An arm of HealthCare Inc. has introduced a health insurance product that sits somewhere on the edge between between traditional, bare-bones short-term health insurance and full-blown major medical insurance.
The company’s Pivot Health division has developed the new Quantum PPO policy with underwriting muscle from Companion Life Insurance Company and provider network help from Cigna Corp.
For a few years, the federal government imposed a three-month limit on the duration of short-term health insurance policies. The administration of President Donald Trump has since given states the ability to let short-term policies stay in place for up to 364 days, and to let policyholders use renewals to keep the coverage in place for up to three years.
The new policy can stay in force for up to 364 days, in states that allow that.
Policies “may include extended coverage options,” HealthCare Inc. says.
HealthCare Inc. the parent of the HealthCare.com web broker site as well as of Pivot Health.
The new Quantum PPO policy offers insureds access to the Cigna preferred provider organization provider network.
A product brochure posted by a distributor shows that purchasers can choose coverage with:
- Up to $1 million in benefits per coverage period.
- Round-the-clock access to telemedicine doctor consultations, with a $49 fee.
- Deductibles ranging from $2,500 to $10,000.
- Coverage for one preventive exam per coverage period.
- Options for co-payments for doctors’ office visits.
- A $10,000 cap on out-of-pocket costs for in-network care.
- Supplemental accident coverage.
- Coverage for mental disorders, subject to a deductible and coinsurance requirements.
- Travel emergency care coverage, subject to a deductible and coinsurance requirements.
HealthCare is offering the policy to people ages 18 to 64 and 11 months, and to their dependent children.
The Underwriting Rules and Coverage Restrictions
The policy is medically underwritten, and it comes with a pre-existing condition exclusion.
The pre-existing condition exclusion provision excludes coverage for conditions that produced symptoms with the 24-month period before the consumer bought coverage.
The policy also comes with many other exclusions that would be prohibited for a major medical policy that was subject to the Affordable Care Act benefits requirements.
The policy does not cover fertility treatments, routine prenatal care or maternity care, or treatments for chronic fatigue, cataracts, sleep disorders, or injuries experienced during bungee jumping or scuba diving.
The policy also excludes:
- Most coverage for care for HIV, AIDS or diabetes.
- Coverage for any sicknesses that arise during the first three days following the coverage effective date.
- Coverage for cancer that arises within the first 30 days following the coverage effective date.
There is a three-month waiting period for care for certain conditions and treatments, such as tonsillectomies.
Jeff Smedsrud, the chief executive officer of Pivot Health, has been active in efforts to provide health insurance products outside of the major medical insurance framework for years.
He noted in a statement about the new product that Cigna has let Pivot Health use its PPO network.
“We believe the plans will be meaningful to customers who need to keep their health care expenses in check,” Smedsrud said.
— Read Short-Term Health Users Say the Coverage Worked: EHealth, on ThinkAdvisor.