How eHealth medical insurance packages work

Now let’s look at how eHealth medical insurance packages may work in several real-life situations. For example, how does it help if you break a leg or are diagnosed with a serious medical condition? What if you become pregnant while enrolled in insurance medical insurance package?
The examples provided below are for illustration purposes only. The coverage and terms offered by any eHealth medical insurance package may differ from the examples given here. We just want to help you better understand how medical insurance packages may work for you.

Scenario 1: “…What if I break a leg?”

There are various parts of an eHealth medical insurance package that may come in handy if you break a leg or suffer a similar injury. For example:

  • Your package’s short-term health insurance plan may cover medical expenses after a deductible.
  • Your gap insurance coverage may reimburse you for out-of-pocket expenses associated with your injury – and you may opt to use that money to help cover your short-term deductible.
  • Your prescription drug discount card (a non-insurance product) may come in handy to help you save on any drugs you’re prescribed.

Scenario 2: “…What if I need to see the doctor for a case of the flu?”

Everyone needs to see the doctor now and then for a persistent cough, a fever, or other minor-to-moderate symptoms of illness. No one likes to get sick, but the good news is that your medical insurance package can help.

  • Your medical insurance package’s gap insurance plan may cover you for up to four doctor’s office visits per year (for some plans).
  • Your medical insurance package’s short-term health insurance plan may cover medical expenses after a deductible.
  • In some cases, your package’s medical indemnity insurance plan may provide you with limited first-dollar coverage for certain kinds of medical care.
  • Rather than visit a doctor’s office, you may also opt to use your telemedicine service (a non-insurance product) to get a diagnosis – or even a prescription – from a licensed medical professional by phone.
  • Your prescription drug discount card (a non-insurance product) may come in handy to help you save on any drugs you’re prescribed.

Here’s an example of how coverage under your medical insurance package may work if you visit the doctor for flu or strep throat and some follow-up tests are needed, after which you are prescribed medicine:

Medical costs Medical insurance package coverage
Doctor visit:
$100
Lab test:
$100
Prescription drugs:
$75
Indemnity medical insurance:
$100 per office visit
$50 for lab test
Rx drug discount:
35% ($48.75)
Total costs: $275 Total coverage:
Insurance Pays:

$176.25
You pay:
$73.75

The dollar values provided above are hypothetical examples and only provided for illustration purposes. The coverage available to you may differ based on a number of factors, so you’ll need to refer to official plan and product documents to understand the coverage, exclusions, limitations, and other terms of each plan or product.

Scenario 3: “…What if I am diagnosed with a critical illness?”

Gap insurance plans, or critical illness insurance plans, may offer you personal reimbursement if you are diagnosed with a covered serious medical condition like heart disease or cancer. Some policies may make you a direct payment after diagnosis while others may reimburse you for expenses you’ve paid out-of-pocket.

  • Your package’s gap insurance or critical illness insurance plan may pay you directly and you can use the money toward medical bills or for any other purpose you like. The amount of payment you receive may vary from one plan to another.
  • If you need follow-up surgery, other lines of coverage in your package may come into play to help you defray major medical expenses.

Here’s an illustration of how your gap or critical illness coverage could come into play if you’re diagnosed with a serious medical condition:

Medical costs Medical insurance package coverage
Office visit:
$100
Lab tests:
$1,200
Gap insurance:
$5,000 upon diagnosis
(for covered conditions)
Total costs:
$1,300
Total coverage:
Insurance pays:

$5,000
You pay:
$0

Now, here’s an illustration of how coverage could potentially work if you needed surgery and had to spend three days in the hospital following an unexpected serious diagnosis:

Medical costs Medical insurance package coverage
Surgery:
$70,000
Post op treatment:
$10,000
Short-term health insurance:
$72,000 (after $10,000 deductible)
Medical indemnity:
$1,500 (per surgery)
$1,000 (per day in the hospital)
Total costs:
$80,000
Insurance pays:
$76,500
You pay:
$3,500

The dollar values provided above are hypothetical examples and only provided for illustration purposes. The coverage available to you may differ based on a number of factors, so you’ll need to refer to official plan and product documents to understand the coverage, exclusions, limitations, and other terms of each plan or product.

Scenario 4: “…What if I need to visit the emergency room?”

If you’re experiencing a medical emergency, the last thing you want to think about is whether the care you receive is going to be covered by your insurance. You’ll be glad to know that in most cases your medical insurance package will provide you with valuable assistance.

  • Depending on your diagnosis, your gap insurance coverage (or accident or critical illness insurance coverage) may provide you with a pay-out to help cover your emergency room visit.
  • Your gap insurance policy or your medical indemnity insurance policy may reimburse you for a portion of your ambulance fees, emergency room fees, or hospital fees.
  • Your short-term health insurance policy may protect you by setting a maximum amount that you'll have to pay after you meet your deductible.
  • Your prescription drug discount card may provide you with valuable savings on prescription drugs associated with your situation after you leave the hospital.

Scenario 5: “…What if I have a pre-existing condition?”

eHealth’s medical insurance packages are not designed to provide you with broad protections against expenses associated with a pre-existing medical condition. In fact, you may be declined coverage for some components of a medical insurance package if you have a pre-existing medical condition. However, other products may provide you with some level of coverage for services associated with your condition. For example:

  • Your prescription drug discount card (a non-insurance product) may provide you with valuable savings on prescription drugs associated with your pre-existing medical condition.
  • “Guaranteed-issue” medical insurance packages – that will cover you no matter what your medical history – may also be available through eHealth in your area.

Scenario 6: “…What if I become pregnant?”

Unlike more expensive major medical health insurance plans, some components of medical insurance packages may not include coverage for pregnancy-related medical care. Other components, however, may still provide you with meaningful financial assistance.

  • Pre-natal and post-natal visits are not covered by medical insurance packages.
  • Your package’s medical indemnity insurance policy may reimburse you for certain hospital expenses associated with your labor and delivery.
  • Your prescription drug discount card (a non-insurance product) may provide you with valuable savings on prescription drugs associated with your labor or delivery.