Short Term Medical Value 5000/30/15000 - OR Short Term Health Plan from UnitedHealthcare - Healthpocket

Short Term Plans Found

 

Short Term Medical Value 5000/30/15000

$99.42/mo

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Zip Code97229
Applicant12/14/1983 Male
Coverage Start12/15/2018
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Benefits & Coverage

Insurance TypeShort Term Medical Insurance
Insurance ProviderUnitedHealthcare
Plan TypePPO
Deductible$5,000
Coinsurance30% after deductible
Coverage Max$1,000,000
Application Fee$0

Plan TypeShort Term Medical Insurance
Office Visit for Primary DoctorYou pay: 30% after deductible
Office Visit for Specialist
Coinsurance30% after deductible
Annual DeductibleIndividual: $5,000.00
Family: $0.00
Separate Prescription Drugs Deductible
Prescription DrugsGeneric: Not covered- Discount Card You may obtain Rx drugs at an average savings of 20-25%. Discounts vary by pharmacy, geographic area, & drug.
Brand Name: Not covered- Discount Card You may obtain Rx drugs at an average savings of 20-25%. Discounts vary by pharmacy, geographic area, & drug.
Non-formulary:
Annual Out-of-Pocket LimitIndividual: $15,000.00
Family: $45,000.00
Does Out-of-Pocket Limit include deductible?Yes
Lifetime Maximum$1,000,000.00
Out-of-Network CoverageYes

Physicians

Primary Care Physician (PCP) RequiredNo
Specialist Referrals RequiredNo

Preventive Care Coverage

Periodic Health ExamNo
Periodic OB-GYN ExamNo
OB-GYN Exam ConditionsYou pay: 30% after deductible
Well Baby CareNo

Prescription Drug Coverage

Generic Prescription DrugsNot covered- Discount Card You may obtain Rx drugs at an average savings of 20-25%. Discounts vary by pharmacy, geographic area, & drug.
Brand Prescription DrugsNot covered- Discount Card You may obtain Rx drugs at an average savings of 20-25%. Discounts vary by pharmacy, geographic area, & drug.
Non-Formulary Prescription Drugs Coverage
Separate Prescription Drugs Deductible

Hospital Services Coverage

Emergency RoomYou pay: 30% after deductible (if admitted) Not covered if not admitted
Outpatient Lab/X-RayYou pay: 30% after deductible
Outpatient Surgery
Hospitalization

Maternity Coverage

Pre & Postnatal Office Visit
Labor & Delivery Hospital Stay

Additional Coverage

Chiropractic Coverage
Mental Health CoverageNot covered

Subject to all policy provisions, the following expenses are covered. To be considered for reimbursement, expenses must qualify as covered expenses and are subject to eligible expense limits unless you use a network provider.

Ambulance Services

Ground ambulance services to a hospital for necessary emergency care.

Dental Services

Dental expenses for an injury to natural teeth suffered during the policy term. Expenses must be incurred within 6 months of the accident or as part of a treatment plan prescribed and began within 6 months of the accident. No benefits payable for injuries due to chewing as limited in the policy.

Diabetes

Diabetes equipment, supplies, services and self-management training.

Diagnostic Testing

Durable Medical Equipment

Rental of wheelchair, hospital bed, and other durable medical equipment.

Home Health Care

Home health aide services limited to 7 visits per week and a lifetime maximum of 365 visits. Outpatient private duty registered nurse services limited to a lifetime maximum of 1,000 hours. Benefits for intermittent private duty registered nurse services limited to $75 per visit.

Hospital Services

Daily hospital room and board at most common semiprivate rate; eligible expenses for an intensive care unit; inpatient use of an operating, treatment, or recovery room; outpatient use of an operating, treatment, or recovery room for surgery; services and supplies, including drugs and medicines, which are routinely provided in the hospital to persons for use only while they are inpatients; emergency treatment of an illness, but if not admitted for that illness, emergency room charges will not be covered.

Hospital does not include a nursing or convalescent home or an extended care facility.

Medical Supplies

  • Dressings and other necessary medical supplies.
  • Cost and administration of an anesthetic or oxygen.

