Health insurance for athletes

by Tony Novak, MBA, MT, OnlineAdviser at Freedom Benefits updated 1/23/2012

Athletes make special demands on their health insurance plans. They tend to be young, healthy and free from the bulk of the type of medical problems that cause the many health insurance claims of non-athletes. Yet they are exposed to an entirely different set of significant medical risks and expenses.

The first and primary concern should be to confirm that the insurance covers injuries related of caused by participation in the sport. Keep in mind that injuries caused by participation in professional sports is excluded from coverage in most individual health insurance. These risks must be handled by a separate groups sports policy held by the organization.

It is important to know that some health insurance policies exclude high-risk activities or self-inflicted injuries. Some extreme athletes are affected by these provisions, but most amateur athletes have no trouble finding coverage for their sports participation.

A second critical consideration is whether the athlete has pre-existing conditions that must be covered by the insurance. Many applicants are surprised to learn that most health insurance policies exclude coverage for pre-existing conditions. I many cases, it makes financial sense to enroll in health insurance with these know exclusions. While pre-existing coverage is absolutely required, the price will be higher and the choices will be fewer.

The third important consideration is the geographic location where insurance coverage is available. Athletes may travel and compete throughout the various states and sometimes outside of the U.S. It is important that the policy offer coverage national or international coverage. Athletes need to know that they may seek treatment from the best qualified medical specialists regardless of their location. It is important to know the "worst case" scenario if medical treatment is obtained outside of the health plan' s preferred provider network or without pre-approval from the health plan.

The final but critical consideration is the cost of insurance. Health insurance premiums vary sharply depending on location of residence. The lowest premiums are less than $100 per month but quickly or to $500 or even more than $1000 per month in some states.

A few health insurance companies offer discounts to preferred risk applicants. The discounts may not available to athletes with significant medically history, even if the condition is now resolved. For example, a distance runner who completed successful orthoscopic knee surgery three years ago would not be eligible to a preferred risk rating. Medically, the athlete is fully recovered and poses minimal risk of claim, yet the insurer will not offer their lowest rate. In the mid-1990' s one commercial insurance company began an experimental insurance program using Olympic athletes as one of the model groups. Since then, this program developed into a preferred risk discount pricing program available to the public.

This strategy was eventually adapted by a handful of other insurance companies to lower prices for the healthiest class of members.

A few other issues to consider:

1) Athletes tend to visit a doctor only when absolutely necessary but annual exams should be encouraged. Look for a policy that includes coverage for wellness benefits including an annual exam. The Celtic Insurance policy above and the other Celticare polices are available at www.celticenrollment.com are both high quality plans that offer this advantage.

2) Insurance companies may rely on standard height/weight table developed by the AMA to determine whether a person' s build is within rating and eligibility limits. Unfortunately, these body build tables were not developed for athletes. I learned the hard way that a muscular amateur wrestler with less than 8% body fat measurement can fall in the medically "obese" classification and subject to a 50% price surcharge under some individual medical insurance plans.

3) When considering short term medical insurance, use a domestic plan while inside the U.S. and a separate international policy while traveling overseas. These plans can be started and stopped to meet your specific travel schedule and plans are issued easily online in only a few minutes at Web sites like FreedomBenefits.net.

Freedom Benefits and the other Web sites mentioned in this article are supported by OnlineAdviser^TM email and telephone support.

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Health insurance for athletes

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