General Information
Q. How much
temporary medical insurance coverage can I have?
A. Length of coverage periods must be a minimum of 30 days (60 days in MN) and can be a maximum of
185 or 365* days. *12 Month coverage option is not available in all
states..
Q. When does my
temporary medical insurance coverage begin?
A. If you are submitting your application by:
Internet using a credit card - The earliest your coverage can begin is the day following transmission, if all other eligibility criteria have been met. For
example, if you submit your application online on March 16th, your coverage begins on 12:01 AM on March 17th.
Mail and writing a check - The earliest that your coverage can begin is the day following the U.S. Postal Service postmark, if all other eligibility
criteria have been met. (If the envelope containing your application is not postmarked by the U.S. Post Office or if the postmark is not legible, the plan date will be the later of a) your
requested date or b) two days prior to the date the application was received by
Assurant Health.)
Coverage will take effect provided the following conditions are met:
- Your completed application and full premium payment are received by
Assurant Health, and,
- Your answers on the application are complete and meet the requirements for acceptance.
Q. Can I backdate a Short Term Medical plan?
A. No. Backdating is not allowed. When completing an application, please follow these steps:
- Complete the application on or before the desired plan date.
- Make your payment on or before the desired plan date and include it with the application.
- When mailing the application to Assurant
Health, the postmark on the envelope containing the application must be on or before the requested plan date.
Please note: There is a one day difference between the plan date and the effective date of coverage.
Q. Can I change my deductible?
A. Deductible changes cannot be made after your plan is issued.
Q. What is the definition of a pre-existing condition?
A. A pre-existing condition is defined as an illness or injury for which the covered person received medical treatment or advice from a
physician within the 5 year* period immediately preceding the covered person's effective date; or that produced signs or symptoms within the 5 year* period immediately preceding the covered
person's effective date.
*May vary by state.
Pre-Authorization Service
Q. Does this
temporary medical insurance plan use an pre-authorization service?
A. Yes. Short Term Medical uses an authorization service which ensures that you and your family receive the most appropriate and cost
effective care available. Trained medical professionals work with you and your physicians to review the course of treatment and advise you of your eligibility for benefits. The identification
card you receive with your policy provides a toll-free number for easy access to this service. The authorization process must be followed in its entirely to receive maximum benefits. The
contract explains the authorization process in detail.
Authorization is required in advance of:
- All hospital or skilled nursing facility admissions
- Outpatient or day surgeries
- Rehabilitation programs
- Home health care
- Physical medicine/Chiropractic care
- Transplants
The number to call for preauthorization is 1-800-800-2412. The Short Term Medical identification card, which is attached to a copy of the insurance
contract, also lists the preauthorization phone number.
Payment Information
Q. If I select the monthly pay option, how will I be billed?
A. If you select the monthly payment option and pay your initial payment by:
- Check - you will receive a sheet of payment coupons via the U.S. Postal Service for all subsequent payments. Each month, mail your check along with the
coupon to Assurant Health. Each coupon pays for an additional 30 days of coverage. Note: No lapse notices are sent.
- Automatic credit card debit - each month, your subsequent premium payments will be automatically debited from the credit card information you provided
with your initial payment. Your card will be debited each month until you have reached a total of six months of coverage. If your temporary need ends prior to the sixth months, simply call
us at 1-800-800-5453 and we will stop the automatic credit card debit. (Please note: 7 days advanced notice is required to ensure future credit card charges are stopped.)
Q. Can I pay my premium by credit card?
A. Yes. If you select the single payment option, your entire premium can be billed to your credit card. If you select the monthly
pay option, each month, your subsequent premium payments will be automatically debited from the credit card information you provided with your initial payment. Your card will be debited each
month until you have reached a total of six months of coverage. If your temporary need ends prior to the sixth months, simply call us at 1-800-800-5453 and we will stop the automatic credit card
debit. (Please note: 7 days advanced notice is required to ensure future credit card charges are stopped.) The following credit cards are accepted: Visa and MasterCard.
Benefits
Q. Do I have the option to select my doctors and hospitals or are there PPO and HMO options available?
A. This plan is not an HMO or PPO. There are no restrictions on which doctors you may see. You have the freedom to select the doctors
and hospitals of your choice.
