Individual Vs Short Term

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Individual Vs Short Term

Those who opt for individual health plans are usually self-employed or work in companies where their employers do not offer group coverage. These people usually contact an agent and buy an individual policy. As far as benefits and protections are concerned, it must be said that they are much less attractive than what job-based group coverage can offer. To obtain health insurance, they must go to an agent and purchase an individual policy. The nature of individual policies is different in different states also.
Still, individual health insurance coverage is a perfectly viable option for many Americans. However, those who are going to purchase it must be aware of their rights and protections under the law so that they are not taken for a ride.

In most states, individual policies follow these rules apply:

Guaranteed issue: Your application for individual health insurance cannot be turned down based on your health status.

Guaranteed renewability: Your health insurance cannot be cancelled if you fall sick.

Limits on Pre-existing Conditions Exclusions: These limits are different in different states. Insurers in some states can impose exclusion riders that completely eliminate coverage for pre-existing conditions for the entire life of the policy.

Portability: Portability requirements also vary by state. In some states, you are not entitled to any credit for prior coverage and must wait out the entire pre-existing condition exclusion period.

COBRA continuation coverage: COBRA applies to job-based coverage only.

Short term medical insurance can fill the temporary coverage gap that can occur when you are between jobs, or laid off, or waiting for group plan etc. You and your dependents may qualify for coverage provided you fulfill certain age, health, and U.S. residency conditions. A short term coverage may not be as extensive as that under a permanent policy, but it normally covers basic charges in the event of an accident or sudden illness.
Short term medical plan may subject you to co-payments and benefit limits as most other plans do.

Short term medical plan coverage usually includes: your choice of doctors and hospitals, charges for inpatient and outpatient services, hospital room and board charges, intensive care unit charges, ambulance services, diagnostic lab exams and x-rays and prescription drugs. It also generally excludes: pre-existing conditions, routine medical tests, dental care, pregnancy and childbirth expenses, intentionally self-inflicted injury, expenses not medically necessary and medical expenses incurred outside the United States.

Short term medical plans are generally available for periods of 30 to 180 days, although some plans offer initial coverage for as long as one year. While you can renew your plan, short-term coverage usually cannot continue for more than 365 total days.

In addition to insurance agencies, some professional organizations and associations are known to offer short-term medical insurance as well. Coverage can often be implemented immediately, sometimes the same day that one’s application is received. Many insurance companies offer you a choice between a single payment or a monthly premium, as well as a choice of plan deductible limits. They may also offer you free look period (mostly the first 10 days after delivery of the policy) during which you are free to cancel your policy for a full refund.

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