National General 5000/20/7000/1000000 - CO Short Term Health Plan from National General - Healthpocket

Short Term Plans Found

 

National General 5000/20/7000/1000000

$80.85/mo

Apply For This Plan

Zip Code80219
Applicant12/10/1983 Male
Coverage Start12/11/2018
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Benefits & Coverage

Insurance TypeShort Term Medical Insurance
Insurance ProviderNational General
Plan TypePPO
Deductible$5,000
Coinsurance20% after deductible
Coverage Max$1,000,000
Application Fee$0

Plan TypeShort Term Medical Insurance
Office Visit for Primary DoctorFirst office visit (primary or specialist) the plan pays $50; all subsequent visits subject to coinsurance after deductible
Office Visit for SpecialistFirst office visit (primary or specialist) the plan pays $50; all subsequent visits subject to coinsurance after deductible
Coinsurance20% after deductible
Annual DeductibleIndividual: $5,000.00
Family: $15,000.00
Separate Prescription Drugs DeductibleN/A
Prescription DrugsGeneric: Not covered
Brand Name: Not covered
Non-formulary: Not covered
Annual Out-of-Pocket LimitIndividual: $7,000.00
Family: $21,000.00
Does Out-of-Pocket Limit include deductible?Yes
Lifetime Maximum$1,000,000.00
Out-of-Network CoverageYes
Out of Country CoverageNo

Physicians

Primary Care Physician (PCP) RequiredNo
Specialist Referrals RequiredNo

Preventive Care Coverage

Periodic Health ExamYes
Periodic OB-GYN ExamNo
OB-GYN Exam ConditionsNot covered
Well Baby CareNo

Prescription Drug Coverage

Generic Prescription DrugsNot covered
Brand Prescription DrugsNot covered
Non-Formulary Prescription Drugs CoverageNot covered
Separate Prescription Drugs DeductibleN/A

Hospital Services Coverage

Emergency RoomUnlimited visits, Subject to an additional $250 access fee unless admitted to a hospital; costs apply to deductible and coinsurance
Outpatient Lab/X-RayCoinsurance after deductible
Outpatient SurgeryCoinsurance after deductible
HospitalizationCoinsurance after deductible

Maternity Coverage

Pre & Postnatal Office VisitNot covered
Labor & Delivery Hospital StayNot covered

Additional Coverage

Chiropractic CoverageNot covered
Mental Health CoverageNot covered

Why Short-Term Medical (STM)?

Short-Term Medical pays benefits like a major medical insurance plan, but for a predetermined length of time. You can select from a wide range of deductible and coinsurance options to tailor a plan to fit your lifestyle needs and budget.

How do I figure out what I need and where do I start?

First, Select Your Benefit Period and Payment Method.

You can select coverage periods of up to 1 month through up to 3 months. This plan is "pay as you go" which gives you the flexibility to continue coverage for as long as it is needed, or you can stop payments to discontinue the plan once your temporary need ends. We accept automatic monthly payments by Visa, MasterCard, or Bank Draft.

Then, based on your lifestyle needs and budget, select one from each of the following:

  • Deductible: $1,000, $2,500, $5,000
    Per person deductible is capped at 3x the individual deductible for a family greater than three. This means that when three insured family members satisfy their individual deductibles, the remaining individual deductibles will be deemed as satisfied for the remainder of the coverage term.
  • Coinsurance Percentage: 100/0, 80/20, 70/30, 50/50
    Your selection of a Coinsurance Percentage represents the percent of covered eligible expenses that we pay and that you pay, after the deductible has been satisfied.
  • Coinsurance Maximum Out-of-Pocket and Coverage Period Maximums are as follows:
    DEDUCTIBLECOINSURANCECOINSURANCE MAXIMUM OUT-OF-POCKETCOVERAGE PERIOD MAXIMUM
    $1,00050%/50%$2,500$250,000
    70%/30%$1,500$1,000,000
    80%/20%$1,500
    $2,50050%/50%$2,500$250,000
    70%/30%$1,500$1,000,000
    80%/20%$1,500
    100%$0
    $5,00050%/50%$3,750$250,000
    70%/30%$2,250$1,000,000
    80%/20%$2,000
    100%$0

What medical expenses are covered?

The following benefits are for the Insured and each Covered Dependent subject to the plan Deductible, Coinsurance Percentage, Coinsurance Maximum Out-of-Pocket and the Coverage Period Maximum. Benefits are limited to any specific limits stated in the policy.