For Additional Savings - You can reduce your medical bills by using the doctors and hospitals participating in PHCS Healthy Directions. Simply call PHCS
1-800-357-6847 or visit them on the web at www.phcs.com, click on the Healthy Directions icon to verify that your doctor or
hospital is part of the PHCS Network. Then present your medical identification card with the PHCS logo on it at time of service and your provider will bill you at the reduced PPO network rate
for services.
Q. What happens if I require further treatment after my plan expires?
A. Short Term Medical plan contains two provisions that extend coverage beyond the expiration date of the plan.
- Total Disability - if a covered person becomes totally disabled and is being treated for that condition during the benefit period, the plan will extend
benefits to the earliest of:
- 12 months following the termination date
- The end of total disability
- Payment of the $2 million maximum benefit
- The date on which treatment is no longer required
(The deductible need not be met to qualify for total disability)
- Non-Total Disability - The insured does not have to be totally disabled to qualify for this benefit. A benefit of up to $1000 may be provided for
follow-up care for an injury sustained or sickness which commenced during the plan period. To qualify, the insured must have met his or her deductible during the benefit period. Qualifying
expenses must be incurred within 60 days of the plan's expiration.
Q. Does the
Temporary Medical plan include a dental and optical benefit?
A. No. This plan is designed to protect you in the event of an illness or injury and is not meant to cover dental and optical care.
Short Term Medical is for temporary coverage only and therefore does not include some of the benefits a permanent heath plan offers.
Q. Is there a drug card?
A. No. However, prescription drugs are covered under the plan. Prescription drugs require the written prescription of a physician and
payment is subject to deductible and coinsurance amounts.
Q. Will a routine check up be covered?
A. No. This plan is designed to protect you in the event of an illness or injury and is not meant to cover routine exams and preventive
care. Short Term Medical is for temporary coverage only and therefore does not include most of the benefits a permanent heath plan offers.
Obtaining a Second Temporary Medical
Insurance Plan
Q. Can I purchase a second Short Term Medical plan?
A. This Short Term Medical plan is non-renewable. However, if your temporary need continues, you may apply for another policy* if:
- There has been no significant change in health, and
*If medical claims were filed, you can apply for
any of the alternate temporary medical insurance plans available
here.
A new application must be completed. Should a second application be approved, a new plan will be issued. Please note: There is no continuous coverage
between the original and second plan.
Q. If I get a second
Temporary Medical Insurance plan, do I have to meet another deductible?
A. Yes. Short Term Medical is not renewable. If you obtain a second Short Term Medical plan, it would be a brand new plan with a new
deductible.
Refunds
Q. Can I get a refund if I am not satisfied?
A. Yes. Our Short Term Medical plan offers a premium refund. We are confident that your Short Term Medical plan will meet your needs.
However, if you are not 100 percent satisfied with the plan, you can return it within 10 days of issuance for a premium refund. Where the one-time application fee applies, it is
non-refundable.
Federal Reform Legislation
Note: The following Q&A's are regarding federal legislation. * State reform legislation may vary.
Q. Are Short Term Medical plans affected by the new Federal Health Insurance Portability and Accountability Act (HIPAA) of
1996?
A. No. Under HIPAA, short term limited duration policies are exempt from this legislation. This means that when issuing a Short Term
Medical policy, insurance carriers do not have to: guarantee renewability, guarantee issue or waive the pre-existing condition limitation for federally eligible individuals.
Q. Is a Short Term Medical plan considered "creditable coverage" under HIPAA?
A. Yes, under HIPAA, Short Term Medical policies are considered creditable coverage to help satisfy any pre-existing condition period.
Previous creditable coverage includes:
- A group health plan
- Health insurance coverage
- Part A or Part B of title XVIII of the Social Security Act (Medicare)
- Title XIX of the Social Security Act, other than coverage consisting solely of benefits under section 1928 (Medicaid)
- Chapter 55 of title 10, United States Code (Champus)
- A medical care program of the Indian Health Service or of a tribal organization
- A state health benefits risk pool
- A health plan offered under chapter 89 of title 5, United States code (Federal Employee Health Benefit Plan)
- A public health plan (as defined in regulations)
- A health benefit plan under section 5(e) of the Peace Corps Act
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