERS.

3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE, THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS PROMISED.

4. THE INSURER SHOULD BE LICENSED EITHER AS A FOREIGN INSURER IN ANOTHER STATE IN THE UNITED STATES OR AS A NON-UNITED STATES (ALIEN) INSURER. YOU SHOULD ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER, OR “SURPLUS LINE” BROKER OR CONTACT THE CALIFORNIA DEPARTMENT OF INSURANCE AT THE FOLLOWING TOLL-FREE TELEPHONE NUMBER 1-800-927-4357. ASK WHETHER OR NOT THE INSURER IS LICENSED AS A FOREIGN OR NON-UNITED STATES (ALIEN) INSURER AND FOR ADDITIONAL INFORMATION ABOUT THE INSURER. YOU MAY ALSO CONTACT THE NAIC’S INTERNET WEB SITE AT WWW.NAIC.ORG.

5. FOREIGN INSURERS SHOULD BE LICENSED BY A STATE IN THE UNITED STATES AND YOU MAY CONTACT THAT STATE’S DEPARTMENT OF INSURANCE TO OBTAIN MORE INFORMATION ABOUT THAT INSURER.

6. FOR NON-UNITED STATES (ALIEN) INSURERS, THE INSURER SHOULD BE LICENSED BY A COUNTRY OUTSIDE OF THE UNITED STATES AND SHOULD BE ON THE NAIC’S INTERNATIONAL INSURERS DEPARTMENT (IID) LISTING OF APPROVED NONADMITTED NON-UNITED STATES INSURERS. ASK YOUR AGENT, BROKER, OR “SURPLUS LINE” BROKER TO OBTAIN MORE INFORMATION ABOUT THAT INSURER.

7. CALIFORNIA MAINTAINS A LIST OF APPROVED SURPLUS LINE INSURERS. ASK YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST, OR VIEW THAT LIST AT THE INTERNET WEB SITE OF THE CALIFORNIA DEPARTMENT OF INSURANCE: www.insurance.ca.gov.

8. IF YOU, AS THE APPLICANT, REQUIRED THAT THE INSURANCE POLICY YOU HAVE PURCHASED BE BOUND IMMEDIATELY, EITHER BECAUSE EXISTING COVERAGE WAS GOING TO LAPSE WITHIN TWO BUSINESS DAYS OR BECAUSE YOU WERE REQUIRED TO HAVE COVERAGE WITHIN TWO BUSINESS DAYS, AND YOU DID NOT RECEIVE THIS DISCLOSURE FORM AND A REQUEST FOR YOUR SIGNATURE UNTIL AFTER COVERAGE BECAME EFFECTIVE, YOU HAVE THE RIGHT TO CANCEL THIS POLICY WITHIN FIVE DAYS OF RECEIVING THIS DISCLOSURE. IF YOU CANCEL COVERAGE, THE PREMIUM WILL BE PRORATED AND ANY BROKER’S FEE CHARGED FOR THIS INSURANCE WILL BE RETURNED TO YOU.

07/11
LSW1146D

Cuba Notice

Travel to Cuba remains subject to restrictions imposed by U.S. sanctions, administered by the US Treasury. Only those who qualify for travel authorized under US Treasury's regulations and who comply with the terms of such authorization can legally travel to Cuba. Individuals traveling to Cuba must meet the following criteria in order to qualify for travel authorized under one of the general licenses outlined below:

Criteria for travel authorized by the US Treasury

If you have read and agree to the terms of both Notices: California and Cuba, please click the continue button if you wish to complete the application process. Otherwise, please click cancel to abort the application process.

To continue with the application please scroll down to confirm this notice

CALIFORNIA RESIDENTS SPECIAL NOTICE

1. THE INSURANCE POLICY THAT YOU ARE APPLYING TO PURCHASE IS BEING ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF CALIFORNIA. THESE COMPANIES ARE CALLED "NONADMITTED" OR "SURPLUS LINE" INSURERS.

2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY REGULATION AND ENFORCEMENT THAT APPLY TO CALIFORNIA LICENSED INSURERS.

3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE, THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS PROMISED.

4. THE INSURER SHOULD BE LICENSED EITHER AS A FOREIGN INSURER IN ANOTHER STATE IN THE UNITED STATES OR AS A NON-UNITED STATES (ALIEN) INSURER. YOU SHOULD ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER, OR “SURPLUS LINE” BROKER OR CONTACT THE CALIFORNIA DEPARTMENT OF INSURANCE AT THE FOLLOWING TOLL-FREE TELEPHONE NUMBER 1-800-927-4357. ASK WHETHER OR NOT THE INSURER IS LICENSED AS A FOREIGN OR NON-UNITED STATES (ALIEN) INSURER AND FOR ADDITIONAL INFORMATION ABOUT THE INSURER. YOU MAY ALSO CONTACT THE NAIC’S INTERNET WEB SITE AT WWW.NAIC.ORG.

5. FOREIGN INSURERS SHOULD BE LICENSED BY A STATE IN THE UNITED STATES AND YOU MAY CONTACT THAT STATE’S DEPARTMENT OF INSURANCE TO OBTAIN MORE INFORMATION ABOUT THAT INSURER.

6. FOR NON-UNITED STATES (ALIEN) INSURERS, THE INSURER SHOULD BE LICENSED BY A COUNTRY OUTSIDE OF THE UNITED STATES AND SHOULD BE ON THE NAIC’S INTERNATIONAL INSURERS DEPARTMENT (IID) LISTING OF APPROVED NONADMITTED NON-UNITED STATES INSURERS. ASK YOUR AGENT, BROKER, OR “SURPLUS LINE” BROKER TO OBTAIN MORE INFORMATION ABOUT THAT INSURER.

7. CALIFORNIA MAINTAINS A LIST OF APPROVED SURPLUS LINE INSURERS. ASK YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST, OR VIEW THAT LIST AT THE INTERNET WEB SITE OF THE CALIFORNIA DEPARTMENT OF INSURANCE: www.insurance.ca.gov.

8. IF YOU, AS THE APPLICANT, REQUIRED THAT THE INSURANCE POLICY YOU HAVE PURCHASED BE BOUND IMMEDIATELY, EITHER BECAUSE EXISTING COVERAGE WAS GOING TO LAPSE WITHIN TWO BUSINESS DAYS OR BECAUSE YOU WERE REQUIRED TO HAVE COVERAGE WITHIN TWO BUSINESS DAYS, AND YOU DID NOT RECEIVE THIS DISCLOSURE FORM AND A REQUEST FOR YOUR SIGNATURE UNTIL AFTER COVERAGE BECAME EFFECTIVE, YOU HAVE THE RIGHT TO CANCEL THIS POLICY WITHIN FIVE DAYS OF RECEIVING THIS DISCLOSURE. IF YOU CANCEL COVERAGE, THE PREMIUM WILL BE PRORATED AND ANY BROKER’S FEE CHARGED FOR THIS INSURANCE WILL BE RETURNED TO YOU.

07/11
LSW1146D

If you have read and agreed to the terms of this notice and wish to continue, please click the continue button. Otherwise, please click cancel to abort the application process.

Cuba Notice

Travel to Cuba remains subject to restrictions imposed by U.S. sanctions, administered by the US Treasury. Only those who qualify for travel authorized under US Treasury's regulations and who comply with the terms of such authorization can legally travel to Cuba. Individuals traveling to Cuba must meet the following criteria in order to qualify for travel authorized under one of the general licenses outlined below:

Criteria for travel authorized by the US Treasury

I certify that I have read the above and that all individuals applying for coverage qualify for travel authorized under one of the general licenses per US Treasury regulations.

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