Short-Term Personal Health Coverage Temporary Coverage for the Unexpected
SHORT-TERM PERSONAL HEALTH COVERAGE AND THE HEALTH CARE LAW The health care law requires almost all Americans to have a certain level of health coverage. Short-Term Personal Health Coverage can give you coverage temporarily, but these plans do not provide the higher level of coverage required by the health care law. Visit HealthCare.gov to find out what it might mean for you if you do not have the required level of coverage. BlueCross BlueShield of Tennessee offers a number of traditional health plans that provide the higher level of coverage and protection required by the health care law. Call your insurance agent/broker or visit bcbst.com to check out traditional health plans available in your area.
Accidents and unexpected illnesses happen. If you need health insurance temporarily, our Short-Term Personal Health Coverage can help protect your health and your budget. Short-Term Coverage might be right for you if you are: waiting for coverage through your job to start a recent college graduate between jobs need temporary coverage 1
THE PLAN PAYS 80 PERCENT AFTER YOUR DEDUCTIBLE IS MET Once you meet the deductible, your Short-Term Personal Health Coverage plan pays 80 percent of the maximum allowable charge* for covered care and services from network providers. You pay the remaining 20 percent of the costs up to your out-of-pocket maximum. Your out-of-pocket maximum is based on the deductible you choose. It s the amount you pay out of your own pocket before your plan pays 100 percent of the maximum allowable charge. After you meet your deductible, your plan will pay 100 percent of the maximum allowable charge for covered care until you reach the plan s $1 million maximum. * The maximum allowable charge is the amount determined by BlueCross to be an appropriate cost for a covered service based on negotiated contracts with providers. 2
BLUECROSS SHORT-TERM PERSONAL HEALTH COVERAGE OFFERS YOU: Health coverage for one, two or three months Benefits for key health care services paid at 80 percent after the plan s deductible is met A choice of deductibles $250, $500, $1,000 or $2,500 for individuals* Blue Network P, our broadest network of providers and pharmacies. Visit bcbst.com to look up network providers and pharmacies near you. Automatically filed claims when you use network providers, which means no paperwork for you A network that goes where you go. Our BlueCard network gives you access to network providers and hospitals across the country and around the world. *Deductibles for family coverage are three times the individual amounts. COVERED CARE AND SERVICES Office visits and services Routine diagnostic and lab services Prescription medicines Hospital stays, including room and board in a semiprivate room, general nursing care, medications, injections, diagnostics and special care units Emergency care Ambulance services (ground transportation only) Skilled nursing facilities (10-day limit per benefit period) Physical, speech, occupational, manipulative, cardiac and pulmonary rehabilitative therapies (10-visit limit per benefit period) Home health services (10-visit limit per benefit period; prior authorization required) Durable medical equipment, such as wheelchairs and walkers This is only a partial list of covered care and services. You will receive a complete list of covered services after you enroll. 3
SHORT-TERM PERSONAL HEALTH COVERAGE CHOICES We offer four options for short-term coverage, so you can find a plan that meets your needs and wallet. FOUR PLAN OPTIONS DEDUCTIBLE COINSURANCE 1 IN-NETWORK Individual Family Plan Pays You Pay $250 $750 80% 20% 2 3 4 $500 $1,500 80% 20% $1,000 $3,000 80% 20% $2,500 $7,500 80% 20% ** Separate deductibles and out-of-pocket maximums apply to in-network and out-of-network services. NEED COVERAGE LONGER? Short-Term Personal Health Coverage is purchased up to three months at a time. If you need coverage longer than that, you can apply for up to four consecutive, three-month plans for a total of 12 months of coverage. After that, you will need to wait six months before applying for short-term coverage again. 4
OUT-OF-POCKET MAXIMUM OUT-OF-NETWORK * Plan Pays You Pay Individual Family 60% 40% $1,250 $2,750 60% 40% $1,500 $3,500 60% 40% $2,000 $5,000 60% 40% $3,500 $9,500
