Accident and Sickness Insurance

This is a form of insurance, which provides for the payments of benefits as a result of sickness or injury. This includes various types of insurance like accident insurance, medical expense insurance and disability income replacement insurance. This insurance is basically needed for students and workers to compensate loss of work and attendance to school or work, due to sickness or accident.

To avail this insurance, first one has to compare the rates of different policies of different insurance companies. Only after getting some financial guidance and comparison of different policies should one fill up the contact form the insurance company provides. After verification of the particulars by the insurance company will one be issued the insurance policy.

The Term ‘Accident’ in the Policy

An accident is something which had gone wrong unexpectedly. It may be an unavoidable collision, falling by chance, getting injured by touching something hot, sharp and electrically live or through ingesting poisons or by any other injuries caused by lack of ordinary precautions. It does not include incidents where someone is at fault or in other words, due to negligence. Such incidents where negligence was foreseeable, is not clubbed as accidental and the negligent person can be held liable for damages and personal injuries.

A work accident is defined as an accident that occurred at work, which is an external, unexpected and sudden event which occurred during the execution of work or arising out of it, and caused damage to the health or life of the employee.

Sickness Benefits For Overseas Treatment

The student accident and sickness insurance policy is offered through colleges and provides basic medical coverage to eligible students who are sick or injured. It covers accident and sickness, lab and x-rays, physician office visits, expenses including hospital room and board, emergency outpatient care, inpatient and outpatient surgical procedures, mental health services and prescription drugs. The coverage varies between 80-100%, depending on the provider. If you seek benefits through a preferred provider, the insurance coverage is usually 100%; and if you seek the benefits through out-of-network providers, the coverage will be 80% of the reasonable and customary charges, subject to $100 per condition, and per visit co-payment.

Sickness benefits are paid for up to 15 weeks to a person who is unable to work due to sickness, injury or quarantine. An employee has to have worked for at least 600 hours in the last 52 weeks, or since the last claim, to avail benefits of this policy. The insurance company requires a medical certificate citing how long the illness is expected to last to provide the benefits. Fees requested by the doctor or dentist are borne by the policyholder. While claiming for sickness benefits, it has to be not only proven that the person is unable to work, but that otherwise he or she would be available for work. In the case of one having to go abroad for medical treatment, sickness benefits will be provided only if that treatment is not available in one’s country. But the insurance company has to be informed of this decision; else one will not be entitled to the benefits!