Limited benefit health plans are insurance products with reduced benefits intended to supplement comprehensive health insurance plans, not to be an alternative to them. You may have seen these types of plans marketed as Short Term Limited Duration Insurance, Accident Policy, Cancer Only, Specific Disease or Heart Policies, Hospital Cash or Indemnity plans. They may also be Discounted Plans such as Pharmacy, Dental or Medical Clinic Memberships. These plans are not considered ACA compliant which could result in you paying additional out-of-pocket expenses for uncovered medical services. The are not required to cover your pre-existing conditions.

Limited benefit health insurance plans are not typically required to provide the same level of coverage, so they cover fewer types of medical services and expenses than a comprehensive policy. These plans typically pay you a flat amount for a specific service, covered item or covered disease or giving you a discount for services, leaving you the rest of the bill to pay yourself. A limited benefit plan may limit the amount of coverage the company will pay per episode of illness or per day, sometimes as low as $50 to $5,000 (not counting co-insurance and deductibles paid out-of-pocket by you). These policies also provide limited surgical, preventative care, testing and emergency benefits upon receipt of the billing. And with low maximum benefit limits called “caps,” it may be possible for you to reach your cap quickly, leaving you responsible for the balance of the bill. Discounted plans still leave you paying for the services yourself.

Buyer beware when purchasing Limited Benefit Plans – understand what you are purchasing!

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• Short Term Limited Duration Insurance: In Oklahoma, currently these plans without state mandated benefits may cover you for twelve (12) months after the original effective date of the contract up to a duration of thirty-six (36) months. Duration may vary by carrier. They may exclude pre-existing conditions and even ask health questions on the application; and may have annual and yearly benefit limits. You will want to see the policy exclusions and limitations before buying.
• All applications and policies must contain prominent wording warning consumers these plans are not major medical or comprehensive major medical and do not have the protections that ACA policies would normally provide.
• Accident Only: Pays only when you are treated for accidental injury or if an accident causes death.
• Disability Income: Pays a fixed amount for a specified period of time when you are unable to work because of an accident or illness.
• Hospital Indemnity: Pays a flat amount (such as $100 per day) when you are hospitalized.
• Long-Term Care: Pays to take care of you for an extended time in a nursing home or your own home. For more information, visit www.longtermcare.gov. For information about the Oklahoma Long Term Care Partnership, visit: oklahoma.gov/ohca
• Medicare Supplement: Pays some medical expenses not paid by Medicare. (See the Choosing a Medigap Policy)
• Special Need: Pays for health care not covered by typical major medical policies (for example, dental or vision care).
• Specific Disease: Pays only for treatment for a disease or condition specifically named in the policy such as cancer.
• Home Health Care: Pays for health care delivered to you in your home.

Other types of plans:

• Discount Plans – These plans are not considered ACA compliant. Medical Discount Plans, Prescription Discount Plans, Dental Discount Plans, and Vision Discount Plans are programs where a consumer pays a fee to join a plan in return for discounts on products and services from participating vendors and providers. Often, members who join these plans are issued a card similar to an insurance card identifying them as a member. However, these plans are NOT insurance. Buyer beware!