Mental Disorders and Substance Abuse

  • Treatment of mental disorders or substance abuse covered the same as any other illness.
  • Outpatient doctor visits limited to $50 per visit.
  • Policy term combined maximum of $3,000 due to mental disorders or substance abuse per covered person.

Mental disorders and substance abuse are not covered with the Short Term MedicalSM Value plan.

Outpatient Surgery

Physician Fees

  • Professional fees of doctors, medical practitioners, and surgeons.
  • Assistant surgeon fee limited to 20% of eligible expenses of the procedure.
  • Fees for another medical professional acting as an assistant surgeon limited to 14% of the eligible expense.

Prescription Drugs (if applicable)

If you purchase name-brand when generic is available, you pay your generic copay plus the additional cost above the generic price.

Visit goldenrule.welcometouchc.com for a current prescription Drug List.

Preventive Care

  • Children’s preventive health services for covered children as defined in the policy.
  • Mammograms, Pap smears, colorectal cancer examinations, prostate-specific antigen testing, and other preventive care as specified in the policy.

Prosthetics

Basic artificial limbs, artificial eyes, and larynx and breast prosthesis. Replacement only if required by a physical change in the covered person and the item cannot be modified.

Rehabilitation and Extended Care Facility (ECF)

Must begin within 14 days of a 3-day or longer hospital stay for the same illness or injury. Limited to 60 days per policy term for both rehabilitation and ECF expenses.

Spine and Back Disorders

Benefits for outpatient treatment of spine and back disorders limited to $50 per visit and 6 visits in any 3-month period.

Temporomandibular (TMJ) Services

Surgery, excluding tooth extraction, to treat craniomandibular disorders, malocclusions, or disorders of the tempormandibular joint limited to a combined $10,000 lifetime maximum for each covered person.

Therapeutic Treatments

  • Radiation therapy and chemotherapy.
  • Hemodialysis, processing, and administration of blood or components (but not the cost of the actual blood or components).

Transplant Expense Benefit

The following transplants are covered the same as any other illness: cornea, artery or vein grafts, heart valve grafts, prosthetic tissue and joint replacement, and prosthetic lenses for cataracts.

For all other covered transplants, see your policy for “Listed Transplants” under Transplant Expenses Benefits. The covered person must be a good candidate, as determined by us. The transplant must not be experimental or investigational. Covered expenses for “Listed Transplants” are limited to 2 during a 10-year period, per covered person.

Golden Rule has arranged for certain hospitals around the country (“Centers of Excellence”) to perform specified transplant services. If you use one of our “Center of Excellence,” the specified transplant will be considered the same as any other illness and will include transportation and lodging incentive (for a family member) of up to $5,000. If a “Center of Excellence” is not used, covered expenses for the “Listed Transplant” will be limited to one transplant in any 12-month period with a maximum benefit of $100,000 for all expenses associated with the transplant.

If a “Center of Excellence” is not used, the acquisition cost for the organ or bone marrow is not covered.

No benefits payable for:

  • Search and testing in order to locate a suitable donor.
  • A prophylactic bone harvest and peripheral blood stem cell collection when no “listed transplant” occurs.
  • Animal-to-human transplants.
  • Artificial or mechanical devices designed to replace a human organ temporarily or permanently.
  • Procurement or transportation of the organ or tissue, unless expressly provided in this provision.
  • Keeping a donor alive for the transplant operation.
  • A live donor where the live donor is receiving a transplanted organ to replace the donated organ.
  • A transplant under study in an ongoing Phase I or II clinical trial as set forth in the USFDA regulation.

See brochure for state variations

  • The definition of “spouse” is expanded to include domestic partner.
  • “Coordination of Benefits (including Medicare)”is deleted and replaced with “Variable Deductible.” If you have other coverage that pays hospital, surgical, or medical benefits, including Medicare, we may apply a variable deductible. If the other plan pays more than our plan’s yearly deductible for a covered expense, then that amount becomes our plan’s variable deductible. The result is that all of your covered, in-network, out-of-pocket expenses are paid by the two policies. Copays not included.
  • Prosthetics - Expanded to include prosthetic and orthotic devices (including services and supplies) and medically necessary repair and replacement.
  • The General Exclusion provision for expenses resulting from intoxication of while under the influence of illegal narcotics or a controlled substance, will not apply.

