Pivot Health Deluxe 2500 / 20 - AL Short Term Health Plan from Companion Life - Healthpocket

Short Term Plans Found

 

Pivot Health Deluxe 2500 / 20

$223.24/mo

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Zip Code35215
Applicant12/17/1983 Male
Coverage Start12/18/2018
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Benefits & Coverage

Insurance TypeShort Term Medical Insurance
Insurance ProviderCompanion Life
Plan TypeIndemnity
Deductible$2,500
Coinsurance20% after deductible
Coverage Max$1,000,000
Application Fee$0

Plan TypeShort Term Medical Insurance
Office Visit for Primary Doctor
Office Visit for Specialist
Coinsurance20% after deductible
Annual DeductibleIndividual: $2,500.00
Family: $7,500.00
Separate Prescription Drugs Deductible$500 Individual Applies to: preferred brand and non-preferred brand
Prescription DrugsGeneric: $10 copay
Brand Name: $50 copay preferred brand $75 copay non-preferred brand
Non-formulary: Not covered
Annual Out-of-Pocket LimitIndividual: $3,000.00
Family: $9,000.00
Does Out-of-Pocket Limit include deductible?No
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 ExamNo
Periodic OB-GYN ExamNo
OB-GYN Exam ConditionsAnnual pap test for women age 18 and older Deductible Applies Coinsurance Applies
Well Baby CareNo

Prescription Drug Coverage

Generic Prescription Drugs$10 copay
Brand Prescription Drugs$50 copay preferred brand $75 copay non-preferred brand
Non-Formulary Prescription Drugs CoverageNot covered
Separate Prescription Drugs Deductible$500 Individual Applies to: preferred brand and non-preferred brand

Hospital Services Coverage

Emergency Room$250 additional deductible if payable if not admitted to the hospital plus medical deductible and coinsurance
Outpatient Lab/X-Ray
Outpatient SurgeryMedical deductible and coinsurance
HospitalizationDeductible applies Coinsurance applies

Maternity Coverage

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

Additional Coverage

Chiropractic CoverageNot covered
Mental Health CoverageOutpatient: $50 per visit; 10 visit max; inpatient: $100 per day, 31 day max

Deductible

The selected Deductible per Covered Person per Coverage Period. Maximum of 3 Deductibles per family per Coverage Period.

Emergency Room Deductible

An additional Deductible of $250 per visit will be applied to charges for use of emergency room in the event of Sickness and Injury unless the Covered Person is directly admitted as an Inpatient for further treatment.

Coinsurance

During a Coverage Period, the Company will pay the selected Coinsurance of eligible Expenses after the Deductible up to the Out-of-Pocket Maximum, then 100% of Eligible Expenses up to the Overall Maximum Limit.

Out-of-Pocket Maximum

The selected Out-of-Pocket Maximum of eligible Expenses, per Covered Person per Coverage Period. The Out-of-Pocket Maximum is deemed to have been satisfied during the Coverage Period for all insured persons in a family once the combined Out-of-Pocket eligible Expense equals three times the individual Out-of-Pocket Maximum. The Deductibles, co-payments and Pre-Certification Penalties do not apply towards the Out-of-Pocket Maximum.

Doctor’s Office Visit**

The Covered Person shall be responsible for a $30 co-payment, after which Coinsurance will apply. Benefits will not be subject to Deductible. Any other covered services or tests performed as part of the office visit will be subject to the Deductible and Coinsurance.

Urgent Care Center Visits**

The Covered Person shall be responsible for a $60 co-payment, after which Coinsurance will apply. Benefits will not be subject to Deductible. Any other covered services or tests performed as part of the office visit will be subject to the Deductible and Coinsurance.

Specialty Doctor’s Office Visit**

The Covered Person shall be responsible for a $60 co-payment, after which Coinsurance will apply. Benefits will not be subject to Deductible. Any other covered services or tests performed as part of the office visit will be subject to the Deductible and Coinsurance.

Hospital Room and Board

Average Semi-private room rate, including nursing services.

Local Ambulance

Injury: Usual and Customary charges to a Maximum of $1,000 per trip for ground ambulance / $2,500 per trip for air ambulance when related to a covered Injury.
Sickness: Usual and Customary charges to a maximum of $1,000 per trip, for ground ambulance / $2,500 per trip for air ambulance when covered Sickness results in hospitalization as Inpatient

Intensive Care Unit

Usual and Customary charges

Physical Therapy

$50 Maximum per visit per day. Maximum of 20 visits during a Coverage Period.

