Even if they are in good health, someone who enjoys an occasional sky or scuba dive, rock climb, or has a job that puts their health at risk, injuries received while doing those activities might not be covered by your health plan. While some activities considered a hazard to insurance companies may seem more normal and every day, even healthy, it could cause as much damage to your health insurance application as being a 75-year-old smoker in the past. However, your premiums cannot increase simply because of your lifestyle.
Whether your risky behavior is simply a fond hobby or your source of employment, it is important to inform the insurer on your application of anything that could be considered as such. In the past, it would cause premium rate increases or even rejection of coverage like any other risk. Why? Because to an insurance company you are viewed as a potentially expensive health care user if any injuries occur. Like smoking, risky activities are seen as a voluntary hazard placing you in danger of needing serious medical attention.
Under health reform, insurers cannot turn you down for any reason, and can only increase your premiums based on age, number of individuals on your health plan, tobacco use and geographic area. But, you may have to purchase another plan to cover injuries you receive while you’re riding off a cliff.
What happens if you say “yes” to participating in risky activities on your health insurance application?
If you agree, and explain in detail what your interests are, how often they take place, and to what extent you partake, this can help the insurer decide whether or not you are a mild or an extreme investment. They can’t change your rates or decline you coverage. It also depends on the insurance company’s willingness to accept a slight risk or consider all risks equal and potentially costly.
Also, your insurer may ask you to fill out an application for a supplemental or travel insurance policy to cover injuries or health problems related to the “dangerous” activity you prefer. Once the insurance company accepts you for a plan, it is likely they will make note to not pay for any care for injuries or illness received from placing yourself in harm’s way. They cannot issue exclusion periods or elimination riders because of this, however.
What happens if you say “no” to participating in risky activities on your health insurance application?
If you know that something you enjoy doing puts you at risk of some sort of injury (which is an incredibly broad definition, and could technically include crossing a busy city street, though insurers have more specific ideas), and say “no” on your application, you will most likely not be covered for any activity-related injuries.
Hazardous Hobbies and Activities
Anything considered thrill-seeking will result in lack of coverage for injuries received as a result of your activity of choice, and higher premiums. If you travel to foreign countries that are at war, you are also considered a risk. Speeding tickets and car accidents are also considered to evaluate your inclination toward high-risk behavior. There are often exclusions made by insurers for skydiving, rock climbing, bungee jumping, racing, and professional sports among other activities. Under health reform, no exclusions are permitted, however.
For healthier activities, you may purchase an additional policy (usually travel insurance with a sports rider not available through major carriers) for specific events that are not covered by your regular medical insurance. Extreme sports, professional sports, and traveling activities may be covered to a certain extent by purchasing such an additional plan. Supplemental accident plans are available through most private health insurers, and cover anything from slipping on ice to getting hit in the face with a basketball. You must rely on whatever terms are associated with the temporary coverage as it will not be connected to your individual policy. Travel insurance typically covers a limited amount of activities, that medical insurance will not, which include:
- Contact sports e.g. baseball, basketball, tennis, volleyball
- Non contact sports e.g. swimming, golf, cycling, rollerblading, skateboarding
- Running (sprint, long distance, jogging, and marathons)
- Scuba diving (maximum depth of 30 meters) under 14 days
- Trekking (under 2000 meters)
- Bungee jumping (up to 3 times)
- Water activities e.g. canoeing, water polo, water skiing, white/black water rafting (grades 1-4), windsurfing, yachting, snorkeling
Based on on-the-job fatalities, the following are considered some of the most dangerous occupations according to the Bureau of Labor Statistics. These professions were likely to cause an increase in health insurance premiums or altogether rejection of coverage before the Affordable Care Act reformed the underwriting process. According to one health insurance broker, a construction worker applying for a plan with their firm was rated up about $25 per month before this occurred.
- Fishers and related fishing workers
- Logging workers
- Aircraft pilots and flight engineers
- Farmers and ranchers
- Mining machine operators
- Drivers/sales workers and truck drivers
- Industrial machinery installation, repair, maintenance workers
- Police and sheriff’s patrol officers
In 2012, seasonal firefighters petitioned to receive health benefits as other full-time federal employees do. Because of their wages as well as their risk level, the occupation made these individuals unable to get a private plan. In quick response to the petition, such workers will now receive health insurance coverage thanks to the Obama administration.
In summary, make sure you are aware of the effect your activities or profession may have on your health insurance application in order to avoid unpleasant surprises. Be prepared to not have activity-related injuries covered at the very least. If you alert your health insurance company to your lifestyle, they cannot decline you coverage. Though it may be seen as a major expense to them, the health reform law protects you and your lifestyle.