Life can get really busy and sometimes important stuff can slip through the cracks. When you suddenly realized you forgot to enroll in a health insurance plan, short term medical plans can help span the gap in coverage. Short term medical plans can best be thought of as asset protection because of the limitations and exclusions that a full-fledged health plan would normally cover.
Short Term Medical To Span The Gap
When you lose your traditional qualified health insurance plan due to divorce, separation from an employer group plan, or move to a new state, you only have a 60 day window to enroll in a new health plan outside of open enrollment. In other words, you must have a qualifying event in order to trigger a special enrollment period. You can’t enroll in a health plan outside of open enrollment for an individual and family plan unless you have a qualifying event. Those are just the rules of the Affordable Care Act.
Because of the outrageous costs of health care services in the United States, having a single small accident on your bicycle can trigger huge expenses. Short Term Medical plans help cover the huge expenses and protect your savings account or forcing you into bankruptcy.
IHC & Petersen Short Term Medical Plans
I represent two different short term medical plan carriers: IHC Anthem Blue Cross and Petersen Short Term Medical. Neither plan qualifies as creditable health insurance to avoid the ACA’s individual responsibility penalty or individual mandate. But both can offer asset protection in case of a major medical incident.
2017 Benefit Comparison Petersen versus IHC
The Petersen plan uses the First Health PPO Network. IHC has two provider networks; MultiPlan and ACS. The ACS network is ancillary providers such as outpatient services, lab and diagnostic testing and does not include doctors.
2017 Monthly Rates
Both IHC and Petersen offer a variety of plans with different deductibles. But each carrier uses slightly different member cost-sharing elements. I have chosen a $5,000 Deductible/MOOP Petersen plan to compare to a IHC $2,500 deductible, $2,500 coinsurance, $5,000 MOOP plan. The critical figure is that both plans cap your maximum out-of-pocket (MOOP) at $5,000.
Petersen: $5,000 Deductible is also Maximum Out-of-Pocket Amount.
- 30 year old male $162.00
- 40 year old male $202.00
- 50 year old male $256.00
- 60 year old male $281.00
IHC: $2,500 Deductible, then 50% coinsurance until $5,000 Maximum Out-of-Pocket is reached.
- 30 year male $216.04
- 40 year old male $303.27
- 50 year old male $486.59
- 60 year old male $801.59
For IHC family plans, when three covered family members each meet their deductible, the deductibles for any remaining covered family members are considered met for the rest of the coverage period. There are some coverage benefit maximums such as $2,500 for a knee injury.
Pre-Existing Conditions Not Covered By Short Term Medical
Neither Petersen nor IHC will cover pre-existing conditions. The Petersen plan will cover some medical conditions in subsequent renewals if the if the initial illness or injury occurred under their short term medical plan. There are no medical questions or underwriting questions on the Petersen plan. There are some medical questions on the IHC if answered in the affirmative will an automatic decline of coverage.
Hazardous Sports Coverage
The Petersen has plans with lower deductible amounts than IHC. Petersen also has an optional hazardous sports or activities rider. Optional Hazardous Sports or Activities Rider – Hazardous Sports or Activities are the following list of activities which are considered to be more than a standard risk. This optional rider will provide up to $250,000 for eligible expenses incurred by participation in the following:
- Bungee Jumping
- Driving/Riding a motor scooter
- Hang Gliding
- Horseback Riding (no jumping)
- Hiking/Trekking (without the need for climbing equipment) up to 20,000 feet above sea level
- Jet Skiing
- Mountaineering up to 10,000 feet
- Roller skating/ inline skating
- Scuba diving (up to depth of 60 feet if PADI or equivalent qualified or accompanied by qualified instructor and not diving alone)
- Skydiving with an instructor
- Snow Skiing/ Snowboarding (excluding back country and helicopter skiing/boarding)
- Snowmobiling (trail riding only)
- Surfing up to 10 foot waves
- Tree canopy tours / Zip lining / repelling
- Wake Boarding
- White Water Rafting / canoeing / kayaking (grades 2-4 only).
To get a quote, visit my Short Term Medical Quotes Page
Both carriers have lots of exclusions to their short term plans.
- Any expense which You are not legally obligated to pay.
- Services which are not Medically Necessary or are not furnished by and under supervision of a Physician.
- Expenses for services and supplies for which You are entitled to benefits, services or reimbursement through the Veterans’ Administration, Workers’ Compensation insurance, any private health plan or from any other source except Medicaid.
- Out of Network expenses in excess of UCR.
- Intentional self-inflicted injuries while sane or insane.
- Treatment for alcoholism, drug addiction, allergies, and/or Mental or Nervous Disorders and all related symptoms and side effects.
- Rest cures, quarantine or isolation.
- Cosmetic surgery unless necessitated by an accidental Injury.
- Dental exams, dental x-rays and general dental care except as a result of an accidental Injury.
- Eye glasses or eye examinations.
- Hearing aids or hearing examinations.
- General or routine examinations.
- Injuries or Sicknesses sustained from participation in Hazardous Sports and Activities.*
- Pregnancy and pregnancy-related conditions including but not limited to fertility, pre-natal care, childbirth, miscarriage, abortion or postpartum conditions.
