Your questions are important to us! If any of your questions are not addressed within the following topics, please call or e-mail us and we will promptly provide you with the answers.

General Information

Q. How much coverage can I have?

A. Length of coverage periods must be a minimum of 30 days (60 days in MN) and can be a maximum of 185 days. The combined total number of days can not exceed 365 days if more than one plan is issued.

Q. When does my coverage begin?

A. If you are submitting your application by:

Internet using a credit card - The earliest your coverage can begin is the day following transmission, if all other eligibility criteria have been met. For example, if you submit your application online on March 16th, your coverage begins on 12:01 AM on March 17th.

Mail and writing a check - The earliest that your coverage can begin is the day following the U.S. Postal Service postmark, if all other eligibility criteria have been met. (If the envelope containing your application is not postmarked by the U.S. Post Office or if the postmark is not legible, the plan date will be the later of a) your requested date or b) two days prior to the date the application was received by Fortis Health.)

Coverage will tCOBRA_Insurancee effect provided the following conditions are met:

Q. Can I backdate a Short Term Medical plan?

A. No. Backdating is not allowed. When completing an application, please follow these steps:

  1. Complete the application on or before the desired plan date.
  2. MCOBRA_Insurancee your payment on or before the desired plan date and include it with the application.
  3. When mailing the application to Fortis Health, the postmark on the envelope containing the application must be on or before the requested plan date.

Please note: There is a one day difference between the plan date and the effective date of coverage.

Q. Can I change my deductible?

A. Deductible changes cannot be made after your plan is issued.

Q. What is the definition of a pre-existing condition?

A. A pre-existing condition is defined as an illness or injury for which the covered person received medical treatment or advice from a physician within the 5 year* period immediately preceding the covered person's effective date; or that produced signs or symptoms within the 5 year* period immediately preceding the covered person's effective date.

*May vary by state.

Pre-Authorization Service

Q. Does this plan use an pre-authorization service?

A. Yes. Short Term Medical uses an authorization service which ensures that you and your family receive the most appropriate and cost effective care available. Trained medical professionals work with you and your physicians to review the course of treatment and advise you of your eligibility for benefits. The identification card you receive with your policy provides a toll-free number for easy access to this service. The authorization process must be followed in its entirely to receive maximum benefits. The contract explains the authorization process in detail.

Authorization is required in advance of:

The number to call for preauthorization is 1-800-800-2412 (as of 4/2001). The Short Term Medical identification card, which is attached to a copy of the insurance contract, also lists the preauthorization phone number.


Payment Information

Q. If I select the monthly pay option, how will I be billed?

A. If you select the monthly payment option and pay your initial payment by:

Q. Can I pay my premium by credit card?

A. Yes. If you select the single payment option, your entire premium can be billed to your credit card. If you select the monthly pay option, each month, your subsequent premium payments will be automatically debited from the credit card information you provided with your initial payment. Your card will be debited each month until you have reached a total of six months of coverage. If your temporary need ends prior to the sixth months, simply call us at 1-800-800-5453 and we will stop the automatic credit card debit. (Please note: 7 days advanced notice is required to ensure future credit card charges are stopped.) The following credit cards are accepted: Visa and MasterCard.

*May vary by state.


Benefits

Q. Do I have the option to select my doctors and hospitals or are there PPO and HMO options available?

A. This plan is not an HMO or PPO. There are no restrictions on which doctors you may see. You have the freedom to select the doctors and hospitals of your choice.

Q. What happens if I require further treatment after my plan expires?

A. Short Term Medical plan contains two provisions that extend coverage beyond the expiration date of the plan.

  1. Total Disability - if a covered person becomes totally disabled and is being treated for that condition during the benefit period, the plan will extend benefits to the earliest of:

    (The deductible need not be met to qualify for total disability)

  2. Non-Total Disability - The insured does not have to be totally disabled to qualify for this benefit. A benefit of up to $1000 may be provided for follow-up care for an injury sustained or sickness which commenced during the plan period. To qualify, the insured must have met his or her deductible during the benefit period. Qualifying expenses must be incurred within 60 days of the plan's expiration.

Q. Does the Short Term Medical plan include a dental and optical benefit?

A. No. This plan is designed to protect you in the event of an illness or injury and is not meant to cover dental and optical care. Short Term Medical is for temporary coverage only and therefore does not include some of the benefits a permanent heath plan offers.

Q. Is there a drug card?

A. No. However, prescription drugs are covered under the plan. Prescription drugs require the written prescription of a physician and payment is subject to deductible and coinsurance amounts.

Q. Will a routine check up be covered?

A. No. This plan is designed to protect you in the event of an illness or injury and is not meant to cover routine exams and preventive care. Short Term Medical is for temporary coverage only and therefore does not include most of the benefits a permanent heath plan offers.


Obtaining a Second Short Term Medical Plan

Q. Can I purchase a second Short Term Medical plan?

A. This Short Term Medical plan is non-renewable. However, if your temporary need continues, you may apply for another policy* if:

A new application must be completed. Should a second application be approved, a new plan will be issued. Please note: There is no continuous coverage between the original and second plan.

*May vary by state.

Q. If I get a second Short Term Medical plan, do I have to meet another deductible?

A. Yes. Short Term Medical is not renewable. If you obtain a second Short Term Medical plan, it would be a brand new plan with a new deductible.


Refunds

Q. Can I get a refund if I am not satisfied?

A. Yes. Our Short Term Medical plan offers a money back guarantee. We are confident that your Short Term Medical plan will meet your needs. However, if you are not 100 percent satisfied with the plan, you can return it within 10 days of issuance for a full refund. No questions asked!


Federal Reform Legislation

Note: The following Q&A's are regarding federal legislation. * State reform legislation may vary.

Q. Are Short Term Medical plans affected by the new Federal Health Insurance Portability and Accountability Act (HIPAA) of 1996?

A. No. Under HIPAA, short term limited duration policies are exempt from this legislation. This means that when issuing a Short Term Medical policy, insurance carriers do not have to: guarantee renewability, guarantee issue or waive the pre-existing condition limitation for federally eligible individuals.

Q. Is a Short Term Medical plan considered "creditable coverage" under HIPAA?

A. Yes, under HIPAA, Short Term Medical policies are considered creditable coverage to help satisfy any pre-existing condition period. Previous creditable coverage includes:

Q. Does "continuity of coverage" apply to Short Term Medical plans?

A. Yes. Continuity of coverage means that any pre-existing period completed under a previous qualifying plan (a defined by each state) will be credited to Fortis Health's pre-existing period. The pre-existing period will be reduced by the amount of time under a previous qualifying plan. Credit will be given provided there is no more than a 62-day* gap in coverage from the termination date of the prior plan and the effective date of Fortis Health's coverage. If a gap is greater than 62-days*, no credit will be given towards the pre-existing condition.

*May vary by state.