Medical Expense Benefits – subject to deductible and copay/coinsurance (if applicable)

General Exclusions Benefits will not be paid for services or supplies that are not administered or ordered by a doctor and medically necessary to the diagnosis or treatment of an illness or injury, as defined in the policy.

  • For a preexisting condition - See brochure for state definition.
  • That would not have been charged if you did not have insurance.
  • Imposed on you by a provider (including a hospital) that are actually the responsibility of the provider to pay.
  • For services performed by an immediate family member.
  • That are not identified and included as covered expenses under the policy or in excess of the eligible expenses.
  • For services that are not covered expenses.
  • For services or supplies that are provided prior to the effective date or after the termination date of the coverage.
  • For weight modification or surgical treatment of obesity, including wiring of the teeth and all forms of intestinal bypass surgery.
  • For breast reduction or augmentation.
  • For sterilization or reversals of sterilization.
  • For modification of the physical body in order to improve psychological, mental, or emotional well-being, such as sex-change surgery.
  • Not specifically provided for in the policy, including telephone consultations, failure to keep an appointment, television expenses, or telephone expenses.
  • For marriage, family, or child counseling.
  • For standby availability of a medical practitioner when no treatment is rendered.
  • For dental expenses, including braces and oral surgery, except as provided for in the policy.
  • For cosmetic treatment.
  • For diagnosis or treatment of learning disabilities, attitudinal disorders, or disciplinary problems.
  • For diagnosis or treatment of nicotine addiction.
  • For charges related to, or in preparation for, tissue or organ transplants, except as expressly provided for under Transplant Services.
  • For injuries from participation in professional or semi-professional sports or athletic activities for financial gain, as determined by Golden Rule.
  • For eye refractive surgery, when the primary purpose is to correct nearsightedness, farsightedness, or astigmatism.
  • For eyeglasses, contact lenses, hearing aids, eye refraction, visual therapy, or any exam or fitting related to these devices, except as provided for in the policy.
  • For treatment of mental disorders, or court-ordered treatment for substance abuse, except as provided in the policy.
  • For preventive care or prophylactic care, including routine physical examinations, premarital examinations, and educational programs, except as provided in the policy.
  • Incurred outside of the U.S., except for emergency treatment.
  • For surrogate parenting
  • For treatments of hyperhidrosis (excessive sweating).
  • For alternative treatments, except as specifically covered by the policy, including: acupressure, acupuncture, aromatherapy, hypnotism, massage therapy, rolfing, and other alternative treatments defined by the Office of Alternative Medicine of the National Institutes of Health.
  • Resulting from intoxication, as defined by state law where the illness or injury occurred, or while under the influence of illegal narcotics or controlled substances, unless administered or prescribed by a doctor.
  • For vocational or recreational therapy, vocational rehabilitation, outpatient speech therapy, or occupational therapy, except as provided for in the policy.
  • Resulting from experimental or investigational treatments, or unproven services.

Please refer to plan brochure for more details.

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Webber, Marilyn
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Hardebeck, Laura
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Gregorio, Maria
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Brunsmann, James
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Rinella, Katherine
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Howrey, Adam
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Willoughby, Ryan
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Muresan, Beniamin
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Krughkov, Viktoriya
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Vilevac, Rebecca
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Bock, Gretchen
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Thwing, Amy
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Adams, Mara
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Herring, Matthew
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Journey To Health Physical Therapy And Wellness Clinic, Llc
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Swim, Jesse
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Benchmark Physical Therapy Of Oregon Llc
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Klingelheber, Hannah
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Spindler, Stephanie
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Hurley, Connor
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Randall, Nicole
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Marilyn Webber, M.D.
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  • Phone Number
    (503) 629-0237
  • Office Locations
    14223 Nw Spruceridge Ln
    Portland, OR 97229
14223 Nw Spruceridge Ln Portland OR, 97229

Please note that the response to these questions is from Agilehealthinsurance and not the insurer.