Mental and Nervous Disorders

Outpatient Treatment: $50 Maximum per visit, Maximum 10 visits per Coverage Period
Inpatient Treatment: $100 Maximum per day, Maximum 31 days per Coverage Period

Home Health Care

Maximum 1 visit per day. Maximum of 40 visits during a Coverage Period

Extended Care Facility

Not to exceed a daily rate of $150 nor a maximum of 60 days

Hospice Care

Not to exceed $2,000 per Coverage Period

Durable Medical Equipment

Not to exceed $500 per Coverage Period

Kidney Stones

Usual and Customary charges not to exceed $1,500 per Covered Person

Appendix/Appendectomy Surgery

Usual and Customary charges not to exceed $2,500 per Covered Person

All Other Eligible Medical Expenses

Usual and Customary charges

Pre-Existing Conditions Expense Allowance

Usual and Customary charges not to exceed an amount equal to ½ the Deductible per Coverage Period. Payment of any benefits, including application to the Deductible, under this Allowance does not waive, or in any manner whatsoever affect, any of the Covered Person’s Short Term Medical Insurance Exclusions, including the Pre-Existing Condition Limitations under Part VI of the Certificate.

Penalty for Failure to Pre-Certify

Eligible Medical Expenses will be reduced by $500

Overall Maximum Limit per Coverage Period

The selected Overall Maximum Limit per Coverage Period

Outpatient Prescription Drugs

Retail Benefits

Prescription Drug Deductible

$500 per Coverage Period for Preferred and Non-Preferred Drugs

Tier 1 Generic Drugs

The Covered Person shall be responsible for a $10 co-payment

Tier 2 Preferred Drugs

After the Prescription Drug Deductible is met, the Covered Person shall be responsible for a $50 co-payment

Tier 3 Non-Preferred Drugs

After the Prescription Drug Deductible is met, the Covered Person shall be responsible for a $75 co-payment

Dispensing Limits

As written by the Doctor, up to a consecutive 34-day supply or 100 unit doses of a Prescription Drug, unless adjusted based on the drug manufacturer's packaging size, or based on supply limits.

**Benefits for all Office Visits and Urgent Care Visits combined will not exceed 3 visits per Coverage Period. Visits in excess of the maximum of 3 visits per Coverage Period will be subject to the Deductible and Coinsurance.

