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 SHORT TERM MEDICAL INSURANCE 

     

 OVERVIEW       

    In Oregon, Short-Term Medical (STM) insurance can purchase for up to 90 days per contract.   It is a type of limited-benefit health insurance and is not subject to the Affordable Care Act/Obamacare regulations.  (I am now required to share that I am compensated by the insurance company should you purchase a plan through me, though there is no direct cost to you).  

     Generally, STM plans do not cover prescription drugs, preventative services, or pre-existing conditions.   They are designed to insure you against new medical conditions you may experience and have some plan limitations to be aware of.  Take time to read the brochure to review the plan limitations and exclusion and be sure to read the 'Schedule of Benefits' after you enroll in a plan.   

 WHEN DOES COVERAGE BEGIN AND HOW DO I QUALIFY?

    Coverage can begin as early as next-day, or you can select a future day for the plan to start.  To qualify you have to answer NO to the 6 or 7 qualifying questions.   I always recommend if possible to have the coverage end the last day of a month.  For example, if your plan starts September 15, have the plan end November 30.   This will benefit you should you transition to a new plan on the Marketplace.  
 

WHAT PLANS DO I OFFER?

   I offer 3 different Short Term Medical plans:   Here is a brief overview from lest expensive to most.

1.  Flex Term:   The Flex Term plan has the richest benefit with unlimited doctor and Urgent Care visits with a $50 copay before your deductible. A preventative exam is also covered (by not the diagnostics or mammogram/pap) with a $50 copay.  They also use a national network of providers for contracted rates or you can use anyone willing to bill the plan.  The rates are a little higher under this plan compared with Pivot Health.   You can pay up month to month, or choose the single-pay option and save 20%.

2.  Pivot Health:  The Pivot Health Plan is least expensive with plan options for any budget.   You have freedom  to use any provider that will bill the plan without a network.  You can pay monthly or single-pay and save about 20%.  The Deluxe & Choice plans include doctor, urgent care and specialist visits before the deductible needs to be met.

3.  National General:  The National General Plan offers 1 doctor visit with a $50 copay prior to your deductible, and $50 Urgent Care visits.  They offer a national network of providers you can see and receive a contracted discount.   This plan only lets you pay monthly with no single-pay option

Plan 1   Flex Term STM Plan 

     The Flex Term STM plan is underwritten by the Everest Reinsurance company and has an A+ financial rating. The plan offers unlimited primary care and Urgent Care office visits with a $50 copay.   In addition, a routine physical exam is covered with a $50 copay before the deductible is met (but not the diagnostics or labs, mammogram/pap)

     You have freedom to see any provider, but if you choose someone in the nationwide PHCS Network you will pay a lower, contracted rate.

Click below to search for contracted providers in the PHCS network

CLICK TO SEARCH PROVIDERS IN THE PHCS NETWORK 

 

Get A Quote and Enroll with Flex Term plan

Click below to access the online quote & application:

 
 
 
 

VIEW THE FLEX TERM BROCHURE 

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

 

CLICK to view the Flex Term Brochure

 

 Plan 2  PIVOT HEALTH 


     Pivot Health Plan is underwritten by Companion Life.  They offer 4 plan designs with various coverage options with pricing lower than National General and Flex Term:  The brochure outlines side-by-side the different plans and benefit options.  Pivot Health has no contracted provider network:  so you can see an doctor that agrees to bill the plan nationwide.  It's important to note that in the quotes, you will see a deductible and an out of pocket maximum. If you had a major event, you would pay BOTH the deductible first, then the coinsurance (percentage) up to the out of pocket maximum.    

EXAMPLE:   A $5000 deductible and $10,000 maximum OOP would leave you potentially up to $15,000 out of pocket under the Choice plan.  Under the Standard plan, the maximum OOP is $5000, and under the Deluxe plan, the maximum OOP is $3000.

       

GET A QUOTE and Enroll with Pivot Health

Click below to view the Pivot Health Brochure:

CLICK to quote Pivot Health STM Plan in Oregon

 

VIEW THE PIVOT HEALTH BROCHURE  

 Click below to view the Pivot Health Brochure, Qualifying questions, and plan limitations and exclusions:   
 

CLICK to view the  Pivot Health Brochure 


Deductible options:  

I recommend the $1000, $2000, or $5000 deductible Standard or Deluxe plans, because the have a lower out of pocket maximum.  You can have a choice of the plans maximum benefit per contract, from $100,000, $250,000, $500,000 or $1,000,000 maximum benefit. (I recommend the $250,000 or better)  If you select the Single payment option, this will save you about 20% of the cost.  However, with the single-pay you cannot cancel the coverage early.

Provider visit Copay   before deductible:   AND NOW TELEHEALTH IS INCLUDED!
 
    The 
Choice and Deluxe plans both offer a combined 3 visits to an Urgent Care, Primary Care, or Specialist visit before your deductible needs to be met.  The Value plan is the least expensive of the plans.  If you don't care about the up front doctor visits, the Standard Plan has a lower out of pocket maximum.   All plans offer free telehealth phone and video visits:  This is available for both primary care concerns, and dermatology.

Application Notes for Pivot Health:   

     When you get to the payment section of the application you will see a 'pre-pay' option. If you single-pay for the 3 months of coverage, you save about 20%!  However, by pre-paying you are not allowed to cancel early with a refund if you only need a month of coverage.

Quick Links for Pivot Health 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@insurancebenefitadministrators.com

 

Plan 3   NATIONAL GENERAL

 

     National General life offers a solid plan with a good benefit and large, national network called the Aetna Open PPO Network.   Be sure to understand the plans limitations and exclusions before you enroll.

