Short Term Medical Insurance Plans
Why Choose Choice Advantage Short Term Medical Insurance Plans?
Life is unpredictable so you should always have health insurance to protect your financial wellbeing. For those times you find yourself without employer health insurance coverage, a Choice Advantage Short Term Medical Insurance plan is an affordable solution. Purchase an Choice Advantage plan until permanent insurance becomes available for you.
Choice Advantage Short Term Medical Insurance plans offer many attractive benefits for its members:
It is ideal for those who are:
$100,000, $250,000, $750,000, $1,000,000, $1,500,000
$1,000, $2,500, $5,000, $7,500 or $10,000
70/30, 80/20, 100/0
$2,000, $5,000, or $10,000
Health insurance can be a confusing product and as a result many people just assume it’s too confusing to learn or understand basic benefits. Not true. Health insurance certainly has various aspects that a member needs to understand but it is not impossible or even that hard to learn. Here are key aspects of a health insurance policy that affect the price of the policy:
An enrollee begins to pay for coinsurance after their deductible has been met. A coinsurance fee refers to a percentage of a healthcare cost that they will be charged. For instance, an in-network doctor’s visit may have a 30% coinsurance rate. If the visit costs $100 total, the consumer will be responsible for paying $30, and the insurance company pays the remaining $70. Generally, the lower the member’s coinsurance percentage, the higher the premium the member must pay.
A copayment is similar to coinsurance, but instead of being figured as a percentage of a service’s cost, it is calculated as a flat fee for a medical service. For instance, your plan may charge a $33 copay for visiting an in-network specialist. As with coinsurance, in many cases copayments will not begin until the consumer has met their deductible. Generally, the more copays that are not after deductible (a.k.a. “first dollar”), the higher the premium the member will pay.
A deductible is the amount an enrollee must pay for covered medical services before an insurance plan will start covering costs. Generally, the lower the deductible, the higher the premium the member must pay.
The maximum dollar amount for medical services that the member’s insurance company will pay during the term of the policy. Traditionally, $1,000,000 has been the standard. However, a lower policy maximum will drive lower premiums.
The amount of money that the member must pay for their insurance policy. Generally, the more benefits provided will mean a higher premium for the member.
OUT-OF-POCKET MAXIMUM (Or Limit)
Your out-of-pocket limit is the maximum amount you pay for deductibles, coinsurance, and copayments within your coverage period. After this amount is reached, the plan pays 100% of covered medical services delivered in-network for the remainder of the policy term. Costs that do not have to be counted towards your out-of-pocket maximum include: premiums, out-of-network costs, and uncovered medical services. Generally, the lower the out-of-pocket maximum, the higher the premium the member must pay.
Policy term is the maximum duration of the initial coverage period offered by the plan. You can purchase a plan for one month up to the maximum duration and you can cancel your policy at any time. We suggest purchasing the maximum duration available. Short-term plans are not guaranteed renewable, but we can help you reapply or find a new plan.
A person with a short term medical insurance plan gets in a serious accident Costing $110,000 in medical claims. Their health plan has the following cost-shares:
All together, the person will pay $10,000 and the insurance Company will pay $100,000 to cover the medical claims from this accident.
Network: Multiplan PHCS
One of the popular aspects of short term medical insurance plans is they do not confine the member to a specific network. In other types of major medical plans, if a member seeks services outside of the network they either have a higher percentage of cost shares or they have to pay the full claim themselves. The only downside to the open network allowance is that the member may get balance billed (definition: the difference between what your health insurance reimburses and what the doctor chooses to charge). To avoid the chance of balance billing, a member needs to see a network provider. Your network is the Multiplan PHCS. Please click on the link to the right to access provider search.
Virtually all health insurance policies have exclusions that are listed in the insurance contract. It is important that a member know those exclusions. Below is a list of some of the more common short-term medical exclusions (for a complete listing read your specific insurance contract):
Short-Term Medical pays benefits for a predetermined length of time. You can select from a wide range of deductible and coinsurance options to tailor a plan to fit their lifestyle needs and budget.
Consider the benefit period and choose payment method:
This option is ideal if it is known exactly how many days the coverage is needed. The minimum number of days that members may apply for coverage is 30 days; the maximum is 180 days depending on their state. Payment via all major credit cards or bank draft is accepted.
This plan gives members the flexibility to continue coverage for as long as it is needed and allows them to discontinue the plan once their temporary need ends. Members can select 3 Coverage Periods x 364 days depending on their state. Payment via all major credit cards or bank draft is accepted.
Consider lifestyle needs and budget and choose one from each of the following:
The following benefits are for the Insured and each Covered Dependent subject to the plan Deductible, Coinsurance Percentage, Out Of Pocket Maximum, Additional Deductibles, and Coverage Period Maximum Benefit. Benefits are limited to Maximum Allowable Expense for each Covered Eligible Expense, in addition to any specific limits stated in the policy.
Pre-Existing Waiver Rider:
If a condition for which a Covered Person received medical treatment, diagnosis, care or advice, including diagnostic tests or medications, develops during your initial policy term, the Waiver of Pre-Existing Conditions Rider will allow resulting charges to be paid in the consecutive policy term. The waiting periods on all subsequent terms will be waived if the member purchased the Waiver of Pre-Existing Conditions Rider during their initial purchase. Terms of coverage and limitations may vary by state.
