Individuals and Families: Short-Term Blue

Is Short-Term Blue right for you?

You are a candidate for Short-Term Blue if you are:

• A recent graduate without coverage;
• Between jobs or laid off;
• Working a part-time or seasonal job;
• A new employee temporarily without coverage;
• A student in need of coverage for the summer;
• Recently retired and not yet eligible for Medicare.

Under a Family Plan, Short-Term Blue also protects your legal spouse, as well as your unmarried children up to age 19.

Eligibility

You are eligible for Short-Term Blue if you are a permanent resident of Arkansas and between the ages of six months and 65.

You are NOT eligible if:

• You are covered by Medicare or any other health insurance. (Short-Term Blue does NOT coordinate benefits with any other health insurer.)
  
• You are pregnant.
  
• Within the last five years, you have received consultation or treatment for any of the conditions identified on the application.
  

Benefits at a Glance

With Short-Term Blue, you:

• Choose the number of days you want coverage (from 30 to 182 days).
  
• Choose your deductible: $500 or $1,000. (If you choose a family plan, there is a maximum of two deductibles per family per policy.) If you need care, you pay the deductible.
  
• Then, Short-Term Blue pays 80 percent of the next $10,000 (individual policy coinsurance maximum) of covered services per person or $20,000 (family policy coinsurance maximum) per family. You would pay the remaining 20 percent.
  
• Once you've met the coinsurance maximum, Short-Term Blue pays 100 percent of covered charges up to the $1 million lifetime maximum per person.

IMPORTANT NOTE: If you go "out of network," your deductible, coinsurance and coinsurance maximums will double.

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Covered Benefits

The following services are covered under Short-Term Blue:

• Inpatient hospital services
• Outpatient services
• Physician services
• Emergency room services
• Diagnostic lab and X-ray
• Children's preventive care and immunizations
• Durable medical equipment: $5,000 policy maximum
• Ambulance: $1,000 policy maximum
• Home health/private duty nursing: $4,000 policy maximum
• Skilled nursing facility: 30-day policy maximum
• Chemotherapy

Preexisting Conditions Exclusion Period

Treatment of preexisting conditions or diseases are NOT covered. A preexisting condition or disease is one that causes symptoms, before the effective date of the policy, that would have caused an ordinarily prudent person to seek diagnosis, care or treatment. This also applies to aggravations of such conditions or diseases. There is NO credit given toward the preexisting condition exclusion for prior insurance.

Excluded Benefits

The following services are NOT covered under Short-Term Blue:

• Pregnancy/childbirth (complications are covered)
• Prescription drugs
• Mental health/substance abuse
• Outpatient physical/occupational/speech therapy
• Transplants
• Infertility
• Adult routine care
• Hospice
• Vision (refractory, eyeglasses)
• Preexisting conditions
• Services that are not medically necessary
• Services or supplies received outside the United States
• Other limits and exclusions apply as written in the policy contract

Prescription Discount

While there are no prescription drug benefits with Short-Term Blue, you will receive a free ScriptSave Discount Drug Card. With savings ranging from 5-30 percent, your ScriptSave card provides instant discounts at participating pharmacies with no claims to file.

Freedom of Choice

As a Short-Term Blue policyholder, you are free to select virtually any health-care provider — with NO referrals and NO primary care physician (PCP) required. However, if you choose a True Blue PPO participating provider, you benefit from prenegotiated discounted fees, resulting in additional cost savings for you. By using network physicians, you maximize your benefits and keep your out-of-pocket costs down. Participating providers also will file claims for you, so there is less paperwork — less hassle.

You will also be covered if you seek medical care outside the network, but —

• The in-network deductible amount will double.
• The policy-year coinsurance maximum amount will double.
• The coinsurance amount Arkansas Blue Cross pays decreases by 20 percent.

You will be responsible for the difference between the billed charge and the allowed amount for that charge.

Go to the Provider Directory for a complete list of True Blue PPO providers.

Policy Terms and Termination

We may terminate the policy only if you have furnished fraudulent information or if you misuse your identification card. If we terminate this policy, we will give you 10 days' written notice. We will not refund any part of your premium.

If your temporary need for coverage continues beyond your original coverage period, you may reapply for a new Short-Term Blue policy.

Any condition which manifested during the term of the previous policy will be considered a preexisting condition and will not be covered by the subsequent policy. This policy does not provide continuous coverage for any Arkansas Blue Cross individually underwritten policies, including any you apply for while your Short-Term Blue policy is in effect.

A policy is issued based on the status of the applicant(s) at the time the policy is effective. No changes are allowed to the policy once it has been issued.

Once you have been accepted into Short-Term Blue and payment has been received, the premium will not be refunded for any reason.

Extension of Benefits

If you are hospitalized for a covered condition when this policy ends, you may be eligible for an extension of benefits. This extension applies only to the condition for which you are hospitalized and covers related hospital and physician services. Benefits may be extended until the earlier of the date you reach any applicable benefit maximum or the date following your discharge from the hospital. Under no circumstances, can benefits be extended more than 60 days from the original termination date of your policy.

Acceptance into Short-Term Blue is not guaranteed. It is vital that you do not cancel any health insurance you now have until Arkansas Blue Cross confirms your coverage. If Arkansas Blue Cross approves your application, you will receive a policy outlining your benefits in detail.

This Web site contains a summary of benefits available to you through Short-Term Blue; it is not your insurance contract. Refer to your policy for a complete list of limitations and exclusions.

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