TWMX All Access: Is Tonik a Cure For MX Insurance Woes?

Insurance is one of those topics that no one likes talking about, but can’t be avoided. Over the years we’ve heard our share of insurance-relate horror stories. Riders with no insurance being badly injured; and riders being denied coverage after their insurance company discovered that their injury was motorcycle-related. And of course, everyone’s heard of tracks being closed after lawsuits, either from uninsured, or underinsured riders.

As far as we’re concerned, anyone who slings a leg over a bike knows (or should know) the risks involved and be fully prepared to accept them, and they should also have their own insurance coverage.

We recently noticed they ads that have been running on www.transworldmx.com for Tonik, and were intrigued. Not only did the insurance plans seem to be designed with action sports in mind, but the company was actually actively pursuing the action sport market. That’s definitely a switch from the days when riders didn’t want to be transported in their riding gear, which made it all-too-obvious that they’d been hurt on a bike.

We hooked up with Eric Tapia, who specializes in Tonik policies, to get some questions answered, and he was gracious enough to help out. If after you read through this you still have questions of your own, you can find his contact information at the end of the story.

The biggest hitch we’ve seen in this so far is that it’s available only in California…though it may open up in additonal states in the future. But for now, we’ll let Eric answer the questions.

What is Tonik?

In November 2004, Blue Cross launched a new group of plans called “Tonik,” specifically targeting active young healthy people who need health insurance but hate forms and jargon. After doing a few years worth of focus groups and case studies on what active young people wanted, in order to sign up for health insurance, Tonik was created. Tonik health plans were designed by, and for, ”young invincibles,” as an effort to expand access to health care coverage for one of the fastest growing uninsured populations in the state and the country. Tonik plans are simple, easy to use and affordable. Tonik covers everyday preventive needs (like routine doctor visits) as well as the more serious medical necessities. Unlike other individual policies on the market, seeing a dentist, getting eye exams, glasses and contacts are all-inclusive within the new benefit design. Californians responded and Blue Cross listened. The end result can be summed up with Tonik’s motto, “Cover your A-Z, and beyond the double entendre it basically means that Blue Cross will offer, for the first time, PPO Health, Dental and Vision for one easy payment. No other health plan that we know of offers all three benefits bundled for one low payment.

That’s, with Tonik you get Blue Cross PPO Health, Dental and Vision for one low price. Tonik is as easy as 1 2 3: Tonik plans are 1) easy to understand, 2) easy to apply for and, 3) very affordable.

Who is Tonik designed for?

Tonik is designed for anyone that wants a health care plan that is easy to understand, easy to apply for, and very affordable monthly. Tonik can be purchased for a newborn up so someone aged 64. Families can apply and every member will get their own insurance card.

In the past we’ve heard of riders having claims denied after their insurance company found out that it was riding-related. This program sounds like it’s targeted to groups insurance companies have run scared from in the past. What prompted Blue Cross to offer this program?

There are 6.5 million uninsured Californians. Young adults have the highest rate of being uninsured, consistently reported between 30 and 40 percent. ”Young invincibles” tend to be people no longer covered by family insurance policies and just beginning to establish their independence. They are also starting their careers and ls likely to be offered insurance by their employers. Nearly half of all full-time workers aged 19 to 29 lack employer-based health benefits.  ”Young adults think of insurance like broccoli,” said Steve Synott, general manager of Individual Services for Blue Cross of California. ”They know it’s good for them but they don’t have a taste for it yet.” As a result, many go without it. There are currently an estimated 1.6 million uninsured 19 to 29-year-olds in California. The financial pain of a sports related injury or other unforeseen event can outweigh the physical. Consider the following: an ambulance ride to the hospital is $607; the average cost of a day in the hospital is $7,175; and knee surgery and care is estimated at $48,302. The costs of Tonik plans are painless. They range from $64 to $123 a month, depending upon the plan, the insured’s age and where they live. Tonik was made for the Young Invincible. Although riders do have claims, in general they probably are healthier and go to the doctor far less than the average Joe. Blue Cross made a decision to go after the young invincible and they are willing to pay for their riding-related claims. This is hard to believe, but Blue Cross will cover our extreme sometimes reckless lifestyles.

Is it a California-only product?

At the current time, Tonik is only for California residents.

With a Blue Cross of California PPO (Preferred Provider Organization) you will have access to the largest network of doctors, physicians and hospitals of any one company in California. Not to mention with Blue Cross you get the BlueCard. The BlueCard program gives Blue Cross PPO members access to doctors and hospitals in participating local Blue plan networks throughout the nation. The program features assistance in locating these participating providers from a roster including more than 70 percent of doctors and 80 percent of hospitals in America. Blue Card extends “Power of Blue cost savings and the security of access to quality health care, wherever you travel within the U.S.