In a state with a maximum policy duration of 6 months, you may have the option to select depending on state:
In a state with a maximum policy duration of 364 days, you may have the option to select depending on state:
When a member applies for consecutive policy terms in one enrollment, they will be issued their initial term of coverage, and subsequent terms will be pended. During the member’s initial enrollment, the member will complete an application and their initial policy and certificate will be issued. Ten days prior to their subsequent policy going into effect, the member will receive an email with their new monthly rate (if applicable), and they will have the opportunity to opt out at this time. If the member does not opt out, upon successful payment, the member will be issued new policy documents, such as, application, policy, certificate, and schedule of benefits. The waiting periods on all subsequent terms will be waived if the member purchased the Waiver of Pre-Existing Conditions Rider during their initial purchase. The limitations on consecutive policy terms varies by state, please see your certificate or master policy for complete details.
“Usual and Customary Fee” (or “Fees”) means the usual, fair and reasonable fee for medical treatment provided to a Covered Person (or any other form of medical care, procedure, drug or supply). In determining a Usual and Customary Fee, the Company at its discretion, consults:
If not 100% satisfied with coverage and members have not already used any of the insurance benefits, they may return the Certificate to us within 10 days of receipt (30 in Indiana). Coverage will be cancelled as of the effective date and the plan cost will be returned. No questions asked!
This exclusion does not apply to any Eligible Expense payable for Pre-Existing Conditions until the Allowance Benefit maximum shown in the Schedule of Benefits has been reached.
*varies by state
Choice Advantage STM is available to members and their spouses, who are between 18 and 64 years old and their dependent unmarried children under 26 years old; and can answer "No" to all of the questions in the application for insurance. Child-only coverage is available for ages 2-17 (adult rates apply to anyone 18 or older).
"Out Of Pocket Maximum" means an amount of Eligible Expenses that are the responsibility of each Covered Person to meet before the Company will begin paying the expenses at 100%. It does not include Deductibles, Copayments, the penalty coinsurance for failure to pre-certify required services or charges in excess of the Maximum Allowable Expense. Once the Out of Pocket Maximum is met, the Certificate will begin paying 100% of Eligible Expenses for the remainder of the Coverage Period, not to exceed the Overall Coverage Period Maximum Benefit and any applicable benefit limits.
Coverage under this Certificate will cease at 12:01 a.m. for a Covered Person, based on the time zone in the place where the Insured resides, on the earliest of the following:
TERMINATION UPON INSURED'S DEATH
The Insured will cease to be a Covered Person on the date of their death. If the Insured's Spouse is a Covered Person when the Insured dies, the Spouse will become the Insured.
TERMINATION OF SPOUSE'S COVERAGE
The Insured’s Spouse will cease to be a Covered Person at the earlier of:
TERMINATION OF A CHILD'S COVERAGE
A child’s coverage will terminate on the earlier of:
Explanation of Benefits
Explanation of benefits (commonly referred to as an EOB form) is a statement the health insurance company sends to members explaining what medical treatments and/or services were paid for on their behalf.
It is most famous as that “waste” of mail that comes to people after accessing medical services announcing that it is “not a bill.” So why bother? The explanation of benefits is important for a few reasons:
All Medical Claims:
Insurance Benefit System Administrators ℅ Zelis
P.O. Box 247
Alpheratta, GA 30009-0247
EDI Payor ID: 07689
All Other Claims Information:
Insurance Benefit System Administrators
P.O. Box 2917
Shawnee Mission, KS 66201-1317
Benefits, Claim Services:
Emdeon EDI Payor ID: 07689
For simple transactions such as a payment error where you payment information needs to be updated or if you want a refund inside the “free-look period” which is 10 days in most states, this can be done in the member portal @ https://members.mybenefitskeeper.com/
For other payment errors where you need to process a payment, you need to call Agile at (877) 353-0962 to process the payment.
Other refund requests will have to be escalated, please call (877) 353-0962 for other requests and they will be addressed on a case by case basis in accordance with each individual insurance company’s policy.
Please call (877)353-0962
You can print replacement ID cards from the member portal @ https://members.mybenefitskeeper.com/
If you need to prove that you had creditable coverage to a new health plan, please contact the following number to receive a certificate of creditable coverage: (877) 353-0962
AGILE SERVICE PLEDGE - We pledge to be:
Reapply for Coverage
Your current insurance policy is short term medical insurance. This is a major medical insurance with an expiration date. There is no renewal of coverage. However, in many cases a member can reapply for another term policy. There are a couple of ways to reapply for a new term policy:
Telephonic: 45 days from policy expiration, an Agile team member will reach out to members to see if they can help them reapply for new coverage.
Self-service: At any time a member can return to healthinsurance.com to reapply for coverage. When doing so, be mindful of dates as one cannot enroll in a new plan that has an overlapping date with current coverage.
Your reapply application will be reviewed for underwriting and can be denied based on pre-existing conditions or other factors.
Select insurance type to get started:
Short Term Medical Insurance
Limited Fixed Indemnity Plans
HealthInsurance.com, LLC is a licensed insurance agency. CA License #0D10265. It is not a government agency, insurer, or medical provider.
This advertisement is for Short-Term Medical, Indemnity, and Affordable Care Act (ACA) products.
Individuals can enroll in ACA plans outside designated enrollment periods only if specific conditions are met. Individuals can enroll in a Short Term Medical or Indemnity product if not met. Short-term and limited-benefit medical insurance are not part of the Affordable Care Act (Obamacare). They may not cover pre-existing conditions or all ten essential benefits. Limited Benefit Medical Indemnity Insurance is designed to provide additional benefits to supplement major medical insurance and may not be available in some states without proof of major medical insurance.
If you provide your contact information, a licensed insurance agent may contact you to help you enroll in a Short Term Medical, Indemnity, or ACA product from one of the carriers we represent. Enrollment is not obligated and depends on the plan’s contract renewal. We may direct you to our partner websites for additional assistance. It is essential to carefully review all policies before making a decision.