State Mandates for this plan may vary. View State Mandates

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. Pre-existing Conditions
    1. Charges resulting directly or indirectly from a condition for which a Covered Person received medical treatment, diagnosis, care or advice within the sixty-month period immediately preceding such person’s Effective Date are excluded for the first 12 months of coverage hereunder.
    2. Pre-existing conditions includes conditions that produced any symptoms which would have caused a reasonable person to seek diagnosis, care or treatment within the sixty-month period immediately prior to the coverage effective date.
    This exclusion does not apply to a newborn or newly adopted child who is added to coverage under this certificate in accordance with PART II – ELIGIBILITY AND EFFECTIVE DATE OF INSURANCE.
  2. Waiting Periods
    1. Covered Persons will only be entitled to receive benefits for Sicknesses that begin, by occurrence of symptoms and/ or receipt of treatment, at least 5 days following the Covered Person’s Effective Date of coverage under the policy.
    2. Covered Persons will only be entitled to receive benefits for Cancer that begins, by occurrence of symptoms or receipt of treatment at least 30 days following the Covered Person’s Effective Date of coverage under the policy.
  3. Outpatient Prescription Drugs, medications, vitamins, and mineral or food supplements including prenatal vitamins, or any over-the- counter medicines, whether or not ordered by a Doctor, unless specifically covered under the Policy.
  4. Routine prenatal care, Pregnancy, childbirth, and postnatal care. (This exclusion does not apply to “Complications of Pregnancy” as defined.)
  5. Alcoholism.
  6. Substance Abuse.
  7. Charges which are not incurred by a Covered Person during his/her Coverage Period.
  8. Treatment, services or supplies which are not administered by or under the supervision of a Doctor.
  9. Treatment, services or supplies which are not Medically Necessary as defined.
  10. Treatment, services or supplies provided at no cost to the Covered Person.
  11. Charges which exceed Usual and Customary charge as defined.
  12. Telephone consultations or failure to keep a scheduled appointment.
  13. Consultations and/or treatment provided over the Internet.
  14. Surgeries, treatments, services or supplies which are deemed to be Experimental Treatment.
  15. All charges Incurred while confined primarily to receive Custodial or Convalescent Care, unless specifically covered under the Hospice Bene t under the Policy.
  16. Weight modification or surgical treatment of obesity, including wiring of the teeth and all forms of intestinal bypass surgery.
  17. Modifications of the physical body in order to improve the psychological, mental or emotional well-being of the Covered Person, such as sex-change surgery.
  18. Surgeries, treatments, services or supplies for cosmetic or aesthetic reasons, except for reconstructive surgery which is expressly covered under this certificate.
  19. Any drug, treatment or procedure that either promotes or prevents conception including but not limited to: artificial insemination, treatment for infertility or impotency, sterilization or reversal of sterilization.
  20. Any drug, treatment or procedure that either promotes, enhances or corrects impotency or sexual dysfunction.
  21. Abortions, except in connection with covered Complications of Pregnancy or if the life of the expectant mother would be at risk.
  22. Dental treatment, except for dental treatment that is expressly covered under this certificate.
  23. Eyeglasses, contact lenses, hearing aids, hearing implants, eye refraction, visual therapy, and any examination or fitting related to these devices, and all vision and hearing tests and examinations.
  24. Eye surgery, such as radial keratotomy, when the primary purpose is to correct nearsightedness, farsightedness or astigmatism.
  25. Treatment for cataracts.
  26. Treatment of the temporomandibular joint.
  27. Injuries resulting from participation in any form of skydiving, scuba diving, auto racing, bungee jumping, hang or ultralight gliding, parasailing, sail planing, flying in an aircraft (other than as a passenger on a commercial airline), rodeo contests or as a result of participating in any professional, semi- professional or other non-recreational sports including boating, motorcycling, skiing, riding all-terrain vehicles or dirt-bikes, snowmobiling or go-carting.
  28. Injury resulting from being under the influence of or due wholly or partly to the effects of alcohol or drugs, other than drugs taken in accordance with treatment prescribed by a Doctor, but not for the treatment of Substance Abuse.
  29. Willfully self-inflicted Injury or Sickness.
  30. Venereal disease, including all sexually transmitted diseases and conditions.
  1. Immunizations and Routine Physical Exams.
  2. Services received for any condition caused by a Covered Person’s commission of or attempt to commit a felony or to which a contributing cause was the Covered Person being engaged in an illegal occupation.
  3. Speech, vocational, occupational, biofeedback, acupuncture, recreational, sleep or music therapy, holistic care of any nature, massage and kinesitherapy.
  4. Any services performed or supplies provided by a member of the Insured’s Immediate Family.
  5. Orthoptics and visual eye training.
  6. Services or supplies which are not included as eligible Expenses as described herein.
  7. Care, treatment or supplies for the feet: orthopedic shoes, orthopedic prescription devices to be attached to or placed in shoes, treatment of weak, strained, at, unstable or unbalanced feet, metatarsalgia or bunions, and treatment of corns, calluses or toenails.
  8. Care and treatment for hair loss including wigs, hair transplants or any drug that promises hair growth, whether or not prescribed by a Doctor.
  9. Treatment of sleep disorders.
  10. Hypnotherapy when used to treat conditions that are not recognized as Mental or Nervous Disorders by the American Psychiatric Association, and biofeedback, and non-medical self-care or self-help programs.
  11. Any services or supplies in connection with cigarette smoking cessation.
  12. Exercise programs, whether or not prescribed or recommended by a Doctor.
  13. Treatment required as a result of complications or consequences of a treatment or condition not covered under this certificate.
  14. Charges for travel or accommodations, except as expressly provided for local ambulance.
  15. Treatment incurred as a result of exposure to non-medical nuclear radiation and/or radioactive material(s).
  16. Organ or Tissue Transplants or related services.
  17. Treatment for acne, moles, skin tags, diseases of sebaceous glands, seborrhea, sebaceous cyst, unspecified disease of sebaceous glands, hypertrophic and atrophic conditions of skin, nevus.
  18. Services received or supplies purchased outside the United States, its territories or possessions, or Canada.
  19. Treatment for or related to any congenital condition, except as it relates to a newborn or adopted child added as a Covered Person to the certificate.
  20. Spinal manipulation or adjustment.
  21. Sclerotherapy for veins of the extremities.
  22. Charges during the first 6 months after the Effective Date of coverage for a Covered Person for the following (subject to all other coverage provisions, including but not limited to the Pre- existing Condition exclusion):
    1. Total or partial hysterectomy, unless it is Medically Necessary due to a diagnosis of carcinoma;
    2. Tonsillectomy;
    3. Adenoidectomy;
    4. Repair of deviated nasal septum or any type of surgery involving the sinus;
    5. Myringotomy;
    6. Tympanotomy;
    7. Herniorrhaphy; or
    8. Cholecystectomy
  23. Chronic fatigue or pain disorders; Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC), or related immunodeficiency disorders.
  24. Treatment or diagnosis of allergies, except for emergency treatment of allergic reactions.
  25. Treatment, medication or hormones to stimulate growth, or treatment of learning disorders, disabilities, developmental delays or deficiencies, including therapy.
  26. Kidney or end stage renal disease.
  27. Joint replacement or other treatment of joints, spine, bones or connective tissue including tendons, ligaments and cartilage, unless related to a covered Injury.
  28. Charges resulting from a declared or undeclared war, or from voluntary participation in a riot or insurrection.
  29. Charges incurred by a Covered Person while on active duty in the armed forces. Upon written notice to Us of entry into such active duty, the unused premium will be returned to the Covered Person on a pro-rated basis.
  30. Injury or Sickness arising out of and in the course of any occupation for compensation, wage or profit, including expenses which are payable under Occupational Disease Law or similar law, whether or not application for such benefits have been made.
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  • Phone Number
    (205) 833-6888
  • Office Locations
    9772 Parkway E
    Birmingham, AL 35215
9772 Parkway E Birmingham AL, 35215

