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:

Single Payment

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.

Monthly Payment

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:

• Deductible:
  • $1,000, $2,500, $5,000, $7,500
  • The selected deductible must be paid by each Covered Person before Coinsurance benefits are payable. After 3 individuals meet their deductible, the deductible is deemed satisfied for any remaining covered individuals.
• Coinsurance Percentage:
  • Choice of 70%, 80%, or 100%
  • The Coinsurance Percentage represents the percent of covered eligible expenses that we pay and that members pay after the deductible has been satisfied up to the Out Of Pocket Maximum.
• Out of Pocket Maximum:
  • $2,000, $5,000, or $10,000
  • Once members reach their Out of Pocket Maximum Amount selected, we pay 100% of up to the Coverage Period Maximum Benefit

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.

• Preventive / Wellness Care
• Doctor's office consultation/Urgent Care visits
• Organ and Tissue transplants
• Inpatient prescription drugs
• Physical, Occupational and Speech Therapy
• Ambulance Transportation
• Outpatient Hospital or Emergency Room Care
• Inpatient Room & Board, including Intensive Care
• Outpatient Miscellaneous Medical Services, doctors medical care and treatment performed in a hospital
• Home Health Care
• Extended Care Facility
• Outpatient Surgical Facility
• Surgeon services in the hospital or outpatient surgical facility

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:

• 6 months
• up to 36 months with Pre-Existing Waiver Rider
• up to 36 months without Pre-Existing Waiver Rider
• Prepay up to 180 days

In a state with a maximum policy duration of 364 days, you may have the option to select depending on state:

• 364 Days
• up to 3 Coverage Periods x 364 days with Pre-Existing Waiver Rider
• up to 3 Coverage Periods x 364 days without Pre-Existing Waiver Rider
• Prepay up to 180 days

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:

• One (1) or more standard industry sources to calculate services of comparable severity and nature in the same geographical area, the cost of the goods and services reasonably required to produce and deliver such treatment and/or the charge most commonly paid for such treatment. The standard industry sources utilize cost-based formula methodology and/or pricing data (updated semi-annually) to produce replicable and consistent cost and/or pricing parameters.
• The cost to the health care provider of performing or providing the medical treatment, including reasonable allowance for overhead and profit.
• Fee schedules used by third parties such as Medicare or Medicaid, including Medicare allowable charge data for Medicare Part B.
• Hospital cost data as submitted to Medicare, including Medicare allowable charge data for Medicare Part A.
• Prevailing negotiated fee schedules for same or similar services performed in the same geographical area.

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!

Pre-Existing Condition

• Charges resulting directly or indirectly from a condition for which a Covered Person received medical treatment, diagnosis, care or advice, including diagnostic tests or medications, within the 24* month period immediately preceding such person’s Certificate Effective Date of coverage under the Policy.
• Pre-Existing Conditions includes conditions that produced any symptoms which would have caused a reasonable prudent person to seek diagnosis, care or treatment within the 24* month period immediately prior to the Covered Person’s Certificate Effective Date of coverage under the Policy.

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:

1. The date premiums are not paid in accordance with the terms of this Certificate, subject to the Grace Period;
2. On the next premium due date after the Company receives a written request from the Insured to terminate coverage, or any later date stated in the request;
3. The date an Insured performs an act or practice that constitutes fraud, or is found to have made a misrepresentation of material fact, relating in any way to the Certificate, including claims for benefits under the Certificate;
4. The date of the Insured’s death or the termination date of the Insured’s coverage, if the Insured’s spouse is not covered under the Policy;
5. The Certificate Termination Date stated on Your Schedule of Benefits.
6. The date that You enter full-time active duty in the armed forces of any country or international organization other than for reserve duty of 30 days or less;
7. The date other major medical insurance coverage becomes effective for a Covered Person;
8. The date You become eligible for Medicare;
9. The date that insurance under the Policy is discontinued; or
10. The first day of any policy month We elect to terminate the Policy by giving the Group Policyholder at least 30 days advance written notice.

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:

• The date of their death;
• The date the Spouse and Insured become legally divorced or legally separated;
• The date the Spouse becomes eligible for Medicare; or
• The date that the spouse enters full-time active duty in the armed forces of any country or international organization other than for reserve duty of 30 days or less.

TERMINATION OF A CHILD'S COVERAGE

A child’s coverage will terminate on the earlier of:

• The date the child ceases to meet the requirements of a Dependent; or
• The date that the child enters full-time active duty in the armed forces of any country or international organization other than for reserve duty of 30 days or less.