Accident, Sickness & Hospital

Under an Accident, Sickness and Hospital plan, you may see whatever doctors or specialists you like, with no referrals required. Though you may choose to get the majority of your basic care from a single doctor, your insurance company will not require you to choose a primary care physician. An Accident, Sickness and Hospital plan may also require that you pay up front for services and then submit a claim to the insurance company for reimbursement. Many Accident, Sickness and Hospital plans give you benefits outright, meaning that coverage starts on the first dollar of your first claim submission, effectively helping you get coverage at your doctors, hospitals, and medical facilities, starting immediately upon your plan going into effect.

Rarely will you be required to pay an annual deductible before the insurance company begins to pay on your claims, but this may occur in some instances. However, once your deductible has been met for that medical service, the insurance company will typically pay your claims at a set percentage of the “usual, customary and reasonable rate” for the service. The UCR rate is the amount that healthcare providers in your area typically charge for any given service.