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Authorized Broker

MATTHEW HAHN

Matthew Hahn

POB 3911, PAGE, AZ 86040
Phone: (800) 543-3505 | Fax: (888) 228-1898

INFO@CRITERIONFINANCIAL.COM

Short-term Medical Insurance

Between health insurance plans? Consider Interim Coverage

If you don’t have health insurance or are between plans, take a look at Interim Coverage. Interim means temporary, so it’s sometimes called short-term coverage or short-term medical.

Keep in mind that Interim Coverage isn’t the same as having an annual health insurance plan under the Affordable Care Act (ACA). For example, it doesn’t provide the same benefits and it won’t excuse you from tax penalties for being uninsured.

It does, however, offer you protection against unforeseen medical expenses such as accidents or hospitalization, as long as it's not from a pre-existing condition. Check out the examples below to see if this might be a solution for you.

To get more information about Short-term Medical Insurance, contact your Broker.

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When to get short-term coverage

Interim Coverage can give you short-term protection for 30-90 days and can begin as soon as the day after you’re approved. Here are a few examples of when to consider this type of health plan:

  • If you started a new job and there’s a waiting period before your benefits begin
  • If you didn't buy health insurance during the annual Open Enrollment Period
  • If your annual plan doesn’t go into effect for a few weeks
  • If you need temporary insurance for 30-90 days

What's Covered

Office Visit Copay


  • 1 copay visit
$50 copay per visit
Deductible
  • You can choose the amount for your Individual or Family deductible from the options shown to the right.
  • Please note that each person’s deductible must be paid before their coinsurance benefits will begin.
  • If you sign up for a Family plan, the most you’ll pay for your deductible is equal to three Individual deductibles. This means if you have four or more members on your plan, you’ll pay the equivalent of three Individual deductible amounts. But if you have two members, you’ll only pay two times the individual deductible amount.

Deductible Option Amounts

Individual Family
$1,000 $3,000
$1,800 $5,400
$2,500 $7,500
$5,000 $15,000
Coinsurance Percentage and Out-of-Pocket
  • After you meet the deductible, you will begin to pay the coinsurance percentage of covered expenses until you reach the out-of-pocket amount.
  • The out-of-pocket amount only includes covered expenses paid after the deductible is met, and does not include the actual amount of the deductible.
  • Once you reach the out-of-pocket amount, your plan will cover the remaining percentage of covered expenses up to the maximum benefit listed below.
Coinsurance Out-of-Pocket
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
Coverage Period Maximum Benefit $2,000,000
Office Visit Copay

The number of copay-eligible office visits you’ll receive depends on the coverage period.

  • 1 copay visit when you buy 30-90 days of coverage
  • 2 copay visits when you buy 91-180 days of coverage*
  • 3 copay visits when you buy 181-364 days of coverage*

*Coverage effective before March 31, 2017 can cover you through the end of the year. After April 1, coverage is available for up to 90 days.

$50 copay per visit
Deductible
  • You can choose the amount for your Individual or Family deductible from the options shown to the right.
  • Please note that each person’s deductible must be paid before their coinsurance benefits will begin.
  • If you sign up for a Family plan, the most you’ll pay for your deductible is equal to three Individual deductibles. This means if you have four or more members on your plan, you’ll pay the equivalent of three Individual deductible amounts. But if you have two members, you’ll only pay two times the individual deductible amount.

Deductible Option Amounts

Individual Family
$1,000 $3,000
$1,800 $5,400
$2,500 $7,500
$5,000 $15,000
Coinsurance Percentage and Out-of-Pocket
  • After you meet the deductible, you will begin to pay the coinsurance percentage of covered expenses until you reach the out-of-pocket amount.
  • The out-of-pocket amount only includes covered expenses paid after the deductible is met, and does not include the actual amount of the deductible.
  • Once you reach the out-of-pocket amount, your plan will cover the remaining percentage of covered expenses up to the maximum benefit listed below.
Coinsurance Out-of-Pocket
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

Who can apply

  • Individuals under age 65. (Your application for coverage includes enrollment in Communicating for America, Inc.)
  • Spouses who are age 18 to 64.
  • Dependent children up to age 18, or 26 if full-time student. A child-only plan is available for children ages 2 to 17.
  • Coverage is not guaranteed. Applicants must apply and answer underwriting questions in order to receive coverage. Some applicants will not be eligible.

The difference between Short-term Medical and Affordable Care Act (ACA) coverage

Short-term Coverage (not ACA-compliant) ACA Coverage
When does coverage start? Usually within 1-14 days Usually within 2-6 weeks
Can it protect me from the ACA tax penalty?
No Yes
Can I buy it year-round at any time? Yes No
Can I be declined because of pre-existing conditions? Yes No
Does it cover maternity care? No Yes
Does it cover prescription drugs? Limited Yes
Does it cover doctor visits? Limited Yes
Does it cover hospitalizations
due to injury or serious illness?
Yes, but typically not for pre-existing conditions Yes
Can I use a government subsidy to
purchase it?
No Yes
Does it have a dollar limit on coverage? Yes No
Can I renew it every year
(as long as the plan is available)?
No, but you can reapply, if needed Yes
When does coverage start?

Short-term Coverage (not ACA-compliant)

Usually within 1-14 days

ACA Coverage

Usually within 2-6 weeks
Can it protect me from the ACA tax penalty?

Short-term Coverage (not ACA-compliant)

No

ACA Coverage

Yes
Can I buy it year-round at any time?

Short-term Coverage (not ACA-compliant)

Yes

ACA Coverage

No
Can I be declined because of pre-existing conditions?

Short-term Coverage (not ACA-compliant)

Yes

ACA Coverage

No
Does it cover maternity care?

Short-term Coverage (not ACA-compliant)

No

ACA Coverage

Yes
Does it cover prescription drugs?

Short-term Coverage (not ACA-compliant)

Limited

ACA Coverage

Yes
Does it cover doctor visits?

Short-term Coverage (not ACA-compliant)

Limited

ACA Coverage

Yes
Does it cover hospitalizations due to injury or serious illness?

Short-term Coverage (not ACA-compliant)

Yes, but typically not for pre-existing conditions

ACA Coverage

Yes
Can I use a government subsidy to purchase it?

Short-term Coverage (not ACA-compliant)

No

ACA Coverage

Yes
Does it have a dollar limit on coverage?

Short-term Coverage (not ACA-compliant)

Yes

ACA Coverage

No
Can I renew it every year (as long as the plan is available)?

Short-term Coverage (not ACA-compliant)

No, but you can reapply, if needed

ACA Coverage

Yes