Frequently asked questions about short term medical insurance

Short-term-medical-insurance.com primarily serves people who buy their own health insurance including those who are changing jobs, starting a business, self-employed individuals, recent graduates, or small businesses that want to partially self-insure with a high deductible policy and a Health Reimbursement Account (HRA) Plan or Health Savings Account (HSA) to cut insurance costs.

1 in 6 Americans are not covered by insurance for at least part of the year, according to the 2000 U.S. census data. Most of these people are in temporary situations - recently graduated or starting a new business, between jobs, waiting for group coverage, etc. Most of these people are eligible for easy and affordable coverage under a short term medical insurance plan. Permanent individual or group medical plans are available at a higher price.

How does short-term-health-insurance.com work?

Short-term-health-insurance.com is a free online service providing fast, professional and reliable search and enrollment support.

What short-term-health-insurance.com can NOT do

Short-term-health-insurance.com is not an insurance company or insurance agency. Short-term-health-insurance.com does not set the premium prices, determine the coverage details, decide who is eligible, etc. These are determined only by the company that offers the specific plan. Also, we cannot access information on an insurance policy that is in force, including coverage information, payment records or claims information. IF YOU NEED TO OBTAIN IN-FORCE POLICY INFORMATION, CHANGE COVERAGE OR CANCEL COVERAGE, PLEASE CONTACT THE INSURANCE COMPANY DIRECTLY.

Why use short-term-health-insurance.com?

Short-term-health-insurance.com provides the highest quality personal service for fast access to professional help by telephone, e-mail and Web. Short-term-health-insurance.com is one of the few services firms providing personal service in all 50 states and the District of Columbia.

How to get a quote on insurance...

All of the insurance plans listed at Short-term-health-insurance.com provide standard rates online. Just follow the link associated with each plan listed.

What is a deductible?

The deductible is the amount of your claims that you pay before the insurance comes into effect. Typically it is determined on a calendar year basis or the life of the policy (whichever is shorter).

For example, if you incur medical bills of $80 for a prescription drug, $1200 for doctor office visits and $200 for lab tests, then simply add them up for a total of $1480 covered medical expenses. If policy deductible is $500, then you pay the first $500 and the insurance covers the next $980 ($1480 minus $500).

Deductibles are further broken down and defined as "per person", "per family", "per year", per policy" or "per cause". Usually two of these are linked together. For example, a popular deductible choice in medical insurance today is "$500 per person per year". In this case the maximum deductible for a family of 4 would be $2,000 per calendar year (4 x $500).

What is co-insurance and how does it work?

Co-insurance is the portion of your total medical claims, above the deductible, that you might pay if the medical provider does not "accept assignment" of your insurance.

The common formula of "80/20 to $5,000" was developed generations ago by the Blue Cross associations for traditional medical insurance plans. Many variations are used today and a "50/50 to $2500" co-payment formula has become more popular in recent years.

In the "80/20 to $5,000" co-insurance, for example, this means that you pay 20% of the first $5,000 of claims above the deductible. Your maximum expense for co-insurance in this example is $1000 ($5000 x 20%).

The "deductible" plus the "co-insurance" taken together are typically referred to as your "maximum out-of-pocket expense".

In MSA plans, the maximum co-payment is limited by tax law (and adjusted annually) which overrides the basic co-payment formula hat would otherwise apply in the insurance policy.

In practical experience, more than 95% of medical providers will take assignment of your medical claims after you pay the policy deductible and accept this insurance assignment as full payment. In this case the patient does not need to be concerned about co-payment.

What about co-payments?

"Co-payment" is the term used by HMOs and managed care plans to set the amount a patient pays when visiting a doctor, buying a prescription or using an emergency room. The private individual medical insurance plans at Short-term-health-insurance.com generally DO NOT use co-payments because all covered medical expenses are lumped together and paid based on the policy deductible and co-payment as described above.

How do I reach customer service?

We offer independent personal enrollment support by e-mail. Send questions to onlineadviser@comcast.net for fast response usually on the same business day. We do not have a pre-enrollment telephone support option.

