IHC Connect Plus
Connect Plus - is a short-term medical (STM) insurance policy with a limited benefit for pre-existing conditions. STM, sometimes called short-term medical limited duration insurance, is designed to provide coverage during transitions or gaps in major medical coverage.
Most STM plans do not cover healthcare expenses for pre-existing medical conditions. Connect Plus provides a benefit not to exceed a maximum of $25,000 for eligible pre-existing healthcare expenses. Short-term medical provides limited duration insurance coverage for 30 to 364 days, which varies by state. Not all states allow for durations of 364 days. STM policies are not ACA plans STM policies do not meet ACA standards. The ACA is a Federal law that requires all major medical plans to provide specific benefits and requires that most Americans have health plans that qualify as Minimum Essential Coverage (MEC). These rules do not apply to STM policies. Short-term medical insurance is a limited duration medical expense policy and is non-renewable. The amount of benefits provided depends on the plan selected and the premium will vary with the amount of benefits selected. STM is not a replacement for the comprehensive health insurance required under the ACA. |
This plan is meant if you:
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IHC Connect Plus Plan Description
Plan Selection
Physician office visit copay After the copay, the balance of the doctor office visit charge is covered at 100 percent. Additional covered expenses incurred during the office visit, including expenses for laboratory and diagnostic tests will be subject to plan deductible and coinsurance. Based on your state of residence, you may be limited to a certain number of copays. |
$50 copay, not to exceed one visit per coverage period 1 copay for 30–90 days of coverage 2 copays for 91-180 days of coverage 3 copays for 180+ days of coverage |
Deductible The selected deductible maximum is an amount of money that must be paid by the covered person before coinsurance benefits begin. Family deductible maximum: When three covered persons in a family each satisfy their deductible, the deductibles for any remaining covered family members are deemed satisfied for the remainder of the coverage period. |
$5,000 $10,000 |
Coinsurance percentage and out-of-pocket maximum After the deductible maximum amount has been met, you pay the selected coinsurance percentage of covered expenses until the out-of-pocket maximum amount has been reached. The out-of-pocket maximum amount is specific to expenses applied to the coinsurance percentage; it does not include covered expenses applied to the deductible, precertification penalty amounts, or expenses not covered under the policy. Once the deductible and out-of-pocket maximum amounts have been satisfied, additional covered expenses within the coverage period are paid at 100 percent, not to exceed the coverage period maximum benefit amount. Benefit-specific maximums may also apply. |
30% coinsurance Out-of-pocket: $6,000 50% coinsurance Out-of-pocket: $10,000 |
Coverage period maximum benefit |
$2,000,000 |
Pre-existing condition coverage period maximum After maximum is reached, expenses due to pre-existing conditions are not covered. |
Primary insured - $25,000 Covered spouse - $25,000 Covered child(ren) - $25,000 |
Covered medical expenses
All benefits, except office visits applied to the copay, are subject to the selected plan deductible and coinsurance. Covered expenses are limited by the usual, reasonable and customary charge as well as any benefit-specific maximum. If a benefit-specific maximum does not apply to the covered expense, benefits are limited by the coverage period maximum. Benefits may vary based on your state of residence. Covered expenses include treatment, services and supplies for:
Usual, reasonable and customary charge
Charges for services and supplies, which are the lesser of: a) the amount usually charged by the provider for the service or supply given; b) the negotiated rate; or c) the average charged for the service or supply in the locality in which it is received. Pre-certification
Precertification is required prior to each inpatient confinement for injury or illness and outpatient chemotherapy or radiation treatment, at least seven days prior to receiving treatment. Emergency inpatient confinements must be pre-certified within 48 hours following the admission, or as soon as reasonably possible. Precertification may also be conducted for a continued stay review for an ongoing inpatient confinement. Benefits are not paid for days of inpatient confinement which extend beyond the number of days deemed medically necessary. Failure to complete precertification will result in a benefit reduction of 50 percent which would have otherwise been paid unless the covered person is incapacitated and unable to contact the administrator. Precertification is not a guarantee of benefits. Precertification is not required in some states. Renewability of coverage
STM is not renewable. In some states you are allowed to apply for another STM plan. Your application is subject to eligibility, underwriting requirements and state availability of the coverage. The next coverage period is not a continuation of the previous period; it is a new plan with a new deductible, coinsurance and pre-existing condition limitation. Note that based on your state, you may be limited to two or three consecutive terms only. Exclusions
The following list of exclusions is a partial list of services or charges not covered. Check your policy for a full listing:
6 Brochure Connect Plus 1018 Exclusions continued
or reversal of sterilization; sex transformation (unless required by law), penile implants, sex dysfunction or inadequacies and/or diagnosis and treatment of infertility, including but not limited to any attempt to induce fertilization by any method, invitro fertilization, artificial insemination or similar procedures, whether the covered person is a donor, recipient or surrogate.
7 Brochure Connect Plus 1018 This coverage is not required to comply with certain federal market requirements for health insurance, principally those contained in the Affordable Care Act. Be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of pre existing conditions or health benefits (such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services). Your policy might also have lifetime and/or annual dollar limits on health benefits. If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage. Also, this coverage is not “minimum essential coverage.” If you don’t have minimum essential coverage for any month in 2018, you may have to make a payment when you file your tax return unless you qualify for an exemption from the requirement that you have health coverage for that month. |
Eligibility
Individuals, spouses and dependents may be covered. Connect Plus is available to the primary applicant from age 18 to 64, his or her spouse age 18 to 64 and dependent children under the age of 26. A child-only plan is available for children age 2 up to age 18 Hospital and confinement definitions
Hospital means an institution which is legally constituted and operated in accordance with the laws pertaining to Hospitals in the jurisdiction where it is located, which meets all of the following requirements:
Confinement means the time in which a covered person is a registered bed patient in a hospital on the order of a physician for medically necessary medical treatment. Confinement in a special unit of a hospital used primarily as a nursing, rest, or convalescent home shall be deemed to be confinement in an institution other than a hospital. Utilize a network provider and save
With your short-term medical plan, you have the freedom to choose any provider. In certain markets, you also have access to discounted medical services through national preferred provider organizations (PPOs). These network providers have agreed to negotiated prices for their services and supplies. At the time of service, simply present your identification card, which will include the network information needed for the provider to correctly process covered billed charges. If this provider discount is not available, then benefits are paid at the usual, reasonable and customary charge. 10-day right to return period
If for any reason you are not satisfied with the policy, you may return it to us within 10-days after you receive it and you will be issued a refund. The refund will include any premium paid minus the enrollment and administrative fees. These fees may vary by state. Your coverage issued under the policy will then be void, as though coverage had not been issued. Coverage termination
Coverage ends on the earliest of the date: the date the policy terminates; the date you become eligible for Medicare; the expiration date of your coverage; the premium is not paid when due, if such payment has not been made within 31 days following such premium due date; you enter full-time active duty in the armed forces; or Independence American Insurance Company determines intentional fraud or material misrepresentation has been made in filing a claim for benefits or the date of your death. A dependent’s coverage ends on the earliest of the date: your coverage terminates; the dependent becomes eligible for Medicare; or the dependent ceases to be eligible. |
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