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 SHORT TERM MEDICAL INSURANCE 

     

 OVERVIEW       

    In Oregon, Short-term insurance, also know as  "limited-benefit health insurance" can be purchased from one to three months per contract.  The plans generally do not cover prescription drugs, preventative services, or pre-existing conditions.   The ObamaCare requirements do not apply to STM plans.  Because of the limited plan duration, the plans cost up to half of what a fully insured plan would, making the coverage more affordable to healthy people.  

 

WHEN DOES COVERAGE BEGIN?

    Coverage can begin as early as next-day, or you can select the future day the plan starts.   If you buy it month to month you can cancel anytime.   If you pre-pay the 3 months (Pivot Health), it is 25% less expensive but you cannot cancel prematurely.  Finally, if you want only a 30 or 60 days of coverage, I recommend National General.

WHAT ARE MY OPTIONS WHEN THE CONTRACT ENDS?

    When the contract ends you have 2 choices:

1.  PICK ANOTHER STM PLAN: 
     You can apply for another 1-3 month contract with one of my other STM carriers.  Oregon requires a 60 day gap before you can reapply with the same carrier.   I recommend the Pivot Health Plan first, then National General.  The LifeMap plan I only recommend  if someone cannot meet the qualifying questions of the other  two plans.

2.  A
PPLY FOR COVERAGE THROUGH THE MARKETPLACE:
     I can help you apply for a 'fully qualified' plan with the Marketplace when your STM plan ends.  The Marketplace accepts loss of STM coverage as a 'qualifying event'.   You have 60 days from the end of your STM plan ending to qualify for a Marketplace plan.

 

 CONSIDER ALSO BUYING A STAND-ALONE ACCIDENT POLICY 

      With high deductibles on plans today, it can really hurt financially when you have a costly accident.  Sometimes even a fall down a stairs brakes a bone and requires surgery.  Stand-alone Accident plans are low-cost and are worth the money.  Visit my Accident Policy page for a quote.  National General will let you bundle the STM and Accident policy together, as will IHC Solutions.

  

 Plan #1  Pivot Health  (Underwritten by Companion Life) 


      My first-choice in STM plans is the Pivot Health Plan. They offer 4 plan designs with various coverage options with pricing lower than National Health:  I only recommend the Choice and Deluxe plans as these 2 plans include office copays before the deductible. 

Deductible options:  Select a $1000, $2000, $5000, or deductible.  You can also choose a $100,000, $250,000, $500,000 or $1,000,000 maximum benefit.  The Single payment option is 20% lower than the monthly pay option.  

Provider visit Copay   before deductible:    The Choice or Deluxe plans both offer a combined 3 visits to a provider before the deductible needs to be met:
Primary Care--$30 copay,  Specialty doctor--$60 copay, Urgent Care $60 copay   


No Network--Use any provider:    You have freedom to see any provider that agrees to bill the plan.  The company pays well enough so that you should not  get balance billed.

PLAN BROCHURE

Please review the plan limitations and exclusions section in the brochure prior to enrolling.  The qualifying questions are also included in the brochure below:

2020 Pivot Health Brochure
 

Get A Quote and Enroll with Pivot Health

You can get a quote and apply by clicking on the link below.

Remember to select only a Choice and Deluxe plan as these 
two plans include office copays for services before the deductible.  

https://www.pivothealth.com/product/short-term-health-
insurance/agent_id=67934&utm_source=67934&utm_
medium=InsuranceServicesUSA&utm_campaign=agents

Application Notes:    In the payment section if you select the 'pre-pay' option, it saves you about 25%!  However, by pre-paying you are not allowed to cancel early with a refund.

 

Quick Links for Customer Service

Customer service can be reached at 844-630-7500 to cancel your plan.

To cancel your plan prematurely you can call customer service or email clientservices@alliednational.com

 

Plan #2 National General Insurance Company  

 

     National General offers a solid plan with a good benefit and strong national network.   

Solid Benefit:  $1,000,000 maximum benefit per contract when you select the 80/20% coinsurance.  I recommend the $1000, $2500, or $5000 deductible.  You can select from a 1 to 3-month contract.   You will be quote Accident Insurance as well--I recommend adding this, but note the Accident policy continues after the STM plan ends.

$50 Urgent Care Copay:  The plan offers unlimited Urgent Care copay a $50 copay (before the deductible).  They also provide 1 doctor visit with a $50 copay per contract period.