Each insurance company has its own customer service telephone number for questions about an issued policy, including billing and claims questions. That telephone number is listed in your insurance policy and printed on your ID card. You should use this direct customer service number after your new plan is started. If you do not have the telephone number for your specific plan then use these general telephone numbers:

American Health Shield (800) 753-1000
Celtic Life (800) 477-7990
Golden Rule Insurance (800) 926-7602
International Medical Group (IMG) (800) 628-4664

Markel Insurance (800) 279-2290

MultiNational Underwriters (800) 605-2282

SAS Insurance (800) 279-2290

Secure STM (800) 397-5800

Seven Corners Inc. (800) 335-0611

What expenses are covered?

The insurance covers ordinary and necessary medical expenses. Insurance companies typically refer to American Medical Association (AMA) standards in determining what is the ordinary and necessary treatment even though not all medical care providers fall under AMA. This typically includes doctors visits, prescription drugs, lab tests, hospital charges, outpatient treatment, therapy and ambulance charges.

What is not covered?

A list of exclusions from coverage is included in the specific description of coverage for each policy.

Pre-existing medical conditions are not covered. Maternity expenses are not covered. Expenses that are not "medical expenses" are not covered (for example dental expenses are not medical expenses).

Expenses that you voluntarily opt for that are not prescribed by a doctor man not meet the "ordinary and necessary standard". For example, you might discover that a weekly spinal manipulation helps your golf game and eases back pain, but this might not meet the standard of "ordinary and necessary".

When an insurer cannot easily determine whether an expense is "ordinary and necessary" then often the policy states that only a limited benefit is covered. For example, outpatient counseling is usually limited to a specific dollar amount and number of visits. This limitation does not mean that you can be cured for that specified number of medical visits, but rather that the insurer is limiting its financial responsibility to that dollar amount.

What is a pre-existing medical condition?

A pre-existing medical condition is a health issue that started before your current insurance. Usually this is evidenced by notations in your medical records. Examples of medical expenses frequently not covered as pre-existing medical conditions are long term prescription drugs and seasonal allergy treatments.

How do I cover a pre-existing medical condition?

There are eight ways to cover the cost of pre-existing medical conditions. Not all of these options are insurance plans and not all of the insurance options provide full coverage. All options are listed to give you the widest range of consideration on the best options for your specific situation.

1) Enroll in an employer-provided group health insurance plan. If you have maintained short term medical insurance of other major medical insurance then a group insurance policy immediately picks up coverage for pre-existing conditions.

2) Use a supplemental or limited benefit plan. These polices accept all applicants regardless of pre-existing conditions and then cover those pre-existing medical conditions after the policy has been in force for six months.

3) Enroll in an "open enrollment" or "assigned risk" plan. These plans are likely to be available to everyone in the state, but some plans have waiting periods before picking up coverage for pre-existing medical conditions.

The procedures vary from state to state, but most states have at least one open enrollment plan. These plans are generally not available on the Internet. Many Blue Cross Associations offer this type of coverage. See the "Blue Cross" link from your state benefits page or contact your state insurance department for more information on locating this type of health plan. Short-term-health-insurance.com does not provide enrollment support for these plans. Enrollment support may also be available through the health plan's member service department.

4) Enroll in COBRA coverage. This only applies if you are leaving a group insurance plan for a "qualifying reason" like termination of employment. This only applies if your former employer has more than 20 employees. COBRA coverage does not apply to small businesses with less than 20 employees.

5) Enroll in a PPO Health Discount Plan like www.ehealthdiscountplan.com. These discount plans cover pre-existing all medical conditions and are available to everyone. This is not insurance. These plans help process medical claims and reduce out-of-pocket costs.

6) Enroll in a Health Savings Account (HSA) or other uninsured health plan if available through your employer. This is not insurance. These plans are usually designed to cover pre-existing medical conditions but the benefit may be limited to the amount defined by the employer. These plans are often combined with a PPO Health discount plan above to cover the out-of-pocket portion of bills not paid by the discount plan. More information on these plans may be found on the specific state page at Short-term-health-insurance.com.

7) Keep your medical insurance with the same company as your previous group coverage. Most insurance companies offer an "individual conversion" option even if this is not advertised. When you change from one insurance plan to another with the same health insurance company, you will usually receive a "Waiver of Pre-existing Conditions Limitation" certificate with your new policy. For example, if you switch from a full coverage group plan to catastrophic individual plan offered by the same company, you still keep your coverage for pre-existing medical conditions that would otherwise not be covered.

