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.

 

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.

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.