Short Term Medical Insurance

 
Customize your health insurance plan
 
From
 

THE IHC GROUP

Short Term Medical Insurance

 
Customize your health insurance plan
 
From
 

THE IHC GROUP

What is Short Term Medical (STM) Insurance ?

Think of it as micro-healthcare plans that are customizable to your needs. They are about 40% to 60% lower on premiums than Obamacare/ACA major medical plans. You can sign up for a plan any time of the year, and the coverage begins the next day.

Plans are available in Florida and Texas are as follows:

 

Florida

See brochure for details here.

There are two types of plans available:

Connect STM OV, Rx : The suffix OV signifies plans that do not have integrated Rx (prescription drugs) component. The suffix Rx signifies plans that have integrated Rx (prescription drugs) component. Plans are available for 364 days, 6 months or less, More than 364 days, and Get coverage until January 1 of ….. (Year).

  • Deductible choices available are: $2,500, $5,000, and $10,000.
  • Coinsurance choices available are: i) 20% with $4,000 out-of-pocket maximum; ii) 30% with $6,000 out-of-pocket maximum;  iii) 50% with $5,000 or $10,000 out-of-pocket.
  • Maximum Policy Limit: $2.0M
  • Exclusions apply.

Connect Plus OV, Rx:  The suffix OV signifies plans that do not have integrated Rx (prescription drugs) component. The suffix Rx signifies plans that have integrated Rx (prescription drugs) component. These plan have pre-existing coverage component up to $25,000. Plans are available for 364 days, 6 months or less, More than 364 days, and Get coverage until January 1 of ….. (Year).

  • Deductible choices available are: $5,000, and $10,000.
  • Coinsurance choices available are: i) 30% with $6,000 out-of-pocket maximum; ii) 50% with $10,000 out-of-pocket.
  • Coverage period maximum benefit: $2.0M
  • Exclusions apply.

Texas

See brochure for details here.

There are two types of plans available:

Connect STM: Plans are available for 364 days, 6 months or less, More than 364 days, and Get coverage until January 1 of ….. (Year).

  • Deductible choices available are: $2,500, $5,000, and $10,000.
  • Coinsurance choices available are: i) 20% with $4,000 out-of-pocket maximum, ii) 30% with $6,000 out-of-pocket maximum; ii) 50% with $10,000 out-of-pocket.
  • Coverage period maximum benefit: $2.0M
  • Exclusions apply.

Connect Plus: Plans are available for 364 days, 6 months or less, More than 364 days, and Get coverage until January 1 of ….. (Year).

  • Deductible choices available are: $5,000, and $10,000.
  • Coinsurance choices available are: i) 30% with $6,000 out-of-pocket maximum; ii) 50% with $10,000 out-of-pocket.
  • Pre-existing coverage limit: $25,000
  • Coverage period maximum benefit: $2.0M
  • Exclusions apply.

Typical Applicability

Generally, short-term medical insurance is applicable to the following groups of people:

  • Individuals who are risk averse to being medically uninsured.
  • Individuals transitioning between jobs.
  • Those seeking an affordable option to COBRA
  • Employees waiting for employer’s group medical coverage to begin as job benefit.
  • Self-employed individuals who find ACA medical plans to be expensive.
  • Those who are waiting to enroll in an ACA compliant major medical plan during its open enrollment period between Nov 01 to Dec 15.
  • Those needing immediate coverage while shopping and applying for permanent coverage.
  • College students or recent graduates.
  • Individuals no longer eligible on parents’ plan.
  • On strike, laid off, or terminating employees.
  • Part-time or temporary workers.
  • Individuals not yet eligible for Medicare coverage.
  • New residents of the United States.

Things to know before I sign up for it.

Eligibility

  • Individuals between ages of 18 to below 65.
  • Child between ages of 2 to 18.
  • Family comprising of you, your spouse, and your dependent child(ren).

Your dependent child is defined as follows:

  • Who is below 19 years of age, (includes just born)
  • Who is at least 19 years of age but less than 25 years enrolled and attending as full time student at an accredited college, university, vocational or technical school,
  • Who is not pregnant at the time of application,
  • Who is not member of armed forces,
  • Who is not medically disqualified due to certain medical conditions or critical diseases.

The applicant must be able to respond ‘Yes’ to following:

  • I have lived in the U.S, for 12 consecutive months.
  • I am not an active member of armed forces,
  • I am not covered by any government sponsored health insurance plan, or any other group or individual medical health insurance on proposed effective date of the new STM policy,
  • I am not pregnant, am not an expectant parent, in process of adopting a child, or undergoing fertility treatment.
  • I am below 300 pounds for male, below 250 pounds for female.
  • I am not medically disqualified due to certain medical conditions or critical diseases.

