Your legal rights: Short term health insuranceMany people find themselves without health insurance when they are between jobs or after they graduate from school. Because health care costs are so high, people often grapple with how to obtain affordable health insurance during these gaps in coverage. As a result, some people turn to short term health insurance policies.
From the Office of Minnesota Attorney General Lori Swanson
Many people find themselves without health insurance when they are between jobs or after they graduate from school. Because health care costs are so high, people often grapple with how to obtain affordable health insurance during these gaps in coverage. As a result, some people turn to short term health insurance policies.
A short term, or temporary, health insurance policy is better than going without coverage, but it typically offers relatively “bare bones” coverage. Before you buy such a policy, keep in mind the following:
The policy is temporary. Short term health insurance policies provide coverage for a period of six months or less. They are not renewable. At the expiration of a short term policy the insurance company may sell you another short term policy. You may not be covered under short term policies more than 365 days out of any 555 day period. If you take out back-to-back short term policies, the insurance company will generally refuse to cover any pre-existing condition that occurred under your prior short term policy.
Beware of pre-existing conditions. Short term health insurance policies typically exclude as a preexisting condition any injury, illness, or condition for which you had medical treatment, symptoms, or any manifestations of illness before the effective date of coverage. This means that, even if you did not receive treatment from a physician before you took out the policy, the insurance company may refuse to cover a claim if you ever had symptoms before you took out the policy.
People are sometimes attracted to short term health insurance policies because they may be more affordable than longer term policies.
Keep in mind, however, that short term health insurance policies are generally intended to only cover major medical expenses. In addition to excluding coverage for preexisting conditions, such policies generally exclude coverage for services like preventive treatment (e.g. routine physical exams and immunizations), pregnancy or childbirth, transplants, treatment of mental illness or substance abuse, and the like.
Policyholders must generally obtain treatment from an in-network provider in order to receive full benefits.
If you are considering purchasing a short term health insurance policy, do the following:
•?Don’t just rely on the glossy marketing materials provided by the insurance company. Do your homework. Review a copy of the actual insurance policy, particularly the exclusions that will apply. The attorney general’s office counted more than 35 exclusions in one short term health insurance policy sold in Minnesota.
•?Be especially careful if you have any preexisting condition, whether or not you have received treatment from a physician for that condition. Short term health insurance policies generally exclude coverage for most preexisting conditions.
•?Beware of taking out back-to-back short term policies. The policies generally exclude coverage for treatment of any conditions for which you submitted a claim under your prior short term policy.
The bottom line is that short term health insurance policies typically offer relatively light coverage. If you have a past medical history or are likely to draw on the policy, you may be better off taking out a regular, longer term health insurance policy.
If you have a preexisting condition, the result of which you have been denied coverage in the private marketplace, you may be eligible for coverage from the Minnesota Comprehensive Health Association (MCHA). MCHA is a health plan for people unable to obtain insurance coverage in the private marketplace due to pre-existing conditions. MCHA generally may not turn you away because you have a pre-existing condition.
You may contact MCHA at: MCHA ?Customer Service, Mail Route CP555, ?401 Carlson Parkway, ?Minnetonka MN 55305-5387; ?1-866-894-8053; ?www.mchamn.com.
MinnesotaCare provides coverage to people who meet certain income and asset requirements. It is administered by county human service agencies, which you may contact directly. For more information, you may also contact the Minnesota Department of Human Services at: Minnesota Department of Human Services, ?444 Lafayette Road N,?St. Paul MN 55155; ?(651) 297-3933; www.dhs.state.mn.us.
Check out any health insurance company before you buy a policy. To obtain more information about a particular health insurance company, contact the following regulatory agency: Department of Commerce, ?85 East Seventh Place, Suite 500, ?St. Paul MN 55101; ?(651) 296-2488; toll free 1-800-657-3602.
If you would like to file a complaint about health care, or if you would like additional information about any consumer issue, you may contact the Office of Minnesota Attorney General ?Lori Swanson,?1400 Bremer Tower, ?445 Minnesota Street, ?St. Paul, MN 55101; ?(651) 296-3353 or 1-800-657-3787; ?TTY: (651) 297-7206 or 1-800-366-4812;?www.ag.state.mn.us/
Short term health policies usually do not cover preexisting conditions. Here is an example of a policy sold to a Minnesota resident with a preexisting condition exclusion:
PREEXISTING CONDITION: A medical condition due to Sickness or Injury:
1. For which the Insured received medical treatment or advice from a provider within the 5-year period immediately preceding the Effective Date of coverage, regardless of whether the condition was diagnosed or not diagnosed; or
2. That produced signs or symptoms within the 5-year period immediately preceding the Effective Date of coverage.
The signs or symptoms must have been significant enough to establish manifestation or onset by one of the following tests:
a. The signs or symptoms would have allowed one learned in medicine to make a diagnosis of the disorder; or
b. The signs or symptoms should have caused an ordinarily prudent person to seek diagnosis or treatment.
A pregnancy that exists on the day before Your Effective Date will be considered a PreExisting Condition.