What to do if you’ve lost your health care coverage

For those who have lost their job (and therefore their health insurance) because of coronavirus, they are eligible for a special enrollment period (SEP), which involves re-opening the Healthcare.gov enrollment site.

Read more: How to get ACA health insurance if you lose your job

Generally, people are only able to obtain health care coverage during open enrollment. However, getting laid off is considered a “qualifying event,” which means the person can sign up for health care coverage outside of open enrollment.

Another option is COBRA, which means the individual continues the same health care coverage they had under their employer-based health insurance, though COBRA has higher premium payments since there is no longer an employer contribution. And if income is considered low enough, a person may be eligible for Medicaid.
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Lastly, don't forget the agency in your back pocket - us! We can help educate you about your options outside of ACA coverage. Just head over to our National General Health E-Store for Health, Dental, Accident, Critical Illness, and Cancer options or our UnitedHealthcare Health E-Store where you'll be able to familiarize yourself with our co-branded health plans designed to meet the needs and budgets of individuals and families. If you feel like nothing there fits or you would simply like to see other options, just let us know and we can send you some additional brochures with other companies.

Affordable plans for everyday health care needs:

Looking for Medicare options instead? Click here

The HealthiestYou telehealth app from Teladoc® offers you access to 24/7 virtual care from a nationwide network of doctors – all for the cost of a monthly membership fee. Now, that access extended to Behavioral Health Care and Dermatology Services!

NEW! Behavioral Health Care – You can receive support for anxiety, depression, eating disorders, family problems, and other issues. Care from a licensed psychiatrist, psychologist, or therapist is available by phone or video 7 days a week.

• Psychiatrist: $200 for initial evaluation & $95 for each ongoing session

• Psychologists or Therapists: $85 per session

NEW! Dermatology Services – You can share photos of your skin condition or infection with a board-certified dermatologist and receive a diagnosis and treatment plan within two business days (typically within 8 hours). Free follow-up is included for a week after the session.

• Dermatologist: $75 per session

Included with Membership – You will still have access to doctors ready to diagnose, treat, and prescribe medication for many of the most common ailments, right over the phone. You can use the app to find a doctor, dentist or other provider in your area, and comparison shop to get the best price on a procedure or prescription.

• Added cost for these services: Nothing! All of this is included with your  $20 HealthiestYou membership fee.

Budget-friendly coverage and straight-forward fixed benefits:

​Need to discuss Medicare options instead? Click here.

Golden Rule Insurance Company is the underwriter of UnitedHealthcare insurance plans. National General Accident and Health markets products underwritten by National Health Insurance Company, Integon National Insurance Company, and Integon Indemnity Corporation. Subject to health underwriting. Product availability and designs vary by state.

Harris, Reed & Seiferth Insurance Group, Inc.
6650 W Indiantown Rd

Now and again, it is our recommendation in the insurance industry that businesses carry higher liability limits. So, someone might wonder: “Why is my medical expenses limit so low compared to my other general liability coverages?”
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To answer this question, let’s take a look at a standard commercial general liability outline:

The answer to why a medical expense limit is so low compared to general liability coverage is  twofold—where liability coverage is for situations where a third-party claims your negligence for bodily injury or property damage, medical payments is considered an exception. This is because the coverage pays for bodily injury medical expenses to third parties as a result of your operations regardless of fault. 

The idea behind reimbursing others—regardless of fault—for medical or funeral expenses they incur as a result of injury or death on your premises is that people are less likely to sue if they receive timely payment for their medical bills.  This also helps to prevent any costly legal fees. 
So why wouldn’t we want our medical payments limit to be higher if the intent is to avoid lawsuit expenses and hefty claims?

First, medical expense limits apply separately to each person, and they are a sublimit of the each occurrence limit. Meaning, payments made under this coverage reduces your each occurrence limit as well as your general aggregate limit. 

Here’s an example:
You carry a $10,000 medical payment limit, a $1,000,000 per occurrence limit and $1,000,000 general aggregate limit.  A customer slips and falls on your wet floor after you neglected to provide adequate warning of it having been mopped.  $5,000 in medical expenses are incurred, so your medical expenses coverage pays that cost.  The hope is this person is satisfied with you having covered their medical bills, but this is not always the case.  This brings us to our second point…

Making a payment under medical payments coverage doesn’t release you of liability from the injured party or prevent them from taking civil action.  Continuing our example, the customer decides to sue, and you are now processing a claim under the liability portion of your commercial general liability.  The $1,000,000 per occurrence limit of liability you originally carried has now been reduced to $995,000 as a result of medical payments.  Your general aggregate has also been reduced to $995,000. 

Now, let’s say five individuals slip and fall on your wet floor—each incurring the maximum $10,000 of medical expense payments.   Remember, medical expense limits apply separately to each person and are a sublimit to the each occurrence limit.  Even before these individuals have decided whether or not to take civil action, the per occurrence and aggregate limit have been reduced by $50,000. 

Once you think about this information, the question of “Why is my medical expenses limit so low?” can quickly become, “Is my medical expense limit too high?”  If you own a business that has an exposure to third party slip and fall accidents on sidewalks, aisles, staircases, or even elevators, perhaps it’s worth asking whether or not your medical payments coverage is at the right limit.  This can help you maintain healthy liability limits in the event that medical payments are not sufficient. 

Contact the trusted advisors at Harris, Reed & Seiferth Insurance Group, Inc. if you have any questions.