 

Medical Qualifying Questions


Unlike ACA compliant plans, the Short Term Medicare plans have limited scope due to disqualifiers, restrictions and limitations, exclusions, covered expenses, pre-existing conditions, precertification requirements and are non-renewable or non-extendable.  Browse here for Medical Qualifying Questions 

Optimization of Medical Insurance


To optimize health coverage, it is significant to understand how your finances will be bear with the outflow of your cash out-of-pocket in emergencies and hospitalization. Hospitalization is very fearful for its inevitable recourse and heavy expenses. It must be covered by in-network providers of insurance company providing coverage. To compare the mainstream major medical plan, the PPACA, with Short Term Medical plans, which are available for as long as 36 month, it is significant to delve into the Cost vs. Benefit of Risk Management analysis when combined with Hospital Supplemental insurance plans.  To cover financial risks over and above what Short Term Medical insurance can provide, it is significant to consider adding following coverages:

Supplemental Medical Plans:  These plans are indemnities designed as financial protections to pay you fixed coverage benefits upon defined occurrences to reduce your out-of-pocket costs of deductible, coinsurance, and other expenses related to your hospitalization, surgery, health emergencies and help you pay for other incidentals. You can buy these plans standalone (a-la-carte) or preferably with your main medical health insurance plan (either Short Term Medical or a Major Medical plan). The plans are offered by The IHC Group and are a part of your sign-up process for Short Term Medical plan as add-ons. Following supplemental plans are offered  in Florida only as part of sign up process for Short Term Medical, or standalone purchase.

Here is an example showing effect of adding a supplemental medical plan to the basic ACA or Short Term Medical plan that pays $1,000 per day of hospitalization. 

Medical Ancillaries: In broad general terms, ancillary medical services refer to a wide range of healthcare services in support of the work of physicians, surgeons, and an array of medical services. Typically, ancillary medical services fall in categories of diagnostic services, medical equipment, therapeutic services, custodial services, and other such services. Following optional plans are offered as part sign up process for Short Term Medical, or standalone purchase.

Healthcare Providers


These plans come with nationwide network of healthcare providers who offer you discounted medical costs and out-of-pocket expenses. It is significant to use providers in the networks so as to get discounted services and processing of your medical claims the Insurance. Reach out to following network of providers to search for providers. Since participation in networks in dynamic, do call to check and verify for appointments.

  • MultiPlan: has a number of networks within.
  • FirstHealth and Cofinity: are national PPO Networks
  • Doctor: Search by specialties.
  • Dentemax: This is PPO network of dental care providers.
  • Ancillary Care: This is network of about 33,000 ancillary providers . They provide diagnostic services, medical equipment, therapeutic services, and some other medical services

From these networks of available providers, search for the providers that you would select to go to, call their office, and verify to make sure they are in the PPO network associated with The IHC Group, and they would honor the policy plans. If you need help, ask question to servicer, Loomis, through membership portal.  

 

Insurance terms to know and understand

While evaluating comparative and contrasting insurance plans to shop for reduction of the probability of risk of ‘effective out-of-pocket’ expense, know and understand the terms of the industry. Important terms are listed and explained here.   

What are some insurance terms that I should understand?

Office Visit Copay: What you pay upfront at the reception of doctor’s office when you present your IHC Short Term Medical insurance card. Please make sure the doctor’s office accepts it and bills to insurance company.

Deductible:

  • Individual: The selected deductible maximum is the covered person must pay an amount before coinsurance benefit begins. The deductible applies per covered person, per covered period. To be risk averse, select the least deductible amount on your plan choices, though the premium will be higher.
  • Family: When three covered persons in a family each satisfy their deductible, the deductibles for any remaining covered family members are considered satisfied for the remainder of the coverage period.

Coinsurance and Out-of-Pocket Maximum:

  • After the deductible maximum amount has been met, you pay the selected coinsurance percentage of covered expenses until the out-of-pocket maximum that you selected has been reached.
  • The out-of-pocket maximum amount is specific to expenses applied to the coinsurance percentage. It does not include covered expenses applied to the deductible, precertification penalty amounts, or expenses not covered under the policy.
  • Once the deductible and Out-of-Pocket maximum amount has been satisfied, additional covered expenses within the coverage period are paid to by insurance at 100 percent, not to exceed the covered period maximum benefit amount. Benefits specific maximums may also apply.