Does a short term health insurance plan help cover the costs of prescription drugs?

The coverage varies depending on the plan. Please reference the brochure for more details.

Can I contact someone if I need help choosing the right short term plan?

Absolutely. Our friendly, licensed Product Advisors are ready to assist you.

Call (800) 314-5594

Do you offer the best prices for a short-term health insurance plan?

Whether you buy directly from golden rule, online or on the phone, or through agilehealthinsurance.com, you’ll pay the same premium for the plan. This means that you can enjoy the benefits and convenience of shopping and purchasing your short term health insurance plan right here online and rest assured that you’re getting the best available price for the particular plan.

What if I get a renewable insurance policy at a future date?

Once you receive written confirmation that you are approved for a renewable insurance plan, contact us to cancel the short term plan.

If I cancel my short term plan early is there a penalty or a refund?

After the first month, there is no penalty for cancelling your plan early. You’ll receive a prorated refund for the unused days of coverage. Remember, you must apply for at least one month of coverage, and there are no refunds during the first month.

Do short term health insurance plans include dental and vision benefits?

No. We offer dental insurance and vision insurance which you can purchase separately from a temporary insurance plan. Short term health insurance plans by themselves are designed to protect you in the event of an unexpected illness or injury and are not intended to cover dental and vision care.

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 anytime during the underwriting process.

Golden Rule does charge a nonrefundable $20 application fee for their short-term plans in most states.

If I don’t qualify for short term coverage, will my credit card still get charged?

In most states there is a $20 nonrefundable application fee associated with the Golden Rule short term products.

How will I know if I qualify for short term health insurance coverage?

If applying online, normally you’ll have an answer the next business day. Golden Rule contact you via email.

Answering “yes” to any of the online application’s medical history questions can lengthen the review process. If this applies to you, please submit a paper application.

How soon can my short term health insurance start?

Your policy can take effect on the later of: (1) the requested effective date; or (2) the day after the postmark date affixed by the U.S. Postal Service,* but only if the following conditions are satisfied:

Your application and the appropriate premium payment are actually received by Golden Rule within 15 days of your signing;**

You are a member of the Federation of American Consumers and Travelers (FACT) in most states;

Your application is properly completed and unaltered;

You are a resident of a state in which the certificate form can be issued; and

If the application is submitted by an agent or broker, the agent or broker is properly licensed to submit applications to Golden Rule.

What happens when I reach the end of my coverage period?

At the end of your coverage term, in most states you may apply for another term for short term health insurance coverage.

What if I only need temporary health insurance coverage for less than 30 days?

In most states you can purchase a short term health insurance plan for one month only.

Why would I want short term insurance coverage for a limited amount of time?

You may be a college student and following graduation you’re no longer eligible for your parent’s health plan and you’re looking for your first job. You may be laid off and looking for work. Maybe you’re an early retiree and waiting for Medicare eligibility. A short term plan can help protect you during life-changing events.

What is short term health insurance?

Short term health insurance is temporary coverage designed to fill gaps in coverage. Short term health insurance plans provide you with coverage for a limited period of time, and may be an ideal solution for those between jobs, waiting for other health insurance to start, college grads coming off their parent’s health plan, or retired early and waiting for Medicare eligibility. If you think you’ll need coverage for a longer period of time, you may want to look at renewable individual and family health insurance plans.

The application process for short term health insurance is usually simpler than renewable health insurance. Short term health insurance plans are designed to cover unforeseen accidents or illnesses, rather than to provide comprehensive coverage, and, as such, typically do not include coverage for preventive care, physicals, immunizations, dental or vision care.

Short term health insurance plans typically do not cover preexisting medical conditions. The definition of a preexisting condition varies by state, but, in general, short term health insurance policies exclude coverage for conditions that have been diagnosed or treated within the previous 2 to 5 years. If you have an existing medical condition, you may want to research whether you can extend your current insurance. Employer-sponsored insurance may be extended under a government-regulated option commonly referred to as COBRA (or similar state program), which you should seriously consider if you have an existing medical condition.

PremiumPlan NameDeductible

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.