8) If the pre-exiting medical condition is minimal with little likelihood of recurrence, coverage may be offered under a standard long term renewable insurance policy. See the section "What insurance companies issue standard long term renewable insurance online?". As an example, typical high blood pressure treatment is often an accepted pre-existing medical condition under a standard renewable individual insurance policy.

How do I get maternity coverage?

Short term medical insurance plans do not cover maternity expenses.

If you need individual health insurance that includes maternity coverage, please see the list of options above for pre-existing medical conditions. Even if the maternity expense is not a pre-existing condition, the options for coverage are the same.

Although maternity coverage is available as an option in commercial health insurance plans, this is usually not the best option.

What about quality of coverage?

We consider the quality of coverage as the primary consideration when recommending a medical insurance plan. All health insurance plans on this Web site must cover ordinary and necessary medical expense with any doctor or hospital of your choice and include a stated maximum financial risk to the policyholder. Coverage limits must be high enough to satisfy any reasonable possible medical situation.

Beyond these factors, evaluating overall the quality of health plans is not an exact science. Our determination of quality is based on six factors: 1) published surveys results ("For Broker's Only" and "Consumer Reports", 2) market share, 3) complaints filed with insurance departments of insurance, 4) use of "internal limits" in defining what is covered by the policy, 5) use of managed care provisions that restrict freedom of choice, and 6) observations, comments and complaints from previous customers.

Why use short term medical insurance?

In the past, most medical plans were renewable year after year as long as we needed them. But with costs rising substantially each year, most people changed health plans every few years anyway. Most plans today are issued with the expectation that you will replace them in less than 3 years. These plans are known as "short tem medical plans" or "STM", regardless of the length of time they are actually used. There are other advantage of STM plans:

1. faster and easier application, with coverage issued immediately. There are no medical exams, medical records, lab tests, agent interviews, etc. You can even print out your enrollment card online.

2. less expensive. The average premium is about half of the comparable premium for other types of major medical insurance.

3. less restrictive coverage. There are no managed care features, no networks, and no required pre-authorization.

4. health plans change frequently. A plan that was a great deal last year is not likely the best deal today. It makes no sense to investigate coverage now for a plan that you won't need until next year. In most cases, the current plans will be replaced by a new policy form with new coverage, rates, eligibility, etc.

6. fewer claims disputes. In most cases the items excluded by STM plans would also be excluded from many other traditional medical plans, but you may not be aware of it until after a claim investigation is completed. With STM, you have a much better chance of knowing what is covered in advance. STM is legally much less complicated than other health plans.

7. satisfaction rates are higher. Our customers have reported a higher level of satisfaction with STM plans than any other type of health plan.

8. more widely available. Almost everybody (with the short list of exceptions) will qualify for this type of coverage. If you don't qualify for STM then you probably would not qualify for other privately issued health insurance plans.

The majority of Americans who buy individual medical insurance will keep that insurance plan in force for less than a year. We can assist in changing to another permanent coverage if the need for health insurance still exists at the end of the STM coverage.

Is this an HMO?

No, the health plans listed on this Web site are indemnity type insurance plans that allow you to obtain covered services at any medical provider of your choice. Some plans use optional preferred provider (PPO) type coverage only. There is no provider network in these plans and no authorization or referral is required to obtain treatment. You are covered for any doctor or hospital across the U.S.

Short-term-health-insurance.com does not provide enrollment support for HMOs.

Which doctors can I use?

Short-term-health-insurance.com health insurance plans can be used with any doctor or hospital anywhere in the United States. There is no provider list or required referral. Some plans also include international coverage.

How much does it cost?

Premium rates are quoted online for all plans based on a number of specific factors including your age, location, sex, method of payment and coverage options specified.

Premiums for short term medical insurance are lower than other types of major medical insurance coverage but vary widely by location, sex, age, length of coverage and method of payment.

Why is short term medical insurance so inexpensive? What's the catch?

This insurance does not cover the cost of treating pre-existing medical conditions so the coverage is usually only about half the price of other plans. The "catch" is that these plans are not suitable for those people with significant ongoing medical problems.

