American Health Shield  - Temporary Health Insurance

The American Health Shield - Short Term Health Insurance provides benefits for Covered Medical Expenses related to covered Injury or Sickness, which are:  1) not in excess of Usual and Customary Charges; 2) not in excess of a maximum benefit amount; 3) made for services and supplies which are a Medical Necessity and listed as Covered Medical Expenses in the Policy or Certificate issued by FSG - Fairmont Specialty Group. 

• Hospital Charges: average semi-private room rate, medical care and treatment

• Surgery in a Hospital or Ambulatory Surgical Center

• Physician Services for diagnosis, treatment and surgery

• Intensive Care: up to three times the average semi-private room rate

• Skilled Nursing Facility: up to $30 per day for 30 days

• X-Ray Exams, Laboratory tests and analyses

• X-Ray and Radioactive isotope therapy, anesthesia, oxygen, casts, splints, crutches, braces, surgical dressings, artificial limbs or eyes, rental of medical supplies

• Blood or blood plasma and their administration

• Ambulance Services: $250 per emergency

• Organ Transplants: $50,000 lifetime maximum

• Acquired Immune Deficiency Syndrome (AIDS): $10,000 lifetime maximum

• Home Health Care: up to 40 visits

• Hospice Care: up to $5,000

• Spinal Manipulation/Adjustment: up to $1,000

• Mammography, pap smear and screens

• Gallbladder Surgery: up to a $2,500 lifetime maximum

• Knee injury or disorder: up to a $2,500 lifetime maximum for both left and right knees

Usual and Customary Charges means the lesser of: 1) the actual charge; 2) what the provider would accept for the same service or supply in the absence of insurance; or 3) the reasonable charge as determined by Fairmont Specialty Group, based on factors such as: a) the most common charge for the same or comparable service or supply in a community similar to where the service or supply is furnished; b) the amount of resources expended to deliver the treatment rendered; c) charging protocols and billing practices generally accepted by the medical community or specialty groups; or d) inflation trends by geographic region.

Pre-Admission Certification: This plan requires a Pre-Admission Certification by a Professional Review Organization prior to in-patient Hospitalization or surgery.  A Covered Person or their Attending Physician must call the Professional Review Organization: 1. For elective or non-emergency Hospitalization or surgery, at least 10-days prior to the date of proposed Hospitalization; 2. Within 48-hours of an emergency admission; or 3. Within 48-hours of delivery for complicated childbirth.  Non-compliance with the Pre-Admission Certification procedure will result in a reduction in benefits of 50%, unless the Covered Person is incapacitated and unable to contact the Professional Review Organization. In such cases, the Covered Person must contact us as soon as possible. 

Covered Medical Expenses and Benefits vary by state. Detailed information about these and additional Covered Medical Expenses is listed in the Policy or Certificate issued by Fairmont Specialty Group to approved applicants