Short Term Medical Insurance

 
Customize your health insurance plan

Short Term Medical Insurance

 
Customize your health insurance plan

What is Short Term Medical (STM) Insurance ?

Think of it as micro-healthcare plans thatare customizable to your needs. They are about 40% to 60% lower on premiums than Obamacare / ACA major medical plans. You can sign up for it any time of the year.

Depending on Zip Code, plans are available in these categories:

  • 364 Days,
  • 6 months or less,
  • Cover me until open enrollment (of ACA plan), coverage ending on Dec 31,
  • More than 364 days extendable by number of months up to 24 months.

All plans are month-to-month allowing flexible terms. These plans are not renewable (unlike Major Medical Plans), however, you can buy new plan as much as 60 days earlier to keep continuity.

Things to know before I sign up for it.

Is my situation suitable for Short Term Medical Insurance?

In Short Term Medical plans; there is a large choice for selecting deductible, coinsurance, and length of coverage. Your selection determines preparation for financial risk due to unexpected medical situation you may run into. 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.

 

Am I eligible for Short Term Medical Insurance?

Short Term Medical insurance is available to primary applicant for:

  • 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.

 

Can I take a quick look to compare these plans?

There are three different plans that can be compared for Short Term Medical. A comparison of plans and benefits for Short Term Medical can be seen here. A downloadable format for plans comparison is also available here.

 

Are there any restrictive qualifying conditions to purchase this plan?

At the beginning of the application process, a questionnaire shows up. Note the disqualifying medical conditions and restrictive pre-existing condition that may be disqualifying.

Unlike ACA compliant plans, the Short Term Medicare plans have limited scope due to age restrictions, disqualifiers, exclusions, covered expenses, pre-existing conditions, precertification requirements and are non-renewable or non-extendable. It is important to weigh to decide whether to purchase 180 days plan or 364 days plan. Supplemental Medical Plans are recommended as add-ons to Short Term Medical plans to reduce or offset expenses. It is also important to know who services these policies, and how to make best use of these services. 

Please review this one page document to learn more about medical qualifying, disqualifying and restrictive conditions.   
 

Are there Federal tax penalties for not having an ACA plan?

Effective Jan 01, 2019 individual mandate to pay tax penalty for not buying major medical plan was repealed from ACA; this occurred in September 2018.  This has been a big relief to people who did not fall into low-income bracket to buy a subsidized major medical plan and for those who found premiums were getting out of their reach.   

As a tax filer (individual or family) prior to Dec 31, 2018 if you did not have qualified health insurance coverage (such as a major medical ACA plan), you had two choices:

Because there were penalties involved, tax filers also received a 1095 form (A, B or C – depending on where you got your health coverage from) to prove that you had an ACA compliant insurance. 

There are no more Federal tax penalties for not having ACA compliant health insurance effective starting in the Year 2019. Please note that Short Term Medical insurance is not ACA compliant health insurance.

 

Can I renew my Short Term Medical insurance once it expires?

STM plans are not auto-renewable. The next coverage period is not in continuation of the previous period; it is the new plan with a new deductible, coinsurance, and pre-existing condition limitations. You can buy the next plan as much as 60 days in advance to ensure continuity of coverage.

The 364-days Connect Value Extend plan renewable for next 24 months will be available in Florida in Aug 2019, followed by Texas sometimes later. The Connect STM Extend plan will soon be put out in the market as well. The extendable plan by 24 months will not be available for Connect Plus, which has limited benefit of $25k for pre-existing conditions.

What are the supplemental medical product plans to add on to Short Term Medical insurance?

While signing up for Short Term Medical plan, you may consider adding supplemental indemnities plans to offset out-of-pocket expenses. The supplemental indemnities plans available are:

  • Hospital and Surgical Insurance: Pays fixed benefits for covered hospital stay and surgical procedures.
  • Hospital Indemnity (Care Access Plan): There are three levels of indemnity plans covering hospital stay, surgical benefits, critical illness benefits, and optional health maintenance.
  • Gap Health Insurance: There are five levels of indemnity plans to covering: accident medical expense, accidental death and dismemberment, critical illness, inpatient surgery, outpatient surgery, hospital admission benefit, and hospital confinement benefit.
How do I compare ACA plan with Short Term Medical plan combined with Medical Supplemental?

ACA mandated health insurance plans are designed with underlying premise of fully and comprehensive medical services inclusive of pre-existing conditions and no-denial to qualified applicants. ACA plans have larger social objective to reach out to lower income level people by governmental subsidies of premiums. For services of providers, the insurers have organized networks of local HMOs and regional PPOs. ACA plans are guaranteed to be renewable.

Short Terms Medical (STM) plans are designed to deny certain pre-existing critical illnesses, have limitations and restrictions on preexisting conditions, and have exclusions for high-risk situations. For services of providers, the insurers have organized networks at national level. STM plans are not auto-renewable.

Supplemental Medical Insurance plans are designed to reduce personal ‘out-of-pocket’ expenses comprising of deductibles and coinsurance.

An insurance company enters into contracts with medical care providers at discounted rates of service for its insured clients. It creates and maintains networks of service providers, and offers their services to its insured clients in exchange for premiums of insurance policy.