Large, National Network.    Using a provider in the contracted network will always cost you less than a non contracted provider.  National General uses the Aetna, Open Choice PPO Network, which you can search at the link below:

http://www.aetna.com/dse/search?site_id=mymeritain

 

Plan Brochure

Please review the plan coverage brochure below, including the plan limitations and exclusions section prior to enrolling.  The qualifying questions are also included in the brochure below:

 

2020 National General Brochure

 

Get A Quote and Enroll:  (Coverage can begin as early as tomorrow) Be sure to review the coverage and plan limitations and exclusions prior to enrolling.

http://quote.nationalgeneral.com/eproIFP
/webPages/infoEntry/InfoEntryZip.asp?ins
uranceTypeID=T&license_no=FQ7F2N


Application Notes:   Select the 'Monthly' option when quoting.  You can keep coverage from 1-3 months, canceling anytime.  The Single pay option does not work in Oregon.

 

Quick Links to Customer Service:

National General Member Services:  888-781-0585 You can call and cancel your plan early if you want

Email memberservices@nhicadmin.com

National General uses the Aetna, Open Choice PPO Network, which you can search at the link below:  You always pay less when you use a contracted provider

http://www.aetna.com/dse/search?site_id=mymeritain

 

Plan #3 LifeMap  

 
   I do offer a third Short Term Medical plan you can explore from a company called LifeMap.  I would only use this plan if you get denied with National General or IHC due to one of the qualifying questions.    
 
Click on the link below to get a quote and enroll.  Be sure you read the plan coverage and limitations prior to enrolling:
 

https://enroll.lifemapco.com/alm_createlife
quote.html?product=STM&broker=0105983-0000

 

Each STM plan offers a distinct advantage overviewed below

1. Pivot Health: 
     The Pivot Health plans offer the relatively best coverage at the lowest cost.  They offer 4 plan designs, each having a choice of deductibles, benefit maximums with freedom to use any provider.  I recommend either the Deluxe or Choice plans, which include a combined 3 visits to a Primary Care,  Specialist, or Urgent Care.   Pre-existing conditions are covered up to 1/2 the deductible selected.   With Pivot Health, if you pay for the entire 3 month term up front you save about 20% in premium.

     2. National General: 

    National General offers a solid choice of deductibles, unlimited $50 Urgent Care visits before your deductible, and a large National provider Network.  The premiums are higher than Pivot Health, and are a good plan to buy after your Pivot Health Plan ends.

3.  IHC Solutions:   
     The Connect Value plan is overall the lowest-premium of any of the 4 companies but has more internal plan limitations in coverage when you read the fine print.  If you bought this plan, you can also add the 'Metal-Gap' rider, which is a separate accident-only plan.   

4. LifeMap:   LifeMap's main advantage is that there are only a few qualifying questions.  This is a good plan when you cannot qualify for any of the other 3 plans due to prior health issues.Other Resources to help you:

 

$49.00 Video Doctor Visits through Providence Express Care Virtual

    Sometimes you want to consult with a nurse due to an illness.   The Providence Express Care Virtual visits are available to anyone.  You can do a video visit with a doctor or nurse for a flat $49.00 per visit.   I've tried it out and it is extremely convenient.  You can download the Express Care Virtual app for your phone, or from a laptop start at the link below:

https://virtual.providence.org/

 

 GENERIC PRESCRIPTION DRUG DISCOUNTS

 

    Since most of the plans do not include prescription drug coverage, you can get steep discounts using the website or app   http://www.goodrx.com 

 

I want to be very clear that Short Term Medical insurance is not the same as a creditable health plan under the Affordable Care Act and has many more plan limitations.    

 

 Short Term Medical Disclosure

This coverage is not required to comply with certain federal market requirements for health insurance,
principally those contained in the Affordable Care Act. Be sure to check your Policy/Certificate carefully to
make sure you are aware of any exclusions or limitations regarding coverage of preexisting conditions or
health
benefits (such as hospitalization, emergency services, maternity care, preventive care, prescription drugs,
and mental health and substance use disorder services).
Your Policy/Certificate might also have lifetime and/or annual dollar limits on health benefits. If this coverage
expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to
get other health insurance coverage. Also, this coverage is not “minimum essential coverage.”
This plan has a pre-existing limitation provision that may prevent coverage from applying to medical
conditions that existed prior to this plan effective date.

Pivot Health Brochure

Click filename below to access file

2019_National_General__STM_Brochure_w_Qualifying_questions1.pdf

2020 Pivot Health Brochure

Click filename below to access file

Pivot_Health_Brochure_w_Qualifying_questions.pdf

2020 National General Brochure

Click filename below to access file

2020_National_General__STM_Brochure_w_Qualifying_questions1.pdf