In the event of a life-threatening emergency out side of the United States you do have coverage. So if you’re snowboarding in the Alps and you wreck and do major internal damage and they have to air lift you to the hospital for major surgery you are covered. Blue Cross cannot pay a claim out of the country, so bring a translated bill or receipt back to California and file your claim. Normal sick visits outside of the US are not covered benefits, only life threatening emergencies.

You said you specialize in Tonik. How’d you come to pick that as a specialty? Personal interest?

I have been an Agent for Blue Cross for four+ years now.  Tonik” Calculated Risk Taker (AKA Tonik1500) is the first plan that actually impressed me. I would and have sold it to anyone and everyone I know, it’s that good. I call Tonik my specialty because it is the best product on the market and I can relate to its target audience. I am Tonik material.  I am 28, a college grad and lead a very active lifestyle. I play traditional sports and I do several extreme sports. I have sprained my wrists, broken my collarbone, and suffered plenty of lacerations, bumps and bruises in my life. I know how expensive emergency room, lab work and hospital visits can cost with and without health insurance.  A good buddy of mine tore his ACL snowboarding about four years ago. At the time he had no health coverage.  He is still paying off his $43,000 surgery to this day. If he had “Tonik1500 he would’ve had a bill of $1,500 and Blue Cross would’ve covered the rest. One year ago, I needed two stitches and four x-rays for a foot laceration I suffered goofing around. My Emergency Room bill was $1,500 for two stitches and four x-rays. On “Tonik1500 I would’ve paid my $100 ER co-pay and Blue Cross would’ve covered the rest.  I believe in Tonik and what it could do for anyone who is insured with it.  I am Mr. Tonik. I know the plan enough to train other agents on the benefits of Tonik.

Who can sign up? Any minimum or maximum ages? Any other limits?

Tonik is designed for anyone that wants a health care plan that is easy to understand, easy to apply for, and very affordable monthly. Tonik can be purchased for a newborn up so someone aged 64. Families can apply and every member will get their own insurance card.

All individual plans are medically underwritten, so we will look at any pre-existing medical issues, medications your on or recent surgeries to determine if you can get coverage with Tonik right now. If you are currently being treated for a health condition or just had surgery you might have a waiting period before Blue Cross will cover you. Only three things can happen when applying for a Tonik plan. 1) You can get the preferred rate because Blue Cross considers you healthy. 2) Because of a pre-existing condition (If you have a high “BMI Body Mass Index, are on medications other than birth control or a ten day antibiotic, or if you have had a recent illness your policy can be rated up 25%, 50% or possibly higher, but you still get insurance. 3) If you have recently had major surgeries or are on major meds or Blue Cross demes you uncover able you can be declined.

What’s the basic cost?

Tonik has an average base cost of around $64 – $123 for a 19-29 year old in California. Under TONIK, we look at the cream of the crop “The Calculated Risk Taker price are around $80-$123 a month.  In Riverside, Inland Empire, San Diego and San Bernardino for a 19-29 year old it runs about $87 a month.  In Orange County it runs about $94 a month. And for Los Angeles County it runs around $81 or $106 depending on your zip code. The price will vary based on current health, zip code, plan and age. There are nine different rate areas in California. Please refer to to the web site at the end of the article to see your rate area and cost depending on your age and zip code.

How about deductibles?

Tonik has three plans for different types of users. They have “The Thrill Seeker, “The Part-Time Daredevil and “The Calculated Risk Taker.” We like these names because it’s now much easy to sort through than the old confusing codes and numbers of traditional plans. With the Blue Cross Tonik’s system, all you have to do is just figure out which category you fall under and then apply. If you are a “Thrill Seeker (AKA Tonik $5,000 deductible),” you probably want to be covered in case of an accident and figure you will only need to see the doctor a few times a year. “Calculated Risk Takers (AKA Tonik $1,500 deductible),” on the other hand, are willing to pay a little more for low deductibles and unlimited trips to the doctor in addition to comprehensive coverage for accidents.  “Part Time Daredevils (AKA Tonik $3,000 deductible),” fall somewhere in between.

After reviewing the price difference in the plans, you will see there is only around a $15-$25 monthly saving for going with a $5,000 deductible instead of a $1,500 deductible with Calculated Risk Taker. This is why I will always refer you to the best plan Blue Cross has ever offered, Tonik Calculated Risk Taker. First of all this is a Blue Cross PPO plan. Unlike and HMO you do not have to pick a primary care physician, you have the freedom of choice to go to any hospital and any doctor you wish. You will have access to 42,000 doctors and over 80% of the hospitals in California. This plan offers you a worst case scenario/max out of your pocket of $1,500 even with a $250,000 surgery/hospital for a motocross accident. You are covered up to $5,000,000 over the life of the policy. You have no yearly max. So is you have a $3,000,000 hospital stay, it is covered. You will have a doctor visit co-pay of $40. This co-pay covers your entire doctor visit, including lab work, x-rays and even routine physical exams I am Mr. Tonik. I know the plan enough to train other agents on the benefits of Tonik.

