Company Information

Short term limited duration health insurance is designed to provide a fast, flexible, and budget-friendly option to help bridge a gap in coverage.

UnitedHealthcare Choice Network (EPO) DE, FL, IA, IN, KS, LA, MI, MO, MS, NE, NV, PA, SC, TN, TX, WI, WV, WY: There are no non-network benefits. You must use a network doctor or hospital. These plans pay no benefits for out-of-network expenses except for emergencies. Emergency treatment from a non-network provider will be treated as network eligible service.

Short-Term Medical Secure Plans – Plan Comparison

Plan Designs	Secure Edge	Secure Bridge	Secure Net
Office visit copay	$50 – 1 copay for 30-90 days 2 copays for 91-180 days      3 copays for 181-364 days	$50 – 1 copay for 30-90 days/             2 copays for 91-180 days 3 copays for 181-364 days	$50 – 1 copay for 30-90 days/ 2 copays for 91-180 days/              3 copays for 181-364 days
Deductible	$1,000 $2,500 $5,000 $7,500	$1,000 $1,500 $2,500 $5,000 $7,500 $10,000	In-Network: $3,500 $5,000 $7,500 $10,000 Out-of-network deductible is two times the in-network deductible.
Coinsurance and out-of-pocket (not including deductible)	20% – $1,000, $2,000, $3,000, $4,000 50% – $2,500, $5,000, $7,500, $10,000	20% – $1,000, $2,000, $3,000, $4,000 30% – $1,500, $3,000, $4,500, $6,000 50% – $2,500, $5,000, $7,500, $10,000	In-Network: 0%1 – $0 20% – $3,500, $5,000, $7,500, $10,000 30% – $3,500, $5,000, $7,500, $10,000 Out-of-network coinsurance is 50% and the out-of-pocket is two times the in- network out-of-pocket ($7,000 for 0%/$0).
Maximum benefit	$1,000,000	$2,000,000	$2,000,000

Covered Expenses	Secure Edge	Secure Bridge	Secure Net
Doctor administering anesthetics	Up to 20% of the surgeon’s benefit2	Up to 20% of the surgeon’s benefit	No benefit-specific limit
Assistant surgeon	Up to 20% of the surgeon’s benefit2	Up to 20% of the surgeon’s benefit	No benefit-specific limit
Surgeon’s assistant	Up to 15% of the surgeon’s benefit2	Up to 15% of the surgeon’s benefit	No benefit-specific limit
Ambulance, ground or air services	Up to $250 per occurrence	Ground: Up to $500 per occurrence Air: Up to $1,000 per occurrence	No benefit-specific limit
Organ, tissue or bone marrow transplants	Up to $150,000 per coverage period	Up to $150,000 per coverage period	Up to $150,000 per coverage period
Acquired Immune Deficiency Syndrome (AIDS)	Up to $10,000 per coverage period	Up to $10,000 per coverage period	Up to $10,000 per coverage period
Emergency room	Up to $500 per day	No benefit-specific limit	No benefit-specific limit
Outpatient hospital surgery or ambulatory surgical center	Up to $1,000 per day	No benefit-specific limit	No benefit-specific limit
Hospital room, board and general nursing care	The amount billed for semi- private room or 90% of the private room billed amount, up to $5,000 per day	The amount billed for semi- private room or 90% of the private room billed amount	The amount billed for semi-private room or 90% of the private room billed amount
Intensive care unit	Three times the amount billed for a semi-private room or three times 90% of the private room billed amount, up to $6,250 per day	Three times the amount billed for a semi-private room or three times 90% of the private room billed amount	Three times the amount billed for a semi- private room or three times 90% of the private room billed amount
Inpatient doctor visits	Up to $500 per confinement	No benefit-specific limit	No benefit-specific limit

All plans Include one-time $25 enrollment fee 

Through the STM plan, you have access to the UnitedHealthcare Choice Network (EPO) DE, FL, IA, IN, KS, LA, MI, MO, MS, NE, NV, PA, SC, TN, TX, WI, WV, WY: There are no non-network benefits. You must use a network doctor or hospital. These plans pay no benefits for out-of-network expenses except for emergencies. Emergency treatment from a non-network provider will be treated as network eligible service.

