TEMPORARY HEALTH INSURANCE
(SMART Short Term Medical) – FREQUENTLY ASKED QUESTIONS

Click on a question below to see the answer and more information on the topic or call us at 877-267-3752 and we will do the work for you!

If I apply for an insurance plan, am I obligated to buy?

No. You are under no obligation to buy a health insurance plan when using our site.  After submitting your application you may cancel it at any time during the underwriting process.  When you submit an application you will typically include your credit card number, bank account information, or a check for the initial premium payment.  Most insurance companies will not charge your card, debit your account, or deposit your check until you are approved.  If you are charged or your check is cashed and you are denied for coverage or cancel your application prior to approval, the insurance company will issue a refund.  A few insurance companies will charge an application fee .  You will be notified at the time of application if the plan you chose require an application fee.  Please note that these fees are non-refundable.

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What is the best health insurance plan for me?

Choosing between different health insurance plans isn't always easy.  There is no one "best" plan for everyone.  the est match for your and your family may be different that the best match for someone else.  In order to help you answer this question, here are a few things to consider: 1. Are you going to need long term coverage or just something for short term? If you are between jobs for 1-6 months,  you may want to look int our short term coverage options.  Alternatively, if you have no prospects of receiving group health insurance coverage through an employer, you may value the stability and increased benefits offered through an individual or family health plan option. 2. Are you looking for basic coverage or more comprehensive coverage? Some insurance plans offer basic coverage to cover  you in case of a major accident or illness.  These insurance plans typically have a lower month premium than plans with more comprehensive coverage and may be appropriate  for people who intend to use their insurance primarily in the event of a serious illness or accident. 3. Would you rather pay for your services before you use them or when you use them? Typically, the higher the monthly premium that you pay, the less you will pay per doctor's visit in co-payments and deductible.s  if you choose a health insurance plan with a low monthly premium, you're likely to have a higher co-payment or deductible.  If you don't anticipate making frequent  use of your health insurance coverage, a higher deductible plan with a lower monthly premium may suit you best.

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What is Temporary Health Insurance?

Temporary Health Insurance (A.K.A. Short Term Medical) is an ideal type of medical insurance for those who are: unemployed, in between jobs, recent college graduates, in need of an alternative to COBRA. You will see that this coverage provides many features while maintaining a very competitive premium structure.

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Who is eligible for short term medical coverage?

You and your spouse under age 65 (and not eligible for Medicare) and you and your spouse's unmarried dependent children under age 19 (or under age 25 if a full-time student) who have a social security number and can answer "No" to the seven health questions on the application. Children age 19 and over should apply separately.   Child-only coverage is available for ages 2 through 18. The application must be completed and signed by the parent or legal guardian.

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How does short term medical coverage work?

The benefit options for covered expenses are per insured person per coverage period. First, you meet your deductible. Choose from four options: $250, $500, $1,000 or $2,500. Then we pay 80% or 50% of the next $5,000 of covered expenses. After this, we pay 100% of covered expenses up to your lifetime maximum of $1 million per certificate.

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Do I have the option to select my doctors, hospitals, and medical providers with short term medical insurance?

Yes. You have the freedom to go to any of the doctors and hospitals of your choice. This plan is not an HMO or PPO.

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How long may I be insured under this short term medical plan?

STM is issued on a temporary need and expires at the end of the period applied for (up to 6 months at a time). If the need for temporary health insurance continues, you may apply for another new STM* coverage period. Your application is subject to the eligibility and underwriting requirements. Furthermore the coverage is not continuous. Any condition that incurred expense during the last coverage period will be treated as a Pre-Existing Condition, and excluded under the next coverage period. Applicants over the age of 64 are not eligible to re-apply for coverage. *Only if an STM Plan is available in your resident state at that time; plan benefits, premium and features may vary.

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Are pre-existing conditions covered under short term medical insurance?

This plan does not provide benefits for pre-existing conditions, work related conditions, and preventive care. If you or a dependent have an existing health condition, you may want to consult with your independent insurance agent prior to applying for or changing health/medical insurance. Insurance fraud is a crime. Any person who, with intent to defraud or knowingly facilitates a fraud against an insurer, submits an application or files a claim containing false, deceptive and/or incomplete information is subject to civil and criminal prosecution.

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Are there expenses not covered under this short term medical plan?

Yes, this plan is designed to protect you in the event of an illness or injury and is not meant to cover routine exams and preventive care. Short Term Medical is for temporary coverage only and therefore does not include some of the benefits a permanent health plan offers. Please refer to the Exclusions and Limitations section of this web site.

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Can I get a refund of my premium if I am not satisfied with this short term medical plan?

Once you receive your Certificate of Insurance, carefully review all information. If you are not satisfied for any reason, return the Certificate of Insurance (within 10 days of receipt) with your written request for cancellation to InsuranceTPA.com. Coverage will be cancelled as of the effective date and you'll receive a full premium refund (minus admin fees), no questions asked. Send written request for cancellation with your signature to: InsuranceTPA.com PO BOX 998 Janesville, WI  53547

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How is short term medical coverage billed?

After submitting your enrollment form with first month's premium, you will then be billed monthly or you can choose to prepay. You indicate on your enrollment form how you wish to pay for your coverage. You may elect to be billed for the monthly premiums (plus the administration fee), OR you can select one of the other two payment methods: (1) Automatic Pre-authorized Bank Withdrawal; or (2) Credit Card – MasterCard and Visa are accepted.

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When does short term medical coverage begin?

The insurance can be effective as early as 12:01 a.m. the next day after the transmission date. However, the applicant can choose a later effective date not to exceed 60 days from transmission date. Coverage ends on expiration date listed in your coverage document.

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Can I change my deductible on my short term medical plan?

No, Deductible changes cannot be made after the policy has been issued.

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Can I add additional family members to my short term medical plan?

No, to add additional family members you need to have the new family members apply on a separate policy.

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Can I change my effective date on my short term medical plan?

No, once the policy has been issued you cannot change the effective date.

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How long can I purchase short term medical coverage?

The minimum amount of days you can purchase is 30.  You may purchase coverage for up to 6 months.  After the 6 months you may apply for a new short term medical plan.

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What is the difference from monthly payment option compared to single payment option with a short term medical plan?

Month-to-month coverage is available for persons who do not know how long they will need coverage.  Coverage is provided month-to-month until you terminate coverage (written request) or you reach the 6 month maximum coverage. Single payment coverage option is the exact number of days of coverage you want.  This option works great if you know exactly the amount of days of coverage you need.  For example; if you have group coverage starting in 45 days you can purchase 45 days of temporary health insurance coverage to satisfy the gap.  Single payment option also provides a discount in the rates.

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After my short term medical coverage ends, may I apply again for additional months?

Temporary Health Insurance plans are not renewable.   However, if your temporary need continues beyond your policy period, you may apply for a new plan under the following circumstances:

  • No claims were incurred under a previous Short Term Medical plan.
  • There has been no significant change in your health.
  • You still meet the eligibility requirements to obtain a new policy
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. There is no continuous coverage between plans -- therefore your new plan will not provide benefits for any condition or symptom which began during a previous plan. In addition, no benefits are available for any period in which you are not covered by a Short Term Medical plan.   To obtain an additional plan, you must complete a new enrollment form. If the enrollment form is approved, a new plan will be issued.

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Is a Short Term Medical plan considered “creditable coverage” under HIPAA?

Under HIPAA, Short Term Medical coverage is generally considered creditable coverage to help satisfy any pre-existing condition period.* 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
* State reform legislation may vary; consult your state for specific rights and requirements.  

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