- Injuries or Illnesses due to War or any Act of War whether declared or undeclared.*
- Injuries or Illnesses due to Terrorism or any Act of Terrorism whether declared or undeclared.*
- Injuries or Illnesses due to an Act of Terrorism involving the use or release of any nuclear weapon or device or chemical or biological agent, regardless of any contributory cause(s).
- Injuries or Illnesses sustained while committing a criminal or felonious act.
- Expenses incurred for or resulting from pain which is not supported by medical diagnosis.
- Cataract surgery.
- Any elective surgery, including but not limited to complications of previous elective or cosmetic surgeries.
- Custodial Care.
- Expenses for supplies and services that were not incurred within the USA.
- Pre-existing conditions.
- Expenses for the treatment of pre-existing conditions; expenses incurred prior to the effective date of a covered person’s coverage or incurred after the expiration date;
- Expenses that do not meet the definition of or are not specifically identified under the Policy as covered expenses;
- Expenses to treat complications resulting from treatment, drugs, supplies, devices, procedures or conditions which are not covered under the Policy or are experimental or investigational services or treatment;
- Expenses for purposes determined by Us to be educational;
- Amounts in excess of the usual and reasonable charges made for covered services or supplies or which you or your covered dependent are not required to pay;
- Expenses to the extent that they are paid or payable under another insurance or medical prepayment plan, Medicare paid expenses or expenses for care in government institutions;
- Expenses paid under workers’ compensation or an automobile insurance policy;
- Expenses incurred by a covered person while on active duty in the armed forces, expenses from war;
- Expenses incurred while engaging in an illegal act or occupation or during the commission, or the attempted commission, of a felony or assault;
- Expenses for the treatment of normal pregnancy or childbirth, except for complications of pregnancy and normal newborn care unless medically necessary due to sickness or injury;
- Expenses for voluntary termination of normal pregnancy or contraception;
- Infertility treatments or sterilization;
- Expenses related to sex transformation or penile implants or sex dysfunction or inadequacies, physical exams, prophylactic treatment;
- Expenses for the treatment of mental illness or nervous disorders; alcoholism or drug addiction;
- Expenses incurred for loss sustained or contracted in consequence of the covered person being intoxicated or under the influence of any narcotic;
- Expenses incurred in connection with programs, treatment or procedures for tobacco use cessation;
- Expenses resulting from suicide or attempted suicide;
- Expenses for dental treatment or temporomandibular joint dysfunction (TMJ) of any kind except as specifically covered;
- Expenses for radial keratotomy; vision exams, eyeglasses or contact lenses, including the fitting of; treatment of cataracts; routine hearing exams or hearing aids;
- Expenses for cosmetic or reconstructive procedures, services or supplies including breast reduction or augmentation or complications except as specifically covered; outpatient prescriptions, unless shown as included in the Schedule of Benefits;
- Expenses incurred in connection with any drug or other item used to treat hair loss; treatment of feet unless due to injury or illness;
- Expenses incurred in the treatment of acne, or varicose veins; weight loss programs or diets;
- Expenses for rest or recuperation cures or care in an extended care facility, convalescent nursing home, a facility providing rehabilitative treatment, skilled nursing facility, or home for the aged, whether or not part of a hospital; transportation expenses, except as specifically covered;
- Expenses for services or supplies for personal comfort or convenience;
- Expenses provided by immediate family;
- Expenses for sleeping disorders;
- Expenses incurred in the treatment of injury or sickness resulting from participation in skydiving, scuba diving, hang or ultralight gliding, riding an all-terrain vehicle such as a dirt bike, snowmobile or go-cart, racing with a motorcycle, boat or any form of aircraft, any participation in sports for pay or profit, or participation in rodeo contests; participating in interscholastic, intercollegiate or organized competitive sports;
- Expenses for the purchase of a noninvasive osteogenesis stimulator (bone stimulator);
- Expenses for services or supplies of a common household use; medical care, treatment, service or supplies received outside of the United States, Canada or its possessions;
- Expenses for spinal manipulation or adjustment;
- Expenses for acupuncture;
- Expenses for marital counseling or social counseling; private duty nursing services;
- Expenses for the repair or maintenance of a wheelchair, hospital-type bed or similar durable medical equipment; orthotics, special shoes, spine and arch supports, heel wedges, sneakers or similar devices unless they are a permanent part of an orthopedic leg brace;
- Expenses incurred in connection with the voluntary taking of a poison or inhaling gas;
- Expenses incurred in connection with obesity treatment or weight reduction including all forms of intestinal and gastric bypass surgery, including the reversal of such surgery even if the covered person has other health conditions that might be helped by a reduction of obesity or weight;
- Expenses for replacement of artificial limbs or eyes; removal of breast implants; or expenses for a service or supply whose primary purpose is to provide a covered person with: 1) training in the requirements of daily living; 2) instruction in scholastic skills such as reading and writing; 3) preparation for an occupation; 4) treatment of learning disabilities, developmental delays or dyslexia; or 5) development beyond a point where function has been demonstrably restored.
IHC Coverage, Benefits, & Exclusions Documents
Petersen Coverage, Benefits, & Exclusions Documents
Petersen 2017 Short Term Major Medical