|
SHORT TERM MEDICAL INSURANCE
OVERVIEW
(This page has been updated to reflect changes in Federal Rules)
In Oregon you can purchase Short-Term Medical (STM) insurance for up to 90 days per contract per company. Short Term medical plans are a type of limited-benefit health insurance and are not subject to the Affordable Care Act/Obamacare regulations, and is not guaranteed-issue. With each plan I offer--Pivot Health and Allstate Health--you can enroll for up to 3 months with each plan, but cannot re-apply for coverage for either company until 12 months has passed.
Generally, STM plans were designed for someone needing medical insurance for a limited amount of time while waiting for other coverage to begin. Most plans do not cover you for a pre-existing condition, prescription drugs, or preventative services. Some healthy people purchase Short Term medical plans if they are less expensive than coverage on the Federal Marketplace. The main appeal of a Short Term Medical plan is for a health person who wants catastrophic coverage and earns too much money to qualify for a plan on the Federal Marketplace place (and receive a tax credit).
Take the time to read the brochure plan limitations and exclusions prior to enrolling in coverage to see if the coverage is right for you. It is important to make and informed decision.
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 effective September 15, have your end November 30 or December 31. This will benefit you should you transition to a new plan on the Marketplace or buy another STM plan with a 1st of the month start-date.
PLAN OVERVIEW
Here is a brief overview of the 2 plans I represent currently.
1. Pivot Health: The Pivot Health Plan (underwritten by Companion Life) is my least expensive plan offering a variety of plan options and deductibles. You can pay monthly or select the single-pay option that saves you about 20% at check-out. The Deluxe & Choice plans include 3 Primary Care, Specialist, or Urgent Care visits with a copay before the deductible needs to be met. The plan has no provider network, so you can see any doctor willing to bill your plan. In the case where the provider will not bill your plan, you can file your own claim. You can purchase a monthly or save 20% with the Single-pay option.
2. Allstate Health Solutions: Allstate Health Solutions, (underwritten by National General) is a more expensive option, and offers a monthly plan or single-pay with a discount. Urgent care visits are available before the deductible is met (read for details). You can pay monthly or save 20% an choose a single-pay option.
Plan 1: PIVOT HEALTH STM PLAN
Pivot Health Plan is underwritten by Companion Life. 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. The Deluxe plan offers the lowest out of pocket maximum.
CLICK HERE to quote and enroll in Pivot Health
Please review the plan coverage plan limitations and exclusions section of the brochure prior to enrolling. The qualifying enrollment questions are also included in the brochure below. All the plans include free Telehealth services.
Pivot Health_2025_Brochure.pdf
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 Deluxe plan has a lower out of pocket maximum and is a better 'safety net'.
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% in premiums. 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 2: ALLSTATE HEALTH SOLUTIONS
Allstate Health, (underwritten by National Health Insurance Company) offers a solid plan with a good benefit and large, national network called the Aetna Open PPO Network. The contract can be taken out for 3 months. Urgent Care visits charge a $50 copay prior to your deductible PLUS coinsurance (20% or 50%), prior to your deductible. Doctor visits are subject to your deductible. You save about 20% if you select the single-pay option, but they only offer this for a 3 month contract.
CLICK HERE to get a quote and enroll
Before making application please review the plan brochure, especially the plan limitations and exclusion section.
Allstate Health_2025_Brochure.pdf
Search for In-Network providers in the Aetna Open Choice PPO Network:
CLICK HERE to search Providers contracted network.
Application Notes for Allstate :
Select the 'Monthly' option when quoting. You can keep coverage from 1-3 months and cancel any month by calling Customer Service in advance. You can save about 20% of you choose the single-pay option. The contract maximum is 90 days.
Allstate Health Solutions Quick Links to Customer Service:
Allstate Health Solutions: 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
DEDUCTIBLE AND OUT OF POCKET MAXIMUM:
It's important to note with Short Term that the plan deductible does NOT go towards meeting the plans out of pocket maximum: This is an important distinction compared with most traditional health insurance plans.
For example, if you purchase a $5000 deductible plan with a $3750 out of pocket maximum, should you have a $30,000 covered medical expense, your out of pocket maximum for covered services would be $8750. Different plans will have different out of pocket maximum options.
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: When your Short Term Medical plan with one company ends, you can possibly do another 3 month plan with my 2nd company. The other option is to purchase coverage through the Marketplace at http://www.healthcare.gov
WHAT IF I WANT TO DO A VIDEO-VISIT FROM HOME?
I believe the Pivot Health and Allstate health 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/
SAVE ON LAB WORK:
If you live in the Portland area and want to save on the high cost of Lab work, you can purchase your own lab work at Quest Diagnostics, then bring the results to the provider of your choice. There are muliple offices around the Portland area.
https://www.questhealth.com/?itm_campaign=QD-Patients-GetTested-HP
EXAMPLE: You can use Quest to order a colorectal screening home test, Comprehensive Metabolic Panel, Cholesteral Panel, TB, A1c, CBC, STD screenings, and more.
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 2025 Brochure
Click filename below to access file
Allstate Health 2025 Brochure
Click filename below to access file
|
