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Affordable Healthcare Solutions / Non-ACA Healthcare Options

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SHORT TERM (STM) COVERAGE

STMs are considered major medical insurance and typically cover 100% of medical costs after a deductible and out of pocket maximum to a lifetime limit of up to $2 million depending upon the plan and carrier.

  • Depending on the State, they now can be written for up to one year and can be renewed up to three years
  • Note: California and several other States do not allow STM plans
  • Short-term medical plans do ask medical questions, so you are not guaranteed to be approved for coverage and they generally do not cover pre-existing medical conditions and prescriptions

Benefits of STM Plans

  • Most STM plans have broad network coverage
  • Premiums are often low, in the range of half of ACA plans
  • Apply all year round, not limited to Open Enrollment periods

Problems with STM Plans

  • Pre-existing conditions coverage not available
  • Applications may be rejected due to health status
  • Poor prescription drug coverage

SPECIFIED BENEFIT LIMITED MEDICAL/INDEMNITY PLANS

These plans pay a specified dollar benefit for medical services such as hospitalization, surgery, and physician office visits.

Benefits of Limited Medical/Indemnity Plans

  • Premiums can be very affordable
  • Member receives a cash payment upon a qualifying event such as an accident, or specific critical illnesses, or hospital admissions as specified in the plan
  • Applications can be made any time of the year, no waiting for Open Enrollment
  • Usually are “guaranteed issue” which means there is no medical underwriting, so applications are not rejected due to health status of applicants
  • Generally, these plans have pre-negotiated rates with a healthcare provider network

Problems with Limited Medical/Indemnity Plans

  • Benefits are tied to specific incidences, such as an accident, critical illness, doctor visits, or hospital admission, depending on the policy
  • No benefits for general conditions such as diabetes, arthritis, etc.
  • Medical expenses often capped at a rate much lower than major medical plans
  • Certain pre-existing conditions may be not covered for up to twelve months

ASSOCIATION SPONSORED HEALTH PLANS

Benefits of Association Health Plans

  • Usually utilize a Health & Welfare Benefit Trust structure wrapped under the Association
  • Usually contain several plans (Bronze through Gold)
  • Utilize nationwide group PPO networks
  • The Trust administers the various plans and uses a Third-Party Administrator (TPA) to verify benefits and pay claims on part of the Trust.
  • These plans are designed for Self-Employed, Independent Contractors, Sole Proprietors, Managing Members of LLCs, Sub-S Shareholders, other Small Business Owners with fewer than five employees, and W2 employees where the company does not provide group coverage
  • May enroll at any time during the year

Problems with Association Health Plans

  • Because the Trust administers the plans they act as the self-insured entity paying the actual claims
  • Trustee may ask health and pre-existing condition related questions (underwriting)
  • Trustee may exclude joining the Trust due to a negative health history or pre-existing conditions

HEALTH CARE SHARING MINISTRY PLANS

Benefits of Member Health Share Ministry Plans

  • Plans tend to mimic ACA mandates
  • Monthly rates may be 40% to 60% less than the cost of ACA (Obamacare) plans
  • Usually utilize a nationwide PPO network
  • Enroll year round, no qualifying event needed

Problems with Member Health Share Ministry Plans

  • Depending on Plan, maximum lifetime benefits may be limited to $1,000,000
  • Limited drug coverage
  • Any pre-existing conditions at time of enrollment will be excluded for up to 24 months
  • Pregnancy benefits will be excluded for the first 10 months after enrollment