What are Short Term Insurance Exclusions?

Short Term Health Plans

What are Short Term Insurance Exclusions?

Main Disclosures about Short Term Health Insurance Coverage:

Short Term Health Insurance is not required to comply with certain federal market requirements for health insurance, principally those contained in the Affordable Care Act. Be sure to check your Policy/Certificate carefully to make sure you are aware of any exclusions or limitations regarding coverage of preexisting conditions or health benefits (such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services).

Your Policy/Certificate might also have lifetime and/or annual dollar limits on health benefits. If this coverage expires or you lose eligibility for Short Term Health Insurance Plan, you might have to wait until an open enrollment period to get other health insurance coverage. Or contact your insurance agent for an alternative solution. Also, this coverage is not “minimum essential coverage.” This plan has a pre-existing limitation provision that may prevent coverage from applying to medical conditions that existed prior to this plan elective date.

Exclusions and Limitations:

Below are the most common excluded treatments and limitations to coverage on Short Term Health Insurance Plans. Always check with your insurnace agent, insurance company, or read policy details for complete details. Read more about 

 

  • For the first policy, pre-existing conditions diagnosed within the sixty-month period immediately preceding such covered person’s elective date are excluded for the first 12 months of coverage. (This exclusion does not apply to a newborn or newly adopted child who is added to coverage under this certificate. ) For policies two, three and four, refer to the policy for the pre-existing condition exclusion.
  • Waiting Period: 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 Elective Date of coverage under the Policy. 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 Elective Date of coverage under the policy.
  • Medications, vitamins, and supplements including pre-natal vitamins, or any over the counter medicines, whether or not ordered by a doctor.
  • Routine pre-natal care, pregnancy, childbirth, and post natal care. However, complications of pregnancy is usually covered.
  • Weight modifications or surgical treatment of obesity.
  • Injuries resulting from participation in any form of skydiving, scuba diving, auto racing, bungee jumping, motorcyling, skiing. Check your plan for complete excluded activities.
  • any drug treatment or procedure including but not limited to: artifcial insemeination, treatment for infertility or impotency, sterilization, or reversal of sterilization.
  • Any drug, treatment or procedure that either promotes, enahnces or corrects impotency or secual dysfunction.
  • Dental treatment, except for dental treatment that is expressly covered under the insurance certificate.

Additional Exclusions to Short Term Health Insurance Plans Include:

  • Eye surgery when the primary purpose is to correct nearshightedness, farsightedness or astigmatism.
  • Treatment for cataracts.
  • 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.
  • Willfully self-inflicted injury or sickness.
  • Veneral disease, including all sexually transmitted diseases and conditions.
  • Immunizations and routine physical exams.
  • Care, treatment, or supplies for the feet.
  • Care and treatmetn for hair loss. 
  • Treatment of sleep disorders.
  • Organ or tissue transplants or releated services.
  • Treatment of acne, moles, skin tags, and other specific conditions of the skin and skin diseases.
  • Services received or supplies purchased outside the United States, its territories or Canada.

How can I confirm if a certain treatment is excluded from my Short Term Policy?

If you are not sure whether a certain treatment or procedure is covered by your Short Term Insurance plan, call the insurance company and ask them.

We may be able to help you. Contact us with any questions you may have.

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