Does short term insurance qualify as a major medical insurance plan and include “essential benefits” that are required by current law?

No, short term health insurance is a temporary insurance product and is not comprehensive, major medical health insurance.

When is each monthly payment deducted from my account?

The first payment is taken at the time of sale and applied to the first monthly premium statement and charged immediately for the first 30 days of coverage. Your second monthly premium statement will be charged on or around the 10th of the month if your coverage effective date is between the 1st and 19th of the month. For coverages effective between the 20th and 30th/31st your credit card will be charged on or around the 22nd. Your 3rd month premium notice will be for fewer days than the prior two months which will be the balance of the maximum 90-day coverage period allowed by federal regulation. All premiums are drafted on normal business days.

What is the network for Pivot Health plans?

Pivot Health plans do not have a network - you can see any doctor or medical facility you wish.

All bills submitted by your providers are repriced to the Medicare allowable price. This reimbursement to your provider is then increased by the percentage above Medicare allowable depending on the provider. This is often referred to as Medicare "plus" reimbursement.

  • Physician services reimbursement: up to 125% of Medicare allowable
  • Medical facilities reimbursement: up to 150% of Medicare allowable

The deductible and coinsurance do not add up to the maximum out-of-pocket. Why?

The deductible does not go towards maximum out-of-pocket. Out-of-pocket expenses are strictly tied to coinsurance. For example, if an individual has a $5,000 deductible, 30% coinsurance and a $10,000 maximum out-of-pocket, they first have to meet their $5,000 deductible, then have more than $30,000 in claims, of which they pay 30%, in order to meet their maximum out-of-pocket amount of $10,000.

Can children apply for short term medical coverage?

Children may apply for a short term policy when they reach six-months of age. Subsequent siblings can be added to the application as dependents.

Can you pre-pay all four coverage certificates at once? (back-to-back offers only)

No. Pivot Health’s pre-pay option is only available for a coverage duration of 90-days or less. Any coverage that is longer than 90-days must be paid monthly.

If a dependent child reaches age 26, do they automatically get transferred to their own plan OR do they need to apply for a new plan?

Any dependent children who reach the age of 26 must apply for separate coverage.

If the primary insured reaches age 65, what happens to the other covered dependents?

If a primary insured reaches age 65 during the term of their coverage, the plan runs out at the end of the term. Any covered dependents can re-apply at PivotHealth.com or contact their agent for help re-enrolling. New rates apply, and a new certificate will be issued at time of sale.

PremiumPlan NameDeductible
from $110LifeShield Flex 2500/20/6500/750000 Extended$2,500.00Select
from $113LifeShield Flex 2500/20/5500/750000 Extended$2,500.00Select
from $114LifeShield Flex 2500/20/6500/1000000 Extended$2,500.00Select
from $116LifeShield Flex 2500/20/4500/750000 Extended$2,500.00Select
from $116LifeShield Flex 2500/20/5500/1000000 Extended$2,500.00Select

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.