Texas Short Term Health Insurance
A Short Term Medical Plan is temporary medical insurance that provides comprehensive protection against unexpected health care health care expenses. Policies can be purchases from 30 days up to 1 year. The application process is simple with only a few qualifying questions to answer and coverage can begin as early as the next day.
Short Term Medical Insurance is perfect for individuals who are:
- Recent college graduates
- Between jobs or laid off
- Waiting for employer-sponsored coverage
- Losing dependent status
- Looking for a lower-cost alternative to COBRA
- Recently retired and not eligible for Medicare
- On strike
The Assurant short-term medical plan allows you to choose your doctors and hospitals and pays for all covered expenses once your deductible and coinsurance amounts have been met. First, you pay your deductible, next Assurant Health pays 100%, 80%, 50% of the next $10,000 (this is called your coinsurance).
Once your deductible and coinsurance are paid, Assurant Health pays 100% up to the policy limits of $2 Million. Plus, if you choose a $500 or greater deductible, only one deductible needs to be satisfied for your entire family.
| Benefit | 6 Month Plan |
| Length of Coverage | 30 – 185 days Up to 6 monthly payments |
| Deductible Amount you pay toward covered expenses before the plan pays benefits |
$1,000, $2,500, $3,500 |
| Rate of Payment (Coinsurance) Percentage of covered expenses we pay after the deductible |
100%, 80%, 50%
Only the 80% coinsurance option is available with the $1,000 deductible plan. The 100%, 80%, and 50% coinsurance options are available with the $2,500, and $3,500 deductible options. |
| Out-of-Pocket Maximum The amount of money an individual pays toward covered hospital and medical expenses. Does not include deductible |
For the 100% coinsurance option, the out-of-pocket is $0.
For the 80% option, the out-of-pocket maximum is $2,000 for one individual. ($4,000 for 2 individuals, and $5,000 for 3 or more individuals) For the 50% option, the out-of-pocket maximum is $5,000 for one individual. (It is also $5,000 for 2 or more individuals) |
| Doctor Visits | Covered |
| Prescription Drugs | Covered |
| Hospital Benefits Inpatient and Outpatient |
Covered |
| Emergency Room Care | Covered |
| Ambulance | Covered |
| Outpatient ServicesServices performed outside a hospital | Covered |
| X-Ray and Laboratory | Covered |
| Transplants | Covered |
| Lifetime Benefit Maximum The total maximum amount the plan pays |
$2 million |
The Blue Cross and Blue Sheild of Texas SelecTEMP PPO Plan is an affordable short-term health insurance plan that provides individuals and families essential protection against unexpected accidents or illness. This plan utilizes the Blue Cross Blue Shield PPO network of doctors and hospitals and provides coverage from 1 – 11 months.
SelecTEMP PPO is your temporary health insurance solution if you are:
- Experiencing a gap in employer coverage or can’t afford COBRA.
- Waiting for employer coverage to begin.
- Between jobs or laid off
- Losing dependent status
- Looking for a lower-cost alternative to COBRA
- Recently graduated and still seeking your dream job.
- Age 64 and about to retire, but not yet eligible for Medicare.
SelecTEMP PPO covers many of the most costly health care services, including:
- Inpatient and outpatient medical, surgical and hospital services.
- Diagnostic services.
- Emergency care
- Office visits
- Prescription drug coverage
- Physical, occupation and speech therapy
SelectTemp PPO – Summary of Coverage
| Benefit | In-Network | Out-of-Network |
| Length of Coverage | 1 – 11 months | |
| Deductible (individual) Amount you pay toward covered expenses before the plan pays benefits. The family deductible is 2 times the individual deductible. |
$500 $1,000 $1,500 $2,000 $2,500 $5,000 |
$1,000 $2,000 $3,000 $4,000 $5,000 $10,000
|
| Rate of Payment(Coinsurance) Percentage of covered expenses BCBS pays after the deductible |
80% | 60% |
| Out-of-Pocket Maximum The amount of money an individual pays toward covered hospital and medical expenses. Does not include deductible |
$1,000
($2,000 for 2 or more individuals) |
$2,000
($4,000 for 2 or more individuals) |
| Lifetime Benefit Maximum The total maximum amount the plan pays |
$5 million | $5 million |
Short Term Medical vs. COBRA
A short term health plan is an excellent alternative to expenseive COBRA premiums for most healthy individuals. Individuals who will need (or soon need) medical care for an exisiting chronic medical condition should elect COBRA since short term medical insurance does not cover pre-existing conditions. The table below illustrates the major differences between short term health insurance and COBRA.
