*IMPORTANT: SHORT TERM MEDICAL PLANS (STM) cost less than permanent ACA compliant major medical plans because they insure less over a 90 to 364 day periods. STM plans insure limited benefits versus ACA compliant (Marketplace plans) that insure unlimited “essential health benefits”. Some STM plans EXCLUDE preexisting medical conditions, and typically reimburse physicians & Hospitals a “referenced-based-pricing”. Off-plan (non-contracted) providers can “balance-bill” a higher charge than the STM plan insures, and bill the patient the difference.
STM Plans that offer four consecutive 90 day policies are far better than plans requiring a new application every 3 to 9 months, and that will exclude a preexisting medical conditions treated in the new plan period. The Pivot CORE plan uses the First Health PPO Network, and is not OPEN ACCESS, meaning care is only insured in the PPO network. CORE plan insures the Usual, Customary & Reasonable (UCR) billed charge, not a referenced based pricing - which is more coverage.
The Pivot: ECONOMY, CHOICE, STANDARD and DELUX plans ARE OPEN ACCESS, and insure eligible care to licensed providers. These four (4) plans insure the billed charge up to 125% / 150% of what the Medicare fee schedule allows. Non-contracted (off-plan) providers “may” charge more, so it is important to ask if your provider will “balance-bill” you for an amount above what your plan insures, before receiving care. *READ your POLICY. Know your plan limits and EXCLUSIONS. If you are not sure, stick with Marketplace offered ACA compliant (more expensive) major medical plan.