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Company Information

National General’s Short Term Medical insurance gives you a plan to face those unpredictable moments in life with confidence. It provides the financial protection you need from unexpected medical bills and other health care expenses, including:

• Doctor visits and some preventive care
• Emergency room and ambulance coverage
• Urgent care benefits, and more

National General Health Insurance Feature Highlights

• Coverage Period Maximum of $250,000 and $1,000,000
• Deductible options of $1,000, $2,500, or $5,000
• Coinsurance Percentage of In-Network plan 100/0, 80/20 and 50/50
• Doctor Office Visit and Urgent Care Co-pay of $50

Standard Issue Plans

Deductible*	Coinsurance	Out-Of-Pocket Max	Coverage Period Max
$1,000	50% / 50%	$2,500	$250,000
	80% / 20%	$1,500	$1,000,000
$2,500	50% / 50%	$2,500	$250,000
	80% / 20%	$1,500	$1,000,000
	100%	$0	$1,000,000
$5,000	50% / 50%	$3,750	$250,000
	80% / 20%	$2,000	$1,000,000
	100%	$0	$1,000,000
$10,000	100%	$0	$1,000,000
$25,000	100%	$0	$1,000,000

* Per-person deductible and out-of-pocket amounts are capped at 3x the individual amounts for a family greater than three. This means that when three insured family members satisfy their individual deductibles and out-of-pocket amounts, the remaining individual deductibles and out-of-pocket amounts will be deemed as satisfied for the remainder of the coverage term. 2 Short Term Medical plans do not cover costs associated with pre-existing conditions.

Choose Your Provider

National General’s Short Term Medical insurance gives you access to the Aetna Open Choice PPO network, one of the largest networks in the country with no referral required.

Aetna PPO Provider Finder

Short Term Health Insurance and Network Breadth

While more than half of ACA plans lack out-of-network coverage,¹⁴ all short term insurance plans offered through AgileHealthInsurance have broad network coverage ensuring that an enrollee has access to quality health care providers. If an enrollee goes out of network and finds that the provider does not accept their short term insurance, in many cases, the enrollee can get reimbursed by submitting their claim to the insurance company. To be sure, enrollees should check with their insurance company first. Short Term insurance plan premiums are also significantly less expensive than unsubsidized premiums for health plans sold on the exchanges. Compared to the average costs for 2016 Obamacare bronze plans for individuals aged 30, 40, and 50, short term insurance plans are 25 percent less expensive. Savings are greater for younger individuals without pre-existing conditions. For healthy males, aged 30, a short term insurance premium is 54.93% less expensive than an Obamacare Bronze plan.¹⁵ It should be noted that unlike ACA plans, short term insurance plans do not cover medical conditions that existed prior to enrollment.

Affordable Care Act plans typically have broader benefits than found in Short Term health insurance and, without the premium subsidies available to some qualified purchasers, cost much more than Short Term plans.

All health plans that fit in the Affordable Care Act must have “10 Essential Health Benefits.” Short Term health insurance plans, in comparison, do not have a standardized set of benefits. Short Term plans usually offer what would be described as “major medical coverage” that covers healthcare costs in the event of serious medical issues. Most Short Term plans also cover normal doctor visits for routine illnesses and injuries.

Considering the prevalence of ACA insurance plans with narrow networks, consumers should heavily research plans before enrolling to ensure that they are not putting themselves at risk for high out-of-network costs.

For those needing broad coverage, short term insurance may be a good option. 100 percent of short term insurance plans sold through Independent Health Agents have out-of-network coverage. Enrollees in these plans can be ensured that they will have access to high quality providers without incurring unknown and potentially sizable costs. The chart below details some of the major benefit differences between Short Term health insurance plans and Affordable Care Act plans. It is important to note that Affordable Care Act plans do not deny care for pre-existing conditions nor do they reject applicants based on health problems.