Short-term medical insurance vs. COBRA
| Short Term Medical | COBRA Insurance | |
| Type of Coverage | Major medical coverage, including inpatient & outpatient care | Same as previous benefits |
| Significant exclusions | Pre-existing conditions, wellness benefits | All previous exclusions |
| Choice of doctors | Free to choose any doctor or hosptial | If previous coverage was PPO or HMO, choice limited to in-network providers |
| Price | Up to 70% less expensive than COBRA coverage, depending on insured’s age, city of residence, and cost of COBRA | Up to 102% of total price of employer’s plan. The 2008 median price in Texas for single coverage is $361/month |
What Short Term Medical Plans Cover
Short Term Medical Insurance plans allow you to choose any doctor or hospital and do not limit you to in-network providers. Once your deductible and coinsurance amounts have been met, the insurance company pays for all covered medical, hospital, and surgical surgical expenses. his includes physician services, prescriptions, X-ray, laboratory services, inpatient hospital stays, inpatient and outpatient hospital surgeries, anesthesia services, skilled nursing facility care and rehabilitation up to a lifetime maximum of $2 million.
Prescription Coverage
Prescriptions are covered under Assurant short term medical plans, but there is no copayments. When you present your STM prescription card, which is part of your ID card, at a participating pharmacy, you will receive a negotiated disounted and then will be subject to deductible and coinsurance amounts. Below are some real-life savings examples of some commonly used precriptions with the Short Term Medical prescription drug card.
Short Term Medical Prescription Drug Card Discounts
| Drug | Strength and quantity |
Retail price | Price using card |
Percentage savings |
| Lipitor | 10 mg, qty 30 | $96.99 | $69.99 | 28% |
| Levaquin | 500 mg, qty 10 | $145.99 | $98.79 | 32% |
| Nexium | 20 mg, qty 30 | $179.99 | $125.89 | 30% |
| Singulair | 10 mg, qty 30 | $124.99 | $88.24 | 29% |
| Zyrtec | 10 mg, qty 30 | $83.99 | $56.59 | 33% |
Retail pricing based on Walgreens Pharmacies in Milwaukee and Oconomowoc, Wisconsin, June 6, 2007. Pricing examples are for illustration purposes only. Prices are subject to change without notice and may vary by region. Payment must be made at the time of service to receive discount. Prescription drug savings do not guarantee benefits under your STM plan.
Short Term Medical Plan Exclusions
Short Term Medical Insurance coverage is designed to protect you in the event of an unexpected illness or injury. Because of this, medical insurance coverage for preventive care, pre-existing conditions, physicals, pregnancy, immunizations, dental or eye care services are not covered by short term medical plans. Any medical expense incurried outside the U.S. or Canada is also excluded from temporary insurance plans. Individuals that need medical coverage outside the country can get an international travel insurance policy.
Payment Options
Most short term health insurance programs will make the applicant pay the entire amount of the premium for the policy up front. With Assurant health insurance, you get the option of either paying for the entire amount up front, or making a monthly payment.
Single payment option: This is ideal if you know the exact number of days that your coverage is needed. The minimum number of days you may apply for is 30 days, the maximum is 365 days. No refunds are available after the 10-day free look period.
Monthly payment option: If you are unsure of how long you will need coverage, this option would be the best for you. The “pay as you go” option gives you the flexibility to continue coverage for as long as it is needed, or simply stop payments and discontinue the plan once your temporary health insurance need ends.
You can pay with either Visa or Master Card, automatic charge to a checking account, or by check.
If you pay your initial 35 day premium by MasterCard or VISA, each additional 30 days of coverage will be automatically charged to your account for up to 365 days. If your temporary medical insurance need ends prior to this date, simply call 1-800-800-5453 and the automatic account charge will be stopped. Seven day advance notice is required to ensure future account charges are stopped.
If you choose to pay monthly by the automatic charge to checking account, you must submit the first 35 day premium via check along with a separate voided check. All subsequent monthly payments will be automatically debited from your checking account for up to 365 days. If your short term health insurance needs end prior to this date, simply call 1-800-800-5453 and we will stop the automatic account charge. Seven day advance notice is required to ensure future account charges are stopped.
If you pay your initial 35 day premium by check, you will be sent a sheet of payment coupons shortly after you receive your policy. Each coupon is for an additional 30 days of coverage.
Purchasing an Additional Plan
Short term health insurance plans are not renewable. However, if your temporary health insurance need continues beyond your policy period, you may apply for a new plan under the following circumstances:
- No claims were submitted while covered under a previous short term medical insurance plan
- There has been no significant change to your health
- Any previous or current health condition or symptom will be considered a pre-existing medical condition that will not be covered under a new plan.
How HIPPA Legistlation affects Short Term Medical Plans
Under HIPAA, short term medical policies are generally exempt from the Federal Health Insurance Portability and Accountability Act (HIPPA). 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.
In Texas, an individual must maintain health coverage for 18 consecutive months without any break in coverage longer than 63 days to avoid pre-existing condition limitations. 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