  • Doctor visits, urgent care, ambulance service and emergency room care.
  • Diagnostic testing, mammograms, cancer testing, radiation therapy and Chemotherapy Note: This is a brief description of the plan benefits, which may vary by state.
  • Surgery, inpatient and outpatient hospital benefits, and hospital confinement benefits.
  • Physical therapy, skilled nursing facility benefits and home health care.
  • Child immunizations, transplant benefits and more.

*Note: This is a brief description of the plan benefits, which may vary by state.

Limitations and exclusions may vary by state. Please check your policy certificate for a full list of limitations and exclusions. This plan will not pay benefits for sicknesses or injuries that are caused by or expenses incurred for:

  1. Conditions for which claims were submitted under a prior Short Term Medical policy or Policy issued by Us that provided coverage that ended within 90 days before the Effective Date of this Policy.
  2. Intentionally self-inflicted sickness or injury, whether sane or insane.
  3. Sickness or injury to the extent that benefits are paid by Medicare or any other government law or program, except Medicaid (Medi-Cal in California); or medical coverage under any automobile or no fault insurance.
  4. Sickness or injury eligible for benefits under worker’s compensation, employers’ liability or similar laws even when you do not file a claim for benefits.
  5. Treatment of sickness or injury caused by or contributed to by war or any act of war; or participation in the military service of any country. Any premium paid for a time not covered will be returned pro-rated.
  6. Dental treatment unless a hospital stay is required due to Injury from an accidental blow to the mouth causing trauma to sound, natural teeth, the gums or supporting structures of the teeth. A sound, natural tooth has no decay and has never had a filling, root canal therapy or crown. Inpatient hospital care must be the least expensive setting needed to produce a professionally adequate result and the hospital charges only are covered expense. The treatment must be received while the Policy is in force.
  7. Eyeglasses, contact lenses, eye exams, eye refraction or eye surgery for correction of refraction error; vision therapy; or artificial hearing devices.
  8. Normal pregnancy or childbirth; routine well baby care including hospital nursery charges at birth; or abortion, except as provided in the complications arising from pregnancy provision in the benefits section.
  9. Infertility diagnosis and treatment for males and females including, but not limited to, drugs and medications, artificial insemination, in-vitro fertilization and reversal of sterilization.
  10. Genetic testing or counseling including, but not limited to, amniocentesis and chorionic villi testing.
  11. Sex transformation; treatment of sexual function, dysfunction or inadequacy; or treatment to enhance sexual performance or desire.
  12. Treatment and medication to stimulate growth and growth hormones for any purpose.
  13. Treatment, services or supplies to address quality of life or lifestyle concerns including, but not limited to: smoking cessation; snoring or sleep disorders; the treatment or prevention of hair loss; change in skin pigmentation; or cognitive enhancement.
  14. Sterilization and drugs or devices used directly or indirectly to promote or prevent conception.
  15. Weight reduction or weight control programs or treatment; or surgery for weight control, obesity or morbid obesity.
  16. All treatments for varicose veins.
  17. Therapy or treatment for learning disorders or disabilities or developmental delays.
  18. Sales tax or gross receipt tax; provider administrative expenses including, but not limited to, charges for claim filing, contacting utilization review organizations, or case management fees.
  19. Cosmetic treatment or reconstructive or plastic surgery that is primarily a cosmetic procedure, including medical or surgical complications arising therefrom, except as provided in the Benefits section.
  20. Treatment of mental health conditions or substance abuse.
  21. Treatment or services rendered by, or supplies purchased from, a member of your immediate family or an employer.
  22. Treatment or services required due to accidental injury sustained in operating a motor vehicle while the covered person's blood alcohol level, as defined by law, exceeds that level permitted by law or otherwise violates legal standards for a person operating a motor vehicle in the state where the injury occurred. This exclusion applies whether or not the injury occurred in connection with an incident involving the operation of a motor vehicle, and whether or not the covered person is charged with any violation in connection with the accident.
  23. Treatment or services required due to injury received while engaging in any hazardous occupation or other activity, including the following: participating, instructing, demonstrating, guiding or accompanying others in parachute jumping, hang-gliding, bungee jumping, flight in an aircraft other than a regularly scheduled flight by an airline, racing any motorized or non-motorized vehicle, rock or mountain climbing, professional or semi-professional contact sports of any kind. Also excluded are treatment and services required due to injury received while practicing, exercising, undergoing conditioning or physical preparation for any such activity.
  24. Treatment or services required due to injury received while engaging in any hazardous occupation or other activity for which compensation is received, including the following: participating, instructing, demonstrating, guiding or accompanying others in skiing and horse riding. Also excluded are treatment and services required due to injury received while practicing, exercising, undergoing conditioning or physical preparation for any such compensated activity.
