What is Short-Term Health Insurance?

Short-Term Health Insurance FAQs


Short-term health insurance plans have a limited duration, typically several months to a year. These plans were initially geared toward people who needed temporary medical insurance to bridge the gap between plan years for standard-term plans. For instance, people who are switching employers, starting graduate school, or young adults who have become ineligible for coverage under their parents' plans and are searching for their own insurance might use a short-term insurance plan until obtaining a more permanent solution. Other examples are:

  • People looking for an alternative to standard individual health plans
  • Part-time or temporary employees
  • Workers between jobs and looking for an affordable alternative to COBRA
  • New employees waiting for health benefits to begin
  • Those who are recently retired and waiting for Medicare eligibility

A WPS Short-Term Health Plan can be taken from one month to one year. Short-term plans are not renewable, but you can sign up for a new one and use them back to back; however, the total length of the policies cannot exceed 18 months in Wisconsin due to state statute. Federal law allows customers to use short-term plans for up to three years.

Short-term health insurance coverage varies greatly depending on the plan and the insurance company. These types of plans are not required to comply with Affordable Care Act (ACA) guidelines and can be lower cost. ACA plans are required to provide certain levels of coverage—called Minimum Essential Coverage. Short-term health plans are not required to meet the same standards. Short-term medical insurance typically provides some level of coverage for: preventive care, doctor visits, urgent care, and emergency care. There may also be coverage for prescriptions. Some plans also offer cost savings for seeing in-network providers. Note: Make sure to read the “exclusions and limitations” information before buying any plan. This will highlight what is covered and not covered by a certain plan but may not be all inclusive. For full plan details, read the policy’s certificate. These plans may not cover claims for conditions that exist prior to the policy effective date.

Short-term health plans are available to customers who can pass medical underwriting. Effective dates can be as soon as the day after application and plans can last from a month to one year. WPS short-term policies have a six-day waiting period for any illness. WPS policies will pay claims related to injuries/accidents that do occur in the first six days provided they are not related to an accident/illness or injury that existed or happened prior to the effective date of the policy.

Customers are eligible for Affordable Care Act individual policies outside of the Open Enrollment Period if they have a Qualifying Life Event (e.g., marriage, divorce, birth, permanent move, etc.). If they do not have a qualifying event, they can apply for a short-term health insurance policy. If they pass the underwriting questions, they can be issued a policy. Note: Preexisting conditions may not be covered under a short-term health plan.

If you are considering temporary health insurance, typical upfront costs include:

  • Premium: This is the monthly fee you pay for having coverage. The premium will vary depending on the level of coverage you choose, including deductible and coinsurance, as well as the types of services covered.
  • Deductible: The deductibles on short-term health plans can be significantly higher than for traditional health plans. You pay out of pocket for services until you meet your deductible. Then your plan starts sharing costs.
  • Coinsurance: This is the percentage of costs you share with your plan after you meet your deductible. It’s often shown as a percentage. Most short-term plans have a deductible and use coinsurance.
  • Copayment: This is a fee you may pay when you visit a doctor; usually payable at the time of the visit. Some short-term plans require you to pay a copay for certain doctor visits.
  • Other out-of-pocket costs: If there are health care services not covered by your short-term plan, you could end up paying all costs. For example, some short-term plans may not cover or may limit your coverage for maternity care, mental health or substance use services, vision care, or dental care—these are costs you’d have to pay yourself for any services you receive.
  • Other costs may apply depending on what type of coverage you buy. Read all plan information carefully before choosing so you are informed on what your plan may actually cost you.

Individuals who are 18–64 years old are eligible.

Rates are based on age, policy duration, gender, and the Wisconsin county in which you live.

Yes. The WPS application contains questions pertaining to your medical history. If you select yes to any of these medical underwriting questions, you will not be eligible for a WPS short-term policy.

If the primary applicant is declined, a spouse over the age of 18 can become the primary applicant. If there is no spouse, all applicants would be declined. WPS does not offer child-only plans.

No, the short-term plan does not cover preexisting conditions. Additionally, if you purchase a subsequent policy, the health plan will not provide coverage for preexisting conditions that developed under the original short-term plan.

Expenses for injuries are eligible for coverage as of your plan's effective date. Coverage for illnesses has a six-day waiting period, so expenses related to illnesses are eligible for coverage beginning on the seventh day following the effective date.

Coverage begins the day after the online application is submitted or the postmark date of the paper application. You can also choose to set the effective date up to 60 days from today’s date. Coverage will not be in effect unless a full month’s premium has been collected.

Yes, exclusions and limitations do apply. Full details are in the WPS policy packet provided for enrollment.

Short-term health plans have a network just like ACA health plans. WPS Short-Term Health Insurance Plan uses the WPS Statewide Network. Our WPS Statewide Network is comprised of more than 15,000 health care providers, a wide range of clinics and specialty care centers, and 138 hospitals throughout Wisconsin, as well as parts of Illinois, Iowa, and Minnesota (nationwide network coverage is not included with these plans). Out-of-network claims are processed subject to maximum allowable charges.

Yes, the WPS Short-Term Health Insurance Plan offers out-of-network benefits at a higher out-of-pocket cost.

If you move outside of Wisconsin after the WPS Short-Term Health Insurance Plan policy is in effect, you can retain the policy for the duration of the policy term. Because the plan is only available to Wisconsin residents, once the policy term expires, you will not be eligible for another term if you move out of state.

On Aug. 3, 2018, the federal government released final rules regulating extending short-term policies from less than three months to less than 12 months and allowing a maximum duration of 36 months with renewals and extensions. However, these final regulations allow states to make laws governing short-term plans. Wisconsin state law only allows consecutive policies to last for a maximum term duration of 18 months.

If you have reached your 18-month maximum policy period with WPS, you must observe a 63-day break before being eligible to apply again for a short-term policy. You must have 63 days of no short-term coverage with WPS to regain eligibility.

Terms for WPS plans can be written in increments from one month up to 12 months, including partial months. However, you can purchase additional terms up to 18 months of coverage.

No, short-term policies are not renewable. You may apply for additional policy terms provided they do not exceed 18 months of consecutive coverage.

Yes. Your effective date can be any date during the month with a 30-day coverage period. Partial months of coverage will be prorated based on the monthly premium.

Your short-term plan will coordinate with other health insurance policies. Please refer to your policy for additional details.

Yes. WPS reserves the right to rescind a policy in the event there is a failure to disclose or misrepresentation of required information during the application process.

Yes. However, since WPS offers one-month terms, this should be a rare occurrence.

Policies are billed monthly. The premium due date is the first day of each month.

Yes, WPS requires payment of a full month’s premium at the time of application submission.

You can pay by credit card, automated payment (ACH), or check. More information is available on our premium payments page.

There is a 10-day grace period following the premium due date.

If your premium is not received prior to the 10-day grace period, your policy will be terminated.

If paying by check, please send payments to:
WPS Health Insurance
P.O. Box 9
Madison, WI 53701-0009

Customers should call the Customer Service number on their WPS ID card. If you’re not yet a customer, please contact one of our sales associates at 800-332-6421.

   

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