GET COVERED. APPLYING IS EASY! You are eligible to apply for Short-Term Personal Health Coverage if you are: A resident of Tennessee A dependent child 25 or under (You must be unmarried and depend on your parents for at least 50 percent of your support.) A foreign resident living in the United States with proof of a Green Card, or a school or work visa. Under age 65 Not covered by another health plan Not pregnant or an expecting parent CALCULATE YOUR PREMIUM Use the chart to calculate your full premium payment: 1 2 3 Pick your plan deductible [ $250 ] [ $500 ] [ $1,000 ] or [ $2,500 ] Find the monthly premium for the age and gender of the person you want to cover. If you are buying coverage for a family, find the rate for the oldest family member to be covered. $ Multiply the monthly rate by the number of months up to three you want coverage. Your full premium for coverage X $ Your coverage becomes effective at 12:01 a.m on your requested effective date. If you apply and pay for a plan online today, your coverage could start as early as tomorrow. Keep in mind you cannot ask for an effective date more than 60 days after the date of your application. Your full premium payment, for the entire period of coverage, is due with your completed application. You can pay online by credit card or echeck.* * If your payment is declined after your coverage starts, your plan can be cancelled back to the effective date. 6
1 MONTH RATE CHART AGE INDIVIDUAL FAMILY $250 Deductible Male Female All 0-6 $57.03 $51.01-7 - 17 $33.60 $30.05-18 - 24 $34.18 $54.57 $147.43 25-29 $41.63 $69.07 $162.93 30-34 $47.39 $78.56 $177.06 35-39 $57.76 $93.14 $208.38 40-44 $68.20 $106.14 $230.77 45-49 $80.75 $120.49 $248.81 50-54 $105.91 $138.80 $277.31 55-59 $143.64 $171.17 $343.88 60-64 $200.45 $202.71 $429.01 $500 Deductible Male Female All 0-6 $45.60 $40.78-7 - 17 $26.86 $24.02-18 - 24 $27.33 $43.62 $117.84 25-29 $33.27 $55.21 $130.24 30-34 $37.88 $62.80 $141.52 35-39 $46.17 $74.45 $166.57 40-44 $54.51 $84.85 $184.47 45-49 $64.55 $96.32 $198.88 50-54 $84.66 $110.95 $221.67 55-59 $114.82 $136.82 $274.88 60-64 $160.24 $162.04 $342.93 $1,000 Deductible Male Female All 0-6 $35.08 $31.37-7 - 17 $20.66 $18.47-18 - 24 $21.03 $33.55 $90.66 25-29 $25.60 $42.47 $100.20 30-34 $29.14 $48.31 $108.88 35-39 $35.52 $57.27 $128.14 40-44 $41.94 $65.27 $141.91 45-49 $49.66 $74.10 $153.00 50-54 $65.13 $85.36 $170.53 55-59 $88.34 $105.27 $211.47 60-64 $123.27 $124.66 $263.82 $2,500 Deductible Male Female All 0-6 $22.61 $20.23-7 - 17 $13.32 $11.91-18 - 24 $13.56 $21.63 $58.45 25-29 $16.51 $27.38 $64.59 30-34 $18.79 $31.14 $70.20 35-39 $22.90 $36.93 $82.62 40-44 $27.04 $42.08 $91.50 45-49 $32.02 $47.77 $98.64 50-54 $41.99 $55.03 $109.94 55-59 $56.95 $67.87 $136.34 60-64 $79.48 $80.37 $170.08
Services and Care Not Covered by Short-Term Coverage To keep premiums affordable, short-term plans do not cover: Pre-existing conditions Routine examinations and shots (immunizations) Treatment of nervous or mental disorders Treatment of alcohol or substance abuse Care that is not medically necessary Eyeglasses, contact lenses or hearing aids, including prescription or fittings Removal of corns, calluses or trimming of nails Allergy testing Services or supplies provided in connection with an experimental or investigative treatment, procedure or supply 8
YOUR COVERAGE CAN START TOMORROW Apply Online at bcbst.com 11. Review the short-term health coverage options available to you. 22. Choose the plan that s right for you. 33. Complete and submit the application online. You can also apply through one of our certified agents/brokers near you. What You Need to Know About Pre-Existing Conditions Short-Term Personal Health Coverage plans will not pay for services or care you receive for a health problem you had before your plan s effective date. This is called a pre-existing condition, and includes any physical or mental condition for which medical advice, diagnosis, care or treatment was recommended, received or should reasonably have been received from a health care provider before your plan was in effect. It s important to know that if you reapply for Short-Term Personal Health Coverage any illness or injury that started before your new plan s effective date will be considered a pre-existing condition and will not be covered.
1 Cameron Hill Circle Chattanooga, TN 37402 bcbst.com BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association COMM-317 (3/14) Short-Term Coverage Brochure