Pre-existing condition limitation

  • A pre-existing condition is defined as any medical condition or sickness for which medical advice, care, diagnosis, treatment, consultation or medication was recommended or received from a doctor within five years** immediately preceding the covered persons’ effective date of coverage; or symptoms within the five years** immediately prior to the coverage that would cause a reasonable person to seek diagnosis, care or treatment will not be a covered benefit.
  • Consultation means evaluation, diagnosis, or medical advice was given with or without the necessity of a personal examination or visit.
  • ** 12 months in VA; 24 months in FL.

Precertification

  • Precertification is required prior to each inpatient confinement for injury or illness and outpatient.
  • Emergency inpatient confinements must be pre-certified within 48 hours following the admission, or as soon as reasonably possible.
  • Precertification may also be conducted for a continued stay review for an ongoing inpatient confinement.
  • Benefits are not paid for days of inpatient confinement, which extend beyond the number of days deemed medically necessary.
  • Failure to complete precertification will result in a benefit reduction of 50 percent, which would have otherwise been paid unless the covered person is incapacitated and unable to contact the administrator.
  • Precertification is not a guarantee of benefits. The servicer must be notified and approval obtained.

Exclusions

  • A list of incidents, conditions, or charges that are not covered in policy benefits.
  • Partial list may be viewed in brochure put out; the full list may be seen in the policy documents.

Usual, Customary and Reasonable Charges (UCR)

  • The term has different meaning and interpretation depending on who uses it. For healthcare providers, it is the bill they float to the insurance company for services provided to the patient and seek reimbursement of charges.
  • The insurance companies enter into negotiated contract rates with the healthcare providers and bring them in its network of Preferred Providers Organization (PPO). Providers need traffic coming in even at lower negotiated contract rates, irrespective of what they bill as their Usual, Customary and Reasonable rates of service to the insurance company. This is also termed as In-Network providers. They accept low percentage payment of bills they float and are still happy to get business from insurance carrying patients. It is ‘take it or leave it situation’, and the providers do not leave it. In parlance of insurance, it is euphemistically called ‘adjustments’ or ‘patient’s saving’. The insurance company holds out to its policy holders that they get service at highly discounted billing rate, thus the blessing of competitive contract rates (PPO) is passed on to insurance policy holders.
  • For Out-of-Network providers, the acceptance of price of service will be much higher than that of negotiated contracted rates with PPO providers, but not near their inflated billing as their deserved cost of service. Often, insurance rates of out-of-network too are set in stone by insurance company to placate the providers and the patients to serve each other. If the provider is emphatic for higher cost of service, the balance of bill, after ‘adjustments’ will be floated to the patient, which in insurance parlance it’s called ‘balance billing’.
  • The insurance company often recrafts its definition of UCR to pay charges based on its contract rate in that geographical area.
  • Be aware of thy bills, for they belong to the patient! Supplemental Medical Insurance comes to help here to avoid financial shocks.
  • What happens when one does not carry the protective shield of an active medical insurance card? He or she shalt be served with the provider’s bills with ferocity of Usual, Customary and Reasonable charges, all red in tooth and claw. And when pressure and persuasion fails, the bills will eventually be pursued by collection agency when providers sell their debts for pennies on a dollar.

 

I want to sign up. How should I go about it?

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Open instructions here to step through sign up Open Instructions

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Open Quote and Sign up window here Quote and Sign up here

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Select duration of the plan you want to buy.

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The more the duration, steadier the insurance coverage for continuity though at higher premium.

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Customize from different Deductibles, Co-insurance, Maximum Out-of-Pocket, and Maximum Limit of Plan. Select a plan.

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The choices impact premium of the plan and the ‘effective out-of-pocket’ expense. The lower your deductible, and the higher the co-insurance for ‘out-of-pocket maximum, the lesser is your financial risk and more your premium.

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Add supplemental medical plan and ancillary insurance plan(s).

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Skip over adding plan here. Look over the description and features of different plans under the menu items, and add them to your health insurance portfolio as standalones. 

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Complete and submit application.

I just signed up. Now What?

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Check your email coming from www.Loomisco.com, and follow instructions.

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Create your account with the servicer. Open instructions on how to create and look into membership account.

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Request for a plastic Membership ID card in membership portal, and download its PDF copy.

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Browse over network of doctors and select one to go to.

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Do make appointment with your selected doctor and make use of copay only free visit.

I’m a policy holder. I need help!

Follow the instructions in the email.
Third party, Loomis Company, provides customer service.

For help:

866-473-6615

Read more customer service information
  • Customer Service: select Option 3 for members at 866-473-6615
  • Onllne Member Portal: http://www.loomisco.com/healthxgateway/member
  • Policy Documents Requests: IHCDocuments@loomisco.com
  • Bill inquiries: 1-856-892-4301; Fax: 610-374-6986

To prevent high medical expenses, get covered today!

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Licensed in FL, TX, VA | NPN: 8652757