A person who is uninsured or is insured but seeks services from out-of-network providers is not protected against usual, reasonable, and customary charges of medical services. Typically, insurance company pays about 25% to 40% of the invoiced bills from its in-network hospitals and medical providers (because of their contracts in place), and the providers are happy to receive to continue with their business. Hospitalization is most threatening due to its costs of service.

A comparison between ACA plan, STM plan, and additional Supplemental Medical Insurance plan is illustrated below.  

 

What are the ancillary medical plans ?

These are add-ons to your main health insurance plan to make your health care plan comprehensive. The ancillary plans available are:

  • Pharmacy / Rx Pay Card: This is fixed copay discount plan for prescription medications. Highly recommended that at the minimum, add this choice to your Short Term Medical plan.
  • Dental Plan: There are three levels of dental plans available, PPO and indemnities.
  • Telemedicine: You can buy access to phone consultations with board certified physicians and can get your prescription medication ordered.
  • Cancer, Heart Attack and Stroke: This indemnities plan covers financial risks associated with occurrence of these critical diseases.
How do I find doctors, medical facilities, and ancillary providers who will accept this insurance?

These underwriting insurance companies under umbrella of The IHC Group have negotiated rates contracts with a number of healthcare providers who are in multiple networks. These are part of different PPO [Preferred Providers Organization] networks. These include providers such as physicians, hospitals, urgent care centers, labs and radiology diagnostic facilities, and ancillary providers. You can visit these PPO providers nationwide. You pay less if you use PPO providers that belong in network. There are three-physician provider PPO’s (MultiPlan, First Choice, Doctors Network) and one Ancillary Provider network. You can search for providers in these networks below.

From these networks of providers’ available, 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.

 

Multiplan

multiplan

Access to seven networks of physician networks and facilities.

First Choice

First Choice

Access to two networks of physicians and facilities.

Doctors Network

Doctors NEtwork

Additional network of physicians by specialty.

Ancillary Providers

Ancillary Providers

Find diagnostic services, medical equipment, therapeutic services, and some other medical services.

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.

 

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 signup. How should I go about it?

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Enter your information and browse plans

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Customize from different Deductibles, Co-insurance, Maximum Out-of-Pocket, and Maximum Limit of Plan

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The choices impact premium for of the plan. The lower your deductible, lower your out-of-pocket costs, and higher the co-insurance; more is the premium and lesser is your financial risk.

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We recommend you get a Rx Pay Card. You may choose to add Dental, Care Access, Hospital & Surgical Indemnity, and Telemedicine.

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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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Open detail instructions on how to create and look into membership account. Watch video showing instructions and familiarization.

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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!

Resource Library. Read more about each plan.

Short Term Medical Plans

Plan Brochures

Connect Plus

Connect Plus

Covers some pre-existing conditions (max $25k). Offers three coinsurance choices, and four deductible choices. Plans are available for 180 days and 364 days. Policy Maximum $2.0M.

Browse Download

Connect Plus

Connect Value

Offers three coinsurance choices, and four deductible choices. Plans are available for 180 days and 364 days. Policy Maximum $1.0M.

Browse Download

Connect Plus

Compare benefits of Short Term Medical plans

See features in tabular format. Check availability in your Zip Code.

Browse Download

Connect Plus

Connect STM

Offers three coinsurance choices, and four deductible choices. Plans are available for 180 days and 364 days. Policy Maximum $2.0M.

Browse Download

Connect Plus

Three Connect Plans: Select One

This brochure shows comparative features and limitations of three Connect Plan. 364 days plan Connect Value Extend is now available to auto-renew for next 24 months.

Browse Download

Supplemental Plans

Plan Brochures

Supplemental Hospital insurance

Hospital Insurance / Hospital and Surgical Insurance

Covers for inpatient hospital and surgical services; outpatient surgical and emergency

Browse Download

Telemedicine

Gap Health Insurance

Covers Accident Medical Expenses, AD & D, Critical Illness, Inpatient Surgery, Outpatient surgery, Hospital Admission Benefit, and Hospital Confinement Benefit.

Browse Download

Care Access Plan

Hospital Indemnity Insurance / Care Access Plan

Customizable plan to cover Hospital Confinement, Surgical expenses, Critical illnesses, Diagnostics and Lab, and Ambulance.

Browse Download

Ancillary Medical Plans

Plan Brochures

Independent Dental PPO

Independence Dental Indemnity

There are three plans available. Go to any doctor of your choice.

Browse Download

Telemedicine

Health Discount Program

This program is bundled in to two sets of products geared towards keeping healthier life style and getting help and assistance related to your healthcare goals.

Browse Download

Supplemental Hospital insurance

Cancer, Heart Attack and Stroke

This indemnities plan covers financial risks associated with occurrence of these critical diseases.

Browse Download

Independent Dental PPO

Independence Dental PPO

There are three plans available. Can go to PPO (lower cost) or Non-PPO doctors.

Browse Download

Pharmacy Rx Pay card

Pharmacy / Rx Pay card

This is a discount plan. Flat copay for medications based n Tier Level of medication. Nationwide service by more than 55,000 participating pharmacies on network.

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Plan availability varies by State. Shop Plans to see what’s currently available for you.

QUESTIONS?

Call us at 407-792-6060 or leave message below. We’ll get back to youwithin 24 hours.


 

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Licensed in FL, TX, VA | NPN: 8652757