|
Short-term Medical Agent Disclosure
All producers who write Short Term Medical Plans (STM’s) for clients as an alternative to COBRA because of cost considerations etc., the following form may be useful. It is designed to explain and clarify that STM coverage is not COBRA or COBRA replacement coverage.
The form should not be sent to the insurance company coinciding with an STM application but should be kept in your client file for your use only. This should help in supporting your STM sales. Please copy the form below for your use.
Short Term Medical plans are affordable and ideal for healthy individuals who are between jobs, waiting for employer group coverage, graduating from college, on strike, laid-off or terminating employment. If you need more information, STM plans or licensing please call.
--------------------------------------------------------------------------------------------------------------------------------------------------------------
Short Term Medical Disclosure
Short Term Medical insurance is temporary health insurance designed for people who are between permanent health plans and may be purchased for 30-185 days (varies by state).
I understand that Short Term Medical insurance is designed to protect me in the case of an unexpected illness or injury and does not cover pre-existing conditions, as defined in the policy. I also understand that the plan contains other exclusions and limitations, and that all exclusions and limitations, as well as covered services, are listed in detail in the policy or certificate.
By signing below, I acknowledge that the benefits and limitations of purchasing a Short Term Medical plan have been explained to me. I also understand that I may have a right to continue my current health plan under the federal law called COBRA or under a state mandated continuation plan. I understand that information about plan options, costs, benefits and limitations may be obtained from my employer.
_________________________________ ______________________________
Insured Signature Date
_________________________________ ______________________________
Agent Date
|
