Short Term Medical Plans

• No Affiliation with the Affordable Care Act
• Has pre-qualification questions which determine applicant eligibility
• Excludes any payment claims resulting from a pre-existing condition
• Maximum cap on coverage from $100k to $5 million
• Term length of plan from 3 months to 12 months (state availability applies)
• Clearly defined exclusions for named procedures
• May include doctor office visits covered at set co-pay
• Effective date within 24 hours
• Rate guarantee for the lifetime of the policy
• Ability to apply for coverage year-round
• Plans are typically 40% to 60% less than industry average
• Most plans include Tele-health visits which allows you to speak with a licensed physician who is able to diagnose and prescribe medications over a video call or text message

Indemnity/Limited Medical Plans

• No affiliation with the Affordable Care Act
• Designed to be a supplement to major medical insurance, not a replacement for major medical coverage.
• Plan pays fixed dollar amounts per the schedule of benefits.
• Most plans are guaranteed issue (excluding specific carriers)
• Most plans have a 12 month waiting period for pre-existing conditions
• Limited plans are designated to be a supplement to major medical insurance, not a replacement for major medical insurance.
• Indemnity plans are frequently known as "First Dollar Plans"
• Most indemnity plans have a contracted network of facilities and physicians
• These plans were designed to cover what major medical plans don't (Deductible /Out of Pocket)

Affordable Care Act

• Meets the "minimum essential coverage" defined by the affordable care act requirements
• Covers Preventive / Wellness visits at 100%
• Insured for an Infinite amount, no cap in benefits
• No exclusions for pre-existing conditions
• Household size and income (IRS filing) are required
• A subsidy may be applied towards premium
• If an applicant qualifies for a subsidy, income verification may be required
• Must cover any claim (if medically necessary), even if resulting from a pre-existing medical condition
• Enrollment is subject to a defined period, known as "open enrollment." Nov. 1st - Dec. 15th
• To enroll outside of open enrollment, an applicant must have experienced a Qualifying Life Event (QLE)
• If a QLE has occurred during the 60 day window, the applicant may apply during the Special Enrollment Period (SEP)
• Must notify the marketplace of any changes in household throughout the calendar year
• Choice of Bronze, Silver or Gold plans