Click below to search for In-Network providers in the Aetna Open Choice PPO Network:
 

CLICK to search for Contracted Providers in the Pivot Health plan 

 

Get A Quote and Enroll with National General

Click below to access the online quote & application:

 

 CLICK to quote National General STM & Accident plan



Multiple deductible, coinsurance and benefit options to choose from:  

DEDUCTIBLE:  I recommend the $1000, $2500, or $5000 deductible option. 

COINSURANCE:  You can chose from 50% of 80% paid after your deductible is met.  The 50/50% coinsurance is less expensive, but the 80/20% provides lower out of pocket costs and a higher benefit maximum.

BENEFIT MAXIMUM:  You have a choice of either the $250,000 max benefit (under the 50% coinsurance), or a $1,000,000 benefit if you select the 80/20% coinsurance option. 


VIEW  THE NATIONAL GENERAL BROCHURE 

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

Click below to view the plan brochure & read the limitations and exclusions:

 

CLICK to view the National General Brochure

 

You will be quoted the Stand-Alone Accident Rider.  I recommend the $5000 Accident rider for you and your family that has a $250 deducible. 

Click below to view the Accident brochure:

 

Click to view the National General Accident Policy brochure
 

Application Notes for National General:   

    Select the 'Monthly' option when quoting.  You can keep coverage from 1-3 months and cancel any month by calling Customer Service in advance.  The Single-pay option is on the quote screen, but not available in Oregon.

National General 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 with general requests like another ID card or billing question.
 

IMPORTANT CONSIDERATIONS

 
WHAT IF BOTH NATIONAL GENERAL AND PIVOT HEALTH DECLINE MY APPLICATION?
 
     I do offer a fourth 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 Pivot Health due to one of the qualifying questions.    This plan will accept someone who is diabetic.
 
Plan 4:   LifeMap
 
Click below to get a quote and enroll.  Be sure you read the plan coverage and limitations prior to enrolling:
 

CLICK HERE to get a quote with LifeMap

 

SINCE THE PLANS DO NOT COVER PRESCRIPTION DRUGS,
WHAT SHOULD I DO IF I TAKE A MEDICATION?

    I recommend going to http://www.goodrx.com and looking up your drugs.  You will find the best cash pricing at local pharmacies.   It's a great tool!

 

WHAT ARE MY OPTIONS WHEN THE STM CONTRACT ENDS?

    When the contract ends you have a few choices:

 

1.  APPLY FOR ANOTHER STM PLAN WITH MY OTHER STM COMPANY: 
      Before your STM contract ends, you can apply for up to 90 days of coverage with my other STM insurance carrier.  Oregon requires a 60 day gap before you can reapply with the same carrier.   I recommend the Pivot Health plan first, then the National General plan, then back to Pivot Health if you need ongoing coverage. 

2.  BUY
 COVERAGE THROUGH THE MARKETPLACE:
      The Marketplace accepts a STM contract ending as a 'qualified event' to purchase coverage.  I can help you apply for a 'fully qualified' plan (such as Kaiser or Providence) through the Marketplace when your STM plan ends.  You have 60 days from the end of your STM plan ending to qualify for a Marketplace plan as a 'Special Enrollment' situation.   Example, if your Pivot health plan ended November 30, I could write you a Marketplace plan that began on December 1.

WHAT IF I WANT TO DO A VIDEO-VISIT FROM HOME?

 I believe the Pivot Health and National General plans offer at no cost telehealth video visits with a doctor.    If not, Providence Express Care Virtual visits are available to anyone.  You can do a video visit with a doctor or nurse for a flat $79.00 per visit.   

Download the Express Care Virtual app for your phone, or from a laptop start at the link below:

https://virtual.providence.org/

 

MONEY IS TIGHT, BUT I STILL NEED TO DO AN ANNUAL EXAM AND WOULD LIKE THE TESTS COVERED.

 Some of my clients sign up for a traditional plan like Kaiser or Providence and have their preventative exams, then switch to Short Term Medical for the rest of the year.  The Flex Term plans will pay for a preventative exam with a $50 copay, but not the tests that go with it like a routine colonoscopy, mammogram or pap.

 

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.  For example, the Pivot Health plan limits treatment for Kidney Stones to a $1500 maximum and an Appendix surgery to a $2500 maximum.   
 
    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.
 
TO MAKE SURE I DON'T MISPRESENT SHORT TERM MEDICAL PLANS, here is the definition of the coverage from the Flex Term brochure
 
"What is Short-term medical insurance? Short-term medical (STM) insurance policies are designed to provide temporary coverage during life’s transitions until you can secure an Affordable Care Act (ACA) insurance plan. STM insurance policies are not required to comply with the requirements of the ACA and may have exclusions and limitations not permitted in ACA plans. ACA plans are guaranteed issue, must cover certain “essential health benefits” (EHBs), and you cannot be denied coverage based on pre-existing medical conditions. In contrast, STM insurance requires that you answer a series of medical questions to determine your eligibility, may not cover all EHBs, and does not cover pre-existing conditions. The limitations on benefits and exclusions, including the pre-existing conditions exclusion, likely will result in STM policies having lower insurance premiums than ACA plans and make them a viable option for your health insurance needs. If you have had medical conditions in the past or have current or chronic conditions, you should seek an ACA or other comprehensive insurance plan as soon as you are eligible for enrollment.
 

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Pivot Health Brochure & Underwriting Questions

Click filename below to access file

Pivot_Health_Brochure_w_Qualifying_questions1.pdf

National General Accident Stand-alone Brochure

Click filename below to access file

2020_National_General_Accident_&_Sickness_Brochure.pdf

2021 National General Brochure

Click filename below to access file

2021_National_General__STM_Brochure_w_Qualifying_questions1.pdf

Flex Term STM Brochure

Click filename below to access file

Flex-Term_STM_Brochure.pdf