Short Term Health Insurance - Common Covered Benefits

What should be Covered?
Below is a sample of what you might find to be covered expenses on most Short Term Health Insurance policies. Required benefits and limitations may vary from state to state or from insurance company to insurance company. Always closely review the covered benefits of the temporary health plan you are considering for purchase to make sure they provide at least the benefits that are outlined below.

Physician services
Inpatient and outpatient professional services provided by physicians, surgeons, assistant surgeons, anesthetists and consultants. The payment provided by a short term health insurance company is usually based on the allowable amount. Allowable amount is usually defined by current "negotiated rates" when using in-network providers. Or, when using out-of-network provides, this amount is usually determined by what is "usual and customary. Benefits for second opinions should also been included in the benefits description of your short term health insurance plan.

Laboratory and diagnostic services
X-rays and laboratory examinations for diagnostic purposes, including mammography and Pap tests for screening should also be included in the benefits of your temporary health plan. It is acceptable that the insurance company state that these are covered benefits only when referred by a physician. Important also is coverage for all generally medically accepted cancer-screening tests and screening and diagnosis of prostate cancer, including prostate-specific antigen testing and digital rectal examinations.

Other professional services
Remember that short term health insurance should be able to cover most incidents that unforeseeable and potentially life threatening. Therefore, make sure there are benefit provisions for the following:

• Services provided by dentists or oral surgeons to treat tumors or damage to natural teeth caused by an accidental injury sustained after the effective date of coverage.
• Services provided by a registered nurse.
• Treatment of diabetes, including all types of diabetes medication, prescription and non-prescription equipment and supplies, as well as diabetes outpatient self-management training, education and nutrition therapy. This is typically excluded as a pre-existing condition unless diagnosis was made after your short term health insurance policy became effective.
• X-ray, radium and isotope therapy.
• Physiotherapy.
• Medical emergencies.
• Radiation and chemotherapy.
• Anesthesiology.
• Diagnosis, treatment and appropriate management of osteoporosis, including all FDA approved technologies, including bone mass measurement technologies as deemed medically appropriate.
• Treatment for Diethylstilbestrol (DES) conditions or exposure.
• Outpatient physical

Many short term health plans may have limitations or maximum benefits on some of the covered benefits listed above. Upon receipt of your policy, always review the covered benefits in detail so you are familiar with these limitations.

Hospital services
Potentially the most costly claim against your short term health insurance company will be for hospital related expenses. When reviewing your policy, make sure that the coverage for this potential expense are adequate. At minimum, benefits should include:

• Hospital charges up to the semiprivate room rate, and services for an intensive care unit, as necessary.
• Surgery and assistance surgery.
• Anesthetist fees and services.
• Registered Nursing.
• Pre-Admission testing.
• Other supplies furnished and billed by the hospital.

Ambulance services
Professional ambulance services should always be part of your short term health insurance policy. Many temporary health plans will place limitations or maximums on this benefit. Some may only cover ground transportation. When reviewing the coverage of your temporary health plan, make certain that the ambulance benefits are reasonable and acceptable.

Durable medical equipment
In the event of an unforeseen illness or injury, the rehabilitation process can also be costly. The purpose of rehab is to get you back to a fully functioning physical state as quickly as possible. So, your short term health insurance policy should make provisions for this by providing the following benefits:

• The rental of wheelchair, hospital bed or other durable medical equipment needed during recovery.
• Oxygen and its administration.
• Prosthetic devices including artificial limbs, eyes or larynx, to permanently replace a natural body part lost while insured.
• Prosthetic devices and reconstructive surgery provided to restore and achieve symmetry incident to a mastectomy.

Prescription drug coverage
Another necessary expense in the treatment and recover of an unexpected illness or injury is prescription drug coverage. Prescription drugs should be available for at least a 30-day supply per 30-day time period. Many short term health insurance plans will put maximum benefits on prescription drug coverage, or limit benefits to drugs only listed within their approved drug formulary. For obvious preventive measures your plan should also provide coverage for diaphragms and birth control pills. Review your temporary health plan policy details to make sure you understand any limitations and restrictions that apply to prescription drug coverage.

Mental health services
The insurance regulations that required treatment for mental health services will vary from state to state based on the state's mental health parity requirements. Your short term health insurance plan should fall within the guidelines as recommended by your state's legislation. Common requirements for mental health benefits include services rendered for the treatment of severe mental illness and serious emotional disturbances of a child and treatment for severe mental illness.

For additional information about short term health insurance policies, you should review the common exclusions and limitations of short term policies or visit our main Short Term Health Insurance page or read through the frequently asked questions.

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