	Short Term Health Insurance Plans	Affordable Care Act Plans
Coverage availability	Apply any time and get coverage as early as the next day	Apply only during Open Enrollment (or Special Enrollment due to a qualifying event) and get coverage in 2-6 weeks
Coverage duration	Coverage duration is less than three months. Many plans can be cancelled at any time.	As long as the plan is available. You can change plans during Open Enrollment (or Special Enrollment with a qualifying event)
Prescription drug coverage	Many Short Term health insurance plans provide a drug discount card but do not provide drug coverage. Some newer plans have a prescription drug coverage option for generic drugs not associated with a pre-existing condition. Brand name drugs and specialty drugs are typically uncovered.	Minimum of 1 drug per class must be covered but the minimum number of drugs per class is often more due to the benchmark chosen for each particular state.
Maternity and newborn care	Complications of maternity are covered but not standard childbirth services.	Full coverage. Applicants cannot be denied based on pregnancy as a precondition.
Mental health services	Coverage is included only when mandated at state level.	Coverage included, but states vary on their definition of “mental health” services, so while some do include learning disabilities or conditions like Autism, other states do not.
Substance use disorder services	Coverage is included only when mandated at state level.	All ACA plans have full coverage.
Rehabilitative and habilitative services	Coverage is included only when mandated at state level.	All ACA plans have full coverage.
Preventive care	Some plans have selected preventive care benefits with cost-sharing. However, most plans do not cover preventive care services.	Preventative services must be provided without cost-sharing (cf.https://www.healthcare.gov/preventive-care-benefits)
Pediatric services – oral and dental care	Coverage is included only when mandated at state level.	All ACA plans have full coverage.
Healthcare provider networks	Short Term plans typically have broad acceptance among healthcare providers. Some have a preferred network with negotiated pricing for healthcare services and a larger non-preferred network where the plans pay ‘usual and customary’ fees for covered healthcare.	These plans have been noted for a significant use of “narrow networks” to increase the ratio of enrollees to healthcare providers.
Uninsured tax penalties	The maximum penalty is the national average premium for a bronze plan. For 2016, the tax is 2.5% of modified adjusted gross household income or $695 per person, whichever is greater.	ACA plans meet the requirements for avoiding the tax penalty.
Coverage of pre-existing conditions	These plans evaluate health status and pre-existing conditions when processing an insurance application and determine whether the applicant is approved or rejected for coverage.	These plans do not consider health status or pre-existing conditions when processing an insurance application.

Short-term health insurance is major medical insurance for a set period of time. It covers doctor visits, hospitalizations, emergency care, lab tests, x-rays, and other common medical needs.

No. Short-term health insurance is a streamlined insurance plan. While it includes many benefits, it does not cover all 12 of the minimum essential benefits that the Affordable Care Act plans are required to cover. For example, in most cases, short-term health insurance will not include maternity care or mental health services.

In addition, short-term health insurance involves an application. Depending on your health status, your application may be declined or your pre-existing condition may be excluded. Obamacare guarantees that all applicants and their pre-existing conditions will be covered, no matter what your health status.

You can apply at any time. There is no fixed open enrollment period. On Texashealthagents.com, you can submit your application and, if approved, your insurance can be effective within as little as 24 hours.

Within the first ten days of the effective date of your plan, you can cancel and will receive a full refund. For cancellation beyond the ten days, you simply email or call the insurance company with your reason for cancelling. If you cancel before your policy period is over, in most cases you will be given a prorated refund based on the unused benefit.

Within the last 5 years if you have been diagnosed, treated, or taken medication for any of the following conditions, term health insurance cannot be issued: Cancer or tumor, stroke, heart disease including heart attack, chest pain or had heart surgery, COPD (chronic obstructive pulmonary disease) or emphysema, Crohn’s disease, liver disorder, degenerative disc disease, rheumatoid arthritis, kidney disorder, diabetes, degenerative joint disease of the knee, alcohol abuse or chemical dependency, or any neurological disorder; HIV or AIDS; or if you are now pregnant or in the process of adoption.

If you are looking for insurance to cover your pre-existing conditions, we can refer you to an agent who can help you find a health insurance plan that to cover these conditions:

• For ACA/Obamacare Plans: 312-726-6565