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Health insurance for athletes

by Tony Novak, CPA, MBA, MT
  updated 4/2/2013

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.

Is it covered?

The first and primary focus should be to confirm that the insurance policy will cover injuries related of caused by participation in the sport. Injuries caused by participation in professional sports are excluded from coverage in most individual health insurance. These risks must be handled by a separate groups sports policy held by the organization.

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.

Pre-existing conditions

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. In many cases, it makes financial sense for an athlete to enroll in health insurance that excludes coverage for pre-existing conditions. When pre-existing condition coverage is absolutely required, the price will be higher and the available insurance choices are reduced.

International travel

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.

Availability and price

The final but critical considerations are the availability of coverage and the cost of insurance. In most states, short term medical insurance can be issued immediately through a secure online enrollment service. Long term coverage through an insurance exchange takes days or even a few weeks. Health insurance premiums vary sharply depending on your location of residence. The lowest premiums are for short term coverage that start at less than $100 per month. An average regular major medical insurance premium is about $500 per month. Young healthy people enjoy lower rates now, but that may change in the future if health care reform law requires insurers to charge all members the same rate regardless of their expected medical care costs.

A few  health insurance companies offer reduced premium rates to preferred risk applicants who obtain coverage before October 2013. 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) For fast coverage, use a short term medical insurance plan. The best of these are listed on this page for temporary health insurance.

2) For coverage outside of the U.S., use  a separate international policy. These are classified as worldwide major medical insurance for long term coverage and travel medical insurance for shorter trip.

2) 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 Company at www.celticenrollment.com offers high quality long term coverage plans that offer this advantage as well as lower rates for preferred risk applicant.

3) 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. If you are an athlete who is not offered a preferred risk rate due to build, don't take it personally. Accept the pricing decision and move on knowing that you are in the same predicament as most world-class athletes.

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