Who can sign up? Any minimum or maximum ages? Any other limits?

Tonik is designed for anyone that wants a health care plan that is easy to understand, easy to apply for, and very affordable monthly. Tonik can be purchased for a newborn up so someone aged 64. Families can apply and every member will get their own insurance card.

All individual plans are medically underwritten, so we will look at any pre-existing medical issues, medications your on or recent surgeries to determine if you can get coverage with Tonik right now. If you are currently being treated for a health condition or just had surgery you might have a waiting period before Blue Cross will cover you. Only three things can happen when applying for a Tonik plan. 1) You can get the preferred rate because Blue Cross considers you healthy. 2) Because of a pre-existing condition (If you have a high “BMI Body Mass Index, are on medications other than birth control or a ten day antibiotic, or if you have had a recent illness your policy can be rated up 25%, 50% or possibly higher, but you still get insurance. 3) If you have recently had major surgeries or are on major meds or Blue Cross demes you uncover able you can be declined.

What’s the basic cost?

Tonik has an average base cost of around $64 – $123 for a 19-29 year old in California. Under TONIK, we look at the cream of the crop “The Calculated Risk Taker price are around $80-$123 a month.  In Riverside, Inland Empire, San Diego and San Bernardino for a 19-29 year old it runs about $87 a month.  In Orange County it runs about $94 a month. And for Los Angeles County it runs around $81 or $106 depending on your zip code. The price will vary based on current health, zip code, plan and age. There are nine different rate areas in California. Please refer to to the web site at the end of the article to see your rate area and cost depending on your age and zip code.

How about deductibles?

Tonik has three plans for different types of users. They have “The Thrill Seeker, “The Part-Time Daredevil and “The Calculated Risk Taker.” We like these names because it’s now much easy to sort through than the old confusing codes and numbers of traditional plans. With the Blue Cross Tonik’s system, all you have to do is just figure out which category you fall under and then apply. If you are a “Thrill Seeker (AKA Tonik $5,000 deductible),” you probably want to be covered in case of an accident and figure you will only need to see the doctor a few times a year. “Calculated Risk Takers (AKA Tonik $1,500 deductible),” on the other hand, are willing to pay a little more for low deductibles and unlimited trips to the doctor in addition to comprehensive coverage for accidents.  “Part Time Daredevils (AKA Tonik $3,000 deductible),” fall somewhere in between.

After reviewing the price difference in the plans, you will see there is only around a $15-$25 monthly saving for going with a $5,000 deductible instead of a $1,500 deductible with Calculated Risk Taker. This is why I will always refer you to the best plan Blue Cross has ever offered, Tonik Calculated Risk Taker. First of all this is a Blue Cross PPO plan. Unlike and HMO you do not have to pick a primary care physician, you have the freedom of choice to go to any hospital and any doctor you wish. You will have access to 42,000 doctors and over 80% of the hospitals in California. This plan offers you a worst case scenario/max out of your pocket of $1,500 even with a $250,000 surgery/hospital for a motocross accident. You are covered up to $5,000,000 over the life of the policy. You have no yearly max. So is you have a $3,000,000 hospital stay, it is covered. You will have a doctor visit co-pay of $40. This co-pay covers your entire doctor visit, including lab work, x-rays and even routine physical exams.  For Emergency Room visits all you have to do is meet your $100 ER co-pay and Blue Cross will cover the entire visit. Lab work, x-rays and all treatment rendered at the time of ER visit are included in this co-pay.  Generic medications are $10. Also with TONIK, you get preventative and diagnostic Dental and Vision free.

The dental PPO gives you one free cleaning, exam and x-rays a year. Also for fillings after meeting a $25 deductible Blue Cross will pay 80% of your filling and you pay 20% up to $500. The Vision benefit gives you a $50 reimbursement. Once a year Blue Cross will reimburse you $50 for any of the following services an eye exam, contacts, lenses, frames and even sunglasses. That’s right, if you don’t use glasses and you buy a pair of Von Zipper sunglasses Blue Cross will reimburse you $50 for those non-prescription sunglasses.

What are the limits to the coverage?

There are two limitations to Tonik that don’t apply to everyone.

1) Tonik doesn’t cover maternity. If you want maternity coverage, please refer to a traditional Blue Cross PPO or HMO.

