Questions & Answers
THIS IS ONLY A SUMMARY OF A LIMITED NUMBER OF POTENTIAL QUESTIONS AND GENERAL ANSWERS.
PURCHASERS OF COVERAGE SHOULD CAREFULLY READ THE O.R.I. OUTLINES OF COVERAGE AND THE O.R.I. POLICIES FOR BENEFIT DETAILS AND OTHER IMPORTANT TERMS AND CONDITIONS.
Q: What's a "deductible" and why should I care that O.R.I. has none?
A: A deductible is fixed amount of money that has to be paid by an insured person before he or she can receive insurance benefits. Many 'high-deductible health plans' impose annual deductibles that may range from $1200 to around $5000, or even more. O.R.I. accident-only benefits are a great way to pay the deductibles imposed by your health insurance plan. And if you use your O.R.I. benefits to do so, we'll completely waive the O.R.I. deductible. That way, you probably won't have to go out of pocket a dime AND you'll be better situated under your health plan in the event you incur more claims later in the year.
Q: What's "co-insurance" and why should I care that O.R.I. has none?
A: Co-insurance is a percentage of the cost of medical services that has to be paid by an insured person. For example, many health plans cover 80% of the cost of certain services and the insured person must pay the remaining 20%. This percentage may seem fairly small...until you have an accident and start incurring medical expenses. For example, let's say you have an accident and need to have your ACL repaired. If the surgery costs $10,000, your co-insurance responsibility would be around $1,800 (assuming a deductible of $1,000). But wait, there's also that $6,000 helicopter ambulance ride for which you must pay another 20% ($1,200). Then there's your share of additional physician services, physical therapy, pharmacy...you get the point. O.R.I. imposes NO co-insurance responsibilities and will pay for the co-insurance amounts imposed by your health insurance plan, subject to O.R.I. benefit maximums.
Q: What's a "co-payment" and why should I care that O.R.I. has none?
A: A co-payment is a fixed dollar amount that must be paid by an insured person for certain medical services, for example, an office visit with a doctor. O.R.I. imposes NO co-payment responsibilities and will pay for the co-payment amounts imposed by your health insurance plan, subject to O.R.I. benefit maximums.
Q: What are the benefit maximums?
A. O.R.I. policies include $10,000 in ambulance and medical benefits per coverage category. In case of accidental death, O.R.I. pays $10,000 in addition to any covered medical/ambulance expenses. Please carefully consider your individual needs prior to purchasing. PURCHASERS OF COVERAGE SHOULD CAREFULLY READ THE O.R.I. OUTLINES OF COVERAGE AND THE O.R.I. POLICIES FOR BENEFIT DETAILS AND OTHER IMPORTANT TERMS AND CONDITIONS.
Q: What if I have no health insurance at all, can I still buy O.R.I?
A: Yes, however, O.R.I. coverage is not designed or intended to be a replacement or substitute for comprehensive health coverage. O.R.I.'s accident-only coverage can certainly help if you participate in any of our Snow, Mountain or Paddle activities. PURCHASERS OF COVERAGE SHOULD CAREFULLY READ THE O.R.I. OUTLINES OF COVERAGE AND THE O.R.I. POLICIES FOR BENEFIT DETAILS AND OTHER IMPORTANT TERMS AND CONDITIONS.
Q: Can I buy O.R.I. coverage for my kids?
A: Yes, if at least 14 years of age. Anyone 14-64 is eligible for coverage - no physical exams, no waiting periods, no hassles.
Q: I'm a skier in the winter and a kayaker in the spring, can I buy SNOW coverage first and then pick up PADDLE later in the year?
A: Absolutely. Just purchase your SNOW coverage during the ski season and then "Upgrade" later in the year to COMBO coverage. By the way, when you upgrade you get all three coverage categories for the remainder of the original policy year. That way, if you get the urge to do some hiking or climbing, you're covered for that too. Note that COMBO pricing gives you all three categories of coverage for about the cost of two separate coverage categories.
Q: What happens if I'm injured and need to file a claim?
A: Persons with O.R.I. coverage have a few reasonable responsibilities: first for letting O.R.I. know you've had an accident, and second for providing information necessary to process the claim. You can find additional information on our CLAIMS page. Please also take a look at our "Tips for Speedy Claims Processing and Payment"
Q: I lost my coverage card, what do I do?
A: No problem, just contact us through our form here and we'll send you a new coverage card via email.
Q: Are there any other costs beside the premium?
A: If you are not liable for the payment of another deductible under a health plan or health insurance policy, you must satisfy the O.R.I. deductible. Note, also that all claimants are responsible for any postage associated with the submission of a Proof of Loss and related documents.
Q: What is an "Explanation of Benefits"?
A: An "Explanation of Benefits" ("EOB") is the term used by health insurance companies and plans to describe the outcome of any claims review (for example, the amounts applied to your deductible, the amounts paid by the plan, and your share of the costs). EOBs can be very important in submitting "Proof of Loss" to O.R.I. The EOB lets us know what charges you got stuck with under your health and what charges may be picked up by O.R.I. For additional claims-related information, go to our CLAIMS page.
Q: What if O.R.I. is my only coverage and I don't have any EOBs from a health insurance company or plan?
A: If O.R.I. is your only coverage and you get injured while participating in a covered activity, you'll need to send us your medical bills along with other information to establish a "Proof of Loss". For additional claims-related information, go to our CLAIMS page. Note, O.R.I. coverage is not designed or intended to be a replacement or substitute for comprehensive health coverage.
Q: Do I "renew" my O.R.I. coverage at the end of my policy year?
A: No, when your original policy year terminates, you buy new coverage and print new information. Of course, you can and should buy new coverage before the end of the first policy year and specify the date upon which you want your new coverage to take effect.
Q: What is the International Rating Scale of whitewater, commonly referred to as "International Scale of River Difficulty"?
A: Persons with PADDLE coverage should familiarize themselves with this numeric rating system and pose questions to qualified professionals. There are many sources of information regarding this topic, for example, American Whitewater posts information at http://www.americanwhitewater.org/content/Wiki/safety:start
Q: I participate in one or more covered activities as a professional, can I still buy O.R.I.?
A: Yes, to the extent you are not covered under your state's the Workers Compensation system.
Q: Does O.R.I. have to be purchased over the Internet, or is there some other way?
A: Yes, coverage can only be purchased over the Internet. That way we're better able to reduce administrative cost and keep premiums low.
Q: At what point am I covered under my Snow policy?
A: You are covered while you are on the snow and you are using skis, a snowboard, or snowshoes or while carrying skis, a snowboard or snowshoes in conjunction with using such gear during the same outing.
Q: At what point am I covered under my Mountain policy?
A: You are covered beginning at the trailhead/hike or at the base of the climbing route.
Q: At what point am I covered under my Paddle policy?
A: You are covered while on the water or during portage.