Is everyone eligible?

People with serious pre-existing medical conditions are not eligible for short term medical coverage or commercial individual health insurance.

Everyone is eligible for international travel insurance coverage and the PPO discount plans that are not insurance.

What about states without short term medical insurance?

The following states do not allow short term medical coverage to anyone within their borders: NJ, NY, MA, RI, VT.

Some residents of these states make an application online while they are travelling to other states that allow more attractive insurance options. Once issued, the policy covers treatment in all states.

How do I answer the eligibility questions?

Your insurance company will not help you make a determination whether the answer to a medical question on the application should be answered "yes" or "no" because this is based on your own medical history that has not been reviewed by the insurer. Simply use your best judgment.

If you intentionally make a misstatement on an insurance application, the coverage may be rescinded. If you use your best judgment and make a mistake interpreting the details of the question as it pertains to your history, then the revision action does not apply.

If you answer the question "no" the insurance coverage is issued. If you answer "yes" the insurance coverage is not issued. Regardless of whether you answer "yes" or "no" the policy excludes coverage for pre-existing conditions.

Are these insurance companies reputable?

All of the companies listed on Short-term-health-insurance.com have solid financial ratings and better than average consumer reputations, we believe, as compared as a whole with the nation's other large health care providers.

It is important to realize that health insurance companies have a slightly different scale of ratings from third party rating services than life insurance companies. This is due to the inherent differences between health insurance and life insurance. For example, an A. M. Best rating of A+ is considered the "standard" for the best life insurance companies but an A. M. Best rating of A- is considered a high rating for a health insurance company.

Why does this site list the names of some insurance companies and not others?

We believe that this Web site lists all of the most reputable short term medical insurance policies available in the United States. If a specific insurance company is not listed, it is likely because consumer complaints were higher than normal or because the insurer or because the insurer does not issue enough of these policies to represent a significant market share in your state.

Are there limitations on the coverage?

Yes, all insurance policies have limitations on the coverage. The limitations and exclusions are clearly listed online and in the printed application materials and included in the policy itself. Some of the most significant exclusions are pre-existing medical conditions, medical expenses incurred outside the U.S., expenses not medically necessary, and maternity expenses.

How fast can I get coverage?

Coverage can be effective at midnight after you enroll online or after your application is received by mail or by fax. Only the online enrollment method offers an immediate confirmation of coverage at the time of enrollment. Your issued insurance policy and insurance ID cards are mailed back to you usually on the next business day.

What if I change my mind, cancel the coverage or want a refund of my payment?

You can always cancel any insurance coverage by calling or writing directly to the insurance company. Short-term-medical-insurance.com is not authorized to cancel insurance coverage. During the first 10 days of a policy, you will receive a full refund of premium less any application charge. If you cancel coverage after the 10 day period you do not get a refund of previously paid premiums.

You can, of course, stop the coverage by simply discontinuing the payment of premiums. This is often the preferred method of stopping coverage.

INTERNATIONAL TRAVEL PLANS DO NOT OFFER A 10 DAY REFUND PROVISION. Due to their unique nature, premiums for international travel medical plans are not refundable.

Application fees or processing fees charged by some plans are not part of the insurance premium and are not refundable.

What are the payment options?

Billing may be either "monthly" or "single pay". You can pay by check, money order, or major credit card (VISA, MC, Amex, Discover). Payments may be made through secure online transaction or by mail.

If you need more than one month of coverage then it is less expensive to pay for 2 or more months of coverage in advance. A monthly premium payment method is best if you do not know how long you will need coverage.

What if I need coverage for a longer period of time?

You may re-apply for short term medical insurance as often as you wish. Some states may have laws that limit the number of times or length of coverage one company can offer. In this case, we suggest changing to another insurance company or switching to a long term insurance plan.

What insurance companies issue standard long term renewable insurance online?

We suggest Celtic Insurance and Golden Rule Insurance for low cost permanent medical insurance for individuals and families.

What other resources are available?

State insurance departments have a useful information and resources about short term medical insurance and other types of coverage. See the link for a directory.

Another resource is the National Association of Insurance Commissioners (NAIC) Web site that collects data on consumer complaints and other information about insurance companies.

Short Term Medical Insurance

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