How is TriTerm different from Short Term Medical?
TriTerm lasts nearly 3 years with one application, while regular Short Term Medical lasts a year at most. TriTerm can also cover pre-existing conditions after your first 12 months, and the two Max plans include some preventive care. In exchange, there's a $40 application fee in most states, the earliest start date is 5 days after UHC receives your application, and you must be 63 or younger to apply.
Is this the same as an ACA (Obamacare) plan?
No. TriTerm is still short-term coverage. It asks health questions before approving you, doesn't include everything an ACA plan must cover, like maternity and mental health care, and doesn't qualify for premium tax credits. If you need those protections, an ACA plan may be the better choice, and I can quote both.
When are pre-existing conditions covered?
Not during your first 12 months. A pre-existing condition is one you were treated for, got advice about, or had symptoms of in the 24 months before your plan starts (12 months in Indiana and Louisiana, 6 months in Georgia and Mississippi). After you've been on the plan for 12 months, eligible costs for those conditions can be covered. A pregnancy that began before your plan starts isn't covered.
How do the three terms work?
You apply once, and your coverage runs for three back-to-back terms: 364 days, then 365, then 365 (three 364-day terms in Indiana). Your deductible, coinsurance limit, and copay visits start over at the beginning of each term. Your premium is expected to change each term, but UHC won't raise it because of your claims or a change in your health.
Can I see any doctor?
You'll use a nationwide UnitedHealthcare network, either Choice or Choice Plus, depending on your state. You don't need referrals. On Choice, there are no out-of-network benefits except for emergencies. On Choice Plus, the plan pays less out of network: your deductible doubles, there's a 25% penalty, and there's no out-of-pocket limit. Pick your state above to see which network you'd have.
How does prescription coverage work?
Copay Select Max: Tier 1 drugs, usually common generics, cost a $25 copay with no deductible. For Tier 2 to 4 drugs, you first meet a $500 prescription deductible each term, then pay a $55 copay (Tier 2), a $75 copay (Tier 3), or 50% (Tier 4).
Plan 100 Max: prescriptions are free after your deductible. Both Max plans cover up to $5,000 in drug costs per person, per term. Value: prescriptions aren't covered, but you get a discount card to use at the pharmacy.
What preventive care is covered?
On the two Max plans, preventive care is covered after a 6-month wait in your first term, up to $200 per person, per term. That includes vaccines, blood tests, mammograms, Pap and HPV tests, bone density scans, and EKGs. You pay a $50 copay on Copay Select Max, or nothing after the deductible on Plan 100 Max. The Value plan doesn't cover preventive care. On every plan, one prostate exam and PSA test per term is covered without the deductible, and children's preventive care is covered separately.
Is there a waiting period for anything?
Yes, three. Pre-existing conditions aren't covered for 12 months. Preventive care starts after 6 months in your first term. And treatment of tonsils, adenoids, middle-ear problems, hemorrhoids, hernias, or reproductive organ disorders isn't covered for the first 6 months, unless it's an emergency. Everything else is covered from your start date.
What happens if I go to the emergency room?
Emergencies are covered on every plan, even at an out-of-network hospital. For an illness, there's an extra $500 deductible if you're not admitted. That extra charge doesn't apply to accidents. An out-of-network hospital can bill you for the difference between its charge and what the plan pays.
When does coverage start, and what does it cost to apply?
The earliest start date is 5 days after UHC receives your application, once you're approved. Plans don't start on the 29th to 31st of a month, so those roll to the 1st. There's a one-time $40 application fee, added to your first month's premium ($6 in Mississippi and none in West Virginia). Your first payment is charged right away.
What is FACT, and do I need to join?
In 11 states, these plans are offered through FACT, the Federation of American Consumers and Travelers, a consumer association. You join when you apply, and the dues are added to your premium. Membership includes extras like prescription, dental, and travel discounts. Pick your state above to see if it applies to you.
Can I cover my spouse and children?
Yes. You can add your spouse and children under 26 (under 30 in Florida). Each person has their own deductible, but a family pays at most 2 deductibles per term. The person applying must be 19 to 63. In Missouri, plans cover one person only, starting at age 20. Coverage ends on the primary insured's 65th birthday.
What if I change my mind?
You have 30 days after your plan is issued to return it for a refund of the premium you paid. The $40 application fee is usually non-refundable, though it's refunded in some states.
How do I manage my plan once I have it?
Register at the UHC Member Hub to see your ID card, pay your premium, submit claims, and find network doctors. Here's my step-by-step Member Hub guide.
What if I only need coverage for a few months?
Regular Short Term Medical may fit better. You can choose a shorter plan, and coverage can start the next day. Here's my Short Term Medical guide.