Tonik does cover female yearly adult preventative services including: mammograms, annual pap examination, and breast exams.

2) Tonik only covers generic medications. If you get a Blue Cross generic formulary drug you only pay a $10 co-pay.  Don’t worry: about seven out of every ten medications come in generic form. If you require a brand name medication it is not covered and you will pay regular price.

We know a few riders who are on a first-name basis with their orthopedic surgeons. Can they pick their own doctors? Or are their choices limited?

With a Tonik PPO you are golden. You have the freedom of choice to select any doctor from any hospital to perform your surgery or treatment.  Other than Kaiser since they are their own network, you will have access to 42,000 doctors and physician and over 80% of the hospitals in California. Hospitals include UCLA, UCI, UC Davis, UCSF, USC, Scripps, Cedars Sinai, Loma Linda, and City of Hope just to name a few.

We know people who’ve gone riding without insurance, gotten injured, and then sued the track they were riding. Any words of advice for other uninsured riders?

Protect your body and your assets. An ER visit with two stitches for $1,500 and $43,000 for a torn ACL snowboarding. What would you rather pay your monthly premium and worst case of $1,500 or $7,175 a day in the hospital without insurance? The average hospital stay in California is right around $7,175 a day, not including the cost of surgery.  My wife had a cyst removed from her wrist in the hospital two month ago; I got the bill a few weeks ago, $21,560 for a one-hour outpatient surgery.  I paid her $1,500 deductible now for the rest of the year if she has any surgeries or hospital stays, she will be covered at 100%. If you don’t believe me about the cost, email me at CaliStudentHealth@yahoo.com and I will forward you a copy of the bill…I promise.

For More Info:

Eric Tapia
CA License #0D77513
Toll-Free (888) 599-7056
CaliStudentHealth@yahoo.com
www.CaliStudentHealth.com

xams.  For Emergency Room visits all you have to do is meet your $100 ER co-pay and Blue Cross will cover the entire visit. Lab work, x-rays and all treatment rendered at the time of ER visit are included in this co-pay.  Generic medications are $10. Also with TONIK, you get preventative and diagnostic Dental and Vision free.

The dental PPO gives you one free cleaning, exam and x-rays a year. Also for fillings after meeting a $25 deductible Blue Cross will pay 80% of your filling and you pay 20% up to $500. The Vision benefit gives you a $50 reimburssement. Once a year Blue Cross will reimburse you $50 for any of the following services an eye exam, contacts, lenses, frames and even sunglasses. That’s right, if you don’t use glasses and you buy a pair of Von Zipper sunglasses Blue Cross will reimburse you $50 for those non-prescription sunglasses.

What are the limits to the coverage?

There are two limitations to Tonik that don’t apply to everyone.

1) Tonik doesn’t cover maternity. If you want maternity coverage, please refer to a traditional Blue Cross PPO or HMO.

Tonik does cover female yearly adult preventative services including: mammograms, annual pap examination, and breast exams.

2) Tonik only covers generic medications. If you get a Blue Cross generic formulary drug you only pay a $10 co-pay.  Don’t worry: about seven out of every ten medications come in generic form. If you require a brand name medication it is not covered and you will pay regular price.

We know a few riders who are on a first-name basis with their orthopedic surgeons. Can they pick their own doctors? Or are their choices limited?

With a Tonik PPO you are golden. You have the freedom of choice to select any doctor from any hospital to perform your surgery or treatment.  Other than Kaiser since they are their own network, you will have access to 42,000 doctors and physician and over 80% of the hospitals in California. Hospitals include UCLA, UCI, UC Davis, UCSF, USC, Scripps, Cedars Sinai, Loma Linda, and City of Hope just to name a few.

We know people who’ve gone riding without insurance, gotten injured, and then sued the track they were riding. Any words of advice for other uninsured riders?

Protect your body and your assets. An ER visit with two stitches for $1,500 and $43,000 for a torn ACL snowboarding. What would you rather pay your monthly premium and worst case of $1,500 or $7,175 a day in the hospital without insurance? The average hospital stay in California is right around $7,175 a day, not including the cost of surgery.  My wife had a cyst removed from her wrist in the hospital two month ago; I got the bill a few weeks ago, $21,560 for a one-hour outpatient surgery.  I paid her $1,500 deductible now for the rest of the year if she has any surgeries or hospital stays, she will be covered at 100%. If you don’t believe me about the cost, email me at CaliStudentHealth@yahoo.com and I will forward you a copy of the bill…I promise.

For More Info:

Eric Tapia
CA License #0D77513
Toll-Free (888) 599-7056
CaliStudentHealth@yahoo.com
www.CaliStudentHealth.com