  25. Treatment or services required due to injury sustained while participating in any interscholastic or inter-collegiate sport, contest or competition or while practicing, exercising, undergoing conditioning or physical preparation for any such sport, contest or competition.
  26. Treatment or services required for sickness or injury resulting from being intoxicated (where the blood alcohol content meets the legal presumption of intoxication under the law of the state where the sickness or injury took place.
  27. Expense incurred due to sickness or injury of which a contributing cause was the covered person's voluntary attempt to commit, participation in or commission of a felony, whether or not charged, or as a consequence of the covered person's being under the influence of illegal narcotics or nonprescribed controlled substances.
  28. Custodial care; respite care; rest care; or supportive care.
  29. Expenses incurred outside of the United States or its possessions or Canada.
  30. Expenses incurred for experimental or investigational treatment.
  31. Private duty nursing services rendered during hospital confinement and charges for standby health care practitioners.
  32. Dental braces, dental appliances, corrective shoes, repairs to or replacement of prosthetic devices or orthotics, except as provided in the Benefits section.
  33. Reduction mammoplasty; revision of breast surgery for capsular contraction or replacement of prosthesis, except as provided in the Benefits section.
  34. Services or supplies for foot care, including care of corns, bunions or calluses, except capsular or bone surgery.
  1. Treatment, services or supplies rendered or received when coverage under the policy is not in effect, except as provided under the Extension of Benefits provision.
  2. Any amount in excess of the Usual, Reasonable and Customary amount as determined by us under the Policy.
  3. Prophylactic treatment or services. Prophylactic means any surgery or other procedure performed to prevent a disease process from becoming evident in the organ or tissue at a later date.
  4. Treatment, services or supplies that are not medically necessary as determined by us under the Policy.
  5. Treatment, services or supplies that are prescribed, provided or furnished in a manner primarily for the convenience of the covered person or doctor.
  6. Treatment, services or supplies not described in the Benefits section.
  7. Expenses for marital counseling or social counseling.
  8. Outpatient prescription drugs, medications, vitamins, and mineral or food supplements including pre-natal vitamins, or any over-the-counter medicines, whether or not ordered by a doctor.
  9. Treatment, services or supplies provided at no cost to the covered person.
  10. Telephone consultations or failure to keep a scheduled appointment.
  11. Abortions, except in connection with covered complications of pregnancy or if the life of the expectant mother would be at risk.
  12. Eye surgery, such as radial keratotomy, when the primary purpose is to correct nearsightedness, farsightedness or astigmatism.
  13. Treatment for cataracts.
  14. Treatment of the temporomandibular joint unless medically necessary and caused by a congenital or developmental deformity, sickness or injury.
  15. Speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy, holistic care of any nature, massage and kinestherapy.
  16. Orthoptics and visual eye training.
  17. Hypnotherapy when used to treat conditions that are not recognized as mental and nervous disorders by the American Psychiatric Association, biofeedback and non-medical self-care or self-help programs.
  18. Any services or supplies in connection with cigarette smoking cessation.
  19. Treatment incurred as a result of exposure to non-medical nuclear radiation and/or radioactive materials.
  20. Treatment for or related to any congenital condition, except as it relates to a newborn or adopted child added as a covered person to this policy.
  21. Spinal manipulation or adjustment.
  22. Sclerotherapy for veins of the extremities.
  23. Chronic fatigue or pain disorders; or immunodeficiency disorders.
  24. Treatment or diagnosis of allergies, except for emergency treatment of allergic reactions.
  25. Kidney or end stage renal disease.
  26. Joint replacement or other treatment of joints, spine, bones or connective tissue including tendons, ligaments and cartilage, unless related to a covered Injury.
  27. Expenses or losses related to or in connection with the treatment of Acquired Immunodeficiency Syndrome and its related effects.
  28. Hospice care.
  29. Costs of services or supplies for personal comfort or convenience, including homemaker services or supportive services focusing on activities of daily life that do not require the skills of qualified technical or professional personnel, including but not limited to bathing, dressing, feeding, routine skin care, bladder care and administration of oral medications or eye drops, except as specifically covered.
  30. Expenses for surgery during the first 6 months after the effective date of coverage for a covered person for a total or partial hysterectomy, unless it is medically necessary due to a diagnosis or carcinoma (subject to all other coverage provisions, including but not limited to, the pre-existing conditions exclusion); tonsillectomy, adenoidectomy, repair of deviated nasal septum or any type of surgery involving the sinus, myringotomy, tympanotomy, herniorraphy or cholecystectomies.

