The Words and Phrases You Need to Know to Make Sense of Short Term Health Insurance

9. Out-of-Pocket Maximum

Your Short Term medical insurance plan’s out-of-pocket maximum is the most you will pay toward covered expenses during the course of your plan’s term. Once you hit your out-of-pocket maximum, your insurance company pays for 100% of your covered expenses. Note: If the plan you picked includes copays, you may still be responsible for those copays beyond your out-of-pocket maximum.

10. Covered Expenses

Your covered expenses are those health care services or items covered by your plan. No health insurance plan covers everything, and this is especially true of Short Term health insurance, which is not required to cover the same health benefits the ACA requires. Be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of preexisting conditions or health benefits. 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.

11. Network

The carrier of the Short Term medical insurance plan you choose will likely have a list of doctors and other health care providers to use when you have health care needs. This list can be called a network or PPO. Using doctors or facilities from that list means you are choosing “in-network” care. Going to a doctor or facility that isn’t on that list means you are going “out of network” for your care.

Check your Short Term health insurance plan for details regarding any restrictions on going to doctors or facilities outside the network. But even if there aren’t any restrictions, it usually makes more sense to stay in-network when you can. In-network doctors and providers have agreed to provide care at a discounted rate for holders of that health care plan, so staying in network can save you money.