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Either the Short Term Medical or Tri-Term Medical plans available pair well with any of these indemnity options:
A) Health ProtectorGuard "Hospital & Doctor" fixed indemnity plans, or
B) Accident ProGuard with up to $10k Accident and $10K-$50k Critical Illness benefit, or
C) Accident ProGap with up to $10k Accident, $10k Critical Illness and $2500 Hospitalization benefits.
The options available include the most popular plans this year in the 'Alternatives' market, which is non-ACA off-Marketplace coverage. These plans will NOT cover pregnancy, mental health or substance abuse, and they will exclude any pre-existing conditions in the past 2 years or 5 years, depending on the condition.
The Tri-Term Medical plans will cover allowed pre-existing conditions after 12 months of coverage; whereas, the Short Term Medical will always exclude coverage for any pre-existing conditions within the exclusionary time frame. Both options, however, will provide coverage for any medically necessary expenses that are not pre-existing, and at a much lower premium than full-price ACA or Obamacare are available for.
These plans are medically underwritten, and are subject to height/weight requirements. I've attached a PDF which outlines the 3 Point Plan we've created here at Hummingbird for the Alternatives market. The idea here is to pair either a Tri-Term Medical or Short Term Medical plan with a supplemental indemnity option - like the higher-end 'Health ProtectorGuard' Hospital & Doctor plan, or a basic Accident/Hospital plan for more complete coverage overall from the first dollar of medical expenses. We also recommend combining these with the 3rd Point of the Plan: affordable access to regular primary care.
Note: The deductibles on the Tri-Term and Short Term Medical plans, as well as the benefit levels on the accident plans sent to you are adjustable when you are reviewing the quotes. Make sure to change the selection of benefits on these to see the difference in premiums. Most people select a $5,000 or $10,000 deductible on the Short Term plan, then a benefit level at or near the same amount on the indemnity plan - to leave as little a gap as possible financially.
The Tri-Term Medical plans are brand new, and are becoming popular quickly. You purchase a policy with the deductible and effective date of your choice, starting out as early as the next day. The plans last up to three years, with the deductible(s) resetting annually per person. The Tri-Term 100 pays all medical costs after you reach the deductible, but the Tri-Term 80 has a coinsurance amount due until you reach an additional $2,000 in out of pocket expenses after the deductible is reached.
These Tri-Term plans will not cover any pre-existing conditions that you've had claims on in the past 24 months for the initial 12 months, but would then cover allowed pre-existing conditions after that for the remaining 2 years on the policy. Pre-existing conditions that would not be allowed include things like recent heart attacks or strokes, congestive heart disease, kidney failure, diabetes, cancer, etc. We should look at ACA plans available if we need to deal with one of these conditions.
Short-Term Medical plans offer a significant savings (usually 20-25%) if paid in one Single Payment, versus regular monthly payments. If you have the wherewithal to pay upfront, it makes good sense here. If you decide to cancel the plan later for any reason, the unused portion of premiums would be refunded. Each plan has a minimum 30-day length. The Tri-Term Medical and indemnity plans run month-to-month and do not offer an option or discount to pay upfront. Short-Term Medical plans were recently changed to allow up to 360 days of coverage on one policy in most states. Also, you can purchase 2 plans at one time, with the second plan starting up to 90 days ahead from the date of application. This allows us to provide continuous, guaranteed coverage for up to 449 days straight, with one plan of 89 days followed by a second plan of 360 days on joint applications. One nice benefits of the Short Term plans is the $250 copay for Emergency Rooms, which is subject to an initial 5-day waiting period after purchase for illness/sickness.
The indemnity plan options available have three main choices:
Health ProtectorGuard Select Value "Hospital & Doctor" plan - Fixed indemnity plan with coverage for hospitalization, doctor visits, prescriptions, outpatient imaging or surgery with Unlimited Benefits. Benefits received may be more than actual costs incurred; you would get to retain any extra funds received. Fixed benefit of $3,000/day of hospitalization is paid directly to you, regardless of when another medical plan starts covering expenses charged.
Accident ProGap - Coordinated indemnity plan which will reimburse you medical expenses that arise from an accident basis up to the amount spent, or the benefit limit - whichever is less, with a Critical Illness benefit equal to the accident benefit amount. No extra funds would ever be received by you from the Accident Benefits listed. The Critical Illness benefits listed are a fixed amount and are lump sum with these plans. The Hospital/Sickness benefit is reimbursable.
Accident ProGuard - Coordinated indemnity plan which will reimburse you medical expenses that arise from an accident basis up to the amount spent, or the benefit limit - whichever is less, with Critical Illness benefit amounts from $10,000 to $50,000 available. No extra funds would ever be received by you from the Accident Benefits listed. The Critical Illness benefits listed are a fixed amount and are lump sum with these plans. There is no Hospital/Sickness benefit on this plan. All of these plans are claims-based and benefits are paid directly to you, not coordinated with any other coverage or carriers. The money sent to you is your to do with as you wish - you can use it to pay medical providers directly for bills due, reimburse yourself, or on other bills altogether.
The most common combinations we've seen of Short-Term Medical + Indemnity plans over the past year are listed below:
Higher-End (Tri-Term or Short Term Medical) + Health ProtectorGuard
Basic Shield A (Tri-Term or Short Term Medical) + Accident ProGap
Basic Shield B (Tri-Term or Short Term Medical) + Accident ProGuard
If you don't already have affordable primary care and you live in Western North Carolina, we highly recommend exploring the Integrative Life Membership at Integrative Family Medicine of Asheville (IFMA). IFMA is located in the River Arts District on Depot Street, and has consistently been one of the highest consumer-rated providers in the area over the past several years.
IFMA were pioneers and are leaders in the 'Direct Primary Care' membership-model revolutionizing the nation, providing healthcare with clear and simple pricing upfront. The normal IFMA membership for an individual is currently $69/mo for EFT payments, or $74/mo for credit card payments. It's not much, but we are able to cut the normal enrollment fee of $80 in half to $40 if you'd like us to refer you in. By the way- there is a $250 early cancellation fee is the membership is quit in under 12 months. You can learn more about IFMA at their website: integrativeasheville.org. Just let me know if you'd like to get the discount here.
Another, lower-priced access to care includes our ‘telemedicine’ or ‘telehealth’ option from HealthiestYou by Teladoc which gives you unlimited video-phone access to doctors 24 hours a day, 7 days a week with NO additional copays. Labs and tests can be ordered, and prescriptions can be sent from your virtual 'visit' - all without the need for any waiting rooms, germs or regular copays. Most common ailments can be handled easily and quite affordably with telemedicine.
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