Pre-existing condition exclusion

Charges resulting directly from a pre-existing condition are excluded from coverage. A pre-existing condition is defined as a condition:

  • For which medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or received within the 12 months immediately preceding the Effective Date; or
  • That had manifested itself in such a manner that would have caused an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) within the 12 months immediately preceding such person’s Effective Date.

This exclusion does not apply to a newborn or newly adopted child who is added in accordance with the coverage eligibility and effective date sections within the certificate of coverage.

This exclusion also does not apply to routine follow-up care for breast cancer to determine whether a breast cancer has recurred in a covered person who has been previously diagnosed with breast cancer, unless evidence of breast cancer is found during or as a result of follow-up care.

Short Term Medical is nonrenewable

This Short Term Medical policy is nonrenewable, and plan termination is not considered a qualifying life event for purposes of enrolling in a major medical . Therefore, depending on the length of your coverage term, you may have a gap in insurance coverage until you can begin coverage with a new Short Term Medical or other health .

If you choose to purchase a new Short Term Medical plan, you must submit a new application. Any illness or condition that developed and was covered under your previous plan is considered a pre-existing condition and will not be covered by subsequent Short Term Medical plans. Reapplication may not be available in all states.

Short Term Medical does not meet Minimum Essential Coverage as mandated by the Affordable Care Act

Short-term, limited duration plans are not subject to certain provisions of federal health care reform, including the provisions related to Essential Health Benefits, lifetime limits, preventive care, guaranteed renewability, and pre-existing conditions. The pre-existing condition exclusion for Short Term Medical plans will apply for all insureds, including those under the age of 19. Know your . Short Term Medical plans offer affordable medical coverage, but are medically underwritten (so you can be declined) and do not provide Minimum Essential Coverage.

What does this mean for the applicant? They may have to pay a tax penalty, depending on their income level and the cost of plans available. Examples of the claims Short Term Medical plans do not cover are for most preventive care, maternity, mental health and treatment related to medical conditions they had prior to the plan’s effective date. Because these plans are not guaranteed renewable, the applicant may not be eligible for another short-term plan after the plan’s termination date; and the pre-existing condition exclusion will apply to any conditions that arose during any prior short-term plans.

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  • Phone Number
    (303) 935-9142
  • Office Locations
    1930 S Federal Blvd
    Denver, CO 80219
1930 S Federal Blvd Denver CO, 80219

What if I have a Pre-existing Condition?

Charges resulting directly from a pre-existing condition are excluded from coverage. Pre-existing conditions are referred to as conditions for which medical advice, diagnosis, care, or treatment (including services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or received within the 12 months immediately preceding the effective date, unless a lesser period is required by state regulation.

This exclusion does not apply to a newborn or newly adopted child who is added in accordance with the coverage eligibility and effective date sections within the certificate of coverage.

This exclusion also does not apply to routine follow-up care for breast cancer to determine whether a breast cancer has recurred in a covered person who has been previously diagnosed with breast cancer, unless evidence of breast cancer is found during or as a result of follow-up care.

Who is eligible to apply for this insurance?

STM is available to members and their spouses, who are between 18 and 64 years old and their dependent unmarried children under 26 years old; and can answer "No" to all of the questions in the application for insurance. Child-only coverage is available for ages 0-25.

Can I choose my own doctor?

Choose your doctor from the 850,000 participating providers in the Aetna Open Choice PPO Network to cut your health care costs by up to 50%.

Find a provider at www.aetna.com/docfind/custom/mymeritain

PremiumPlan NameDeductible
from $39LifeShield Flex 5000/20/9000/750000$5,000.00Select
from $40LifeShield Flex 5000/20/8000/750000$5,000.00Select
from $41LifeShield Flex 5000/20/9000/1000000$5,000.00Select
from $42LifeShield Flex 5000/20/7000/750000$5,000.00Select
from $42LifeShield Flex 5000/20/8000/1000000$5,000.00Select

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.