UnitedHealthcare Tri-Term Plan FAQs: Answers on Coverage, Costs and State Rules
These answers cover the questions people ask most about a UnitedHealthcare tri-term plan. Licensed Vivna agents wrote each one in plain English. Because rules change by state, every answer shows where it applies. Call 888-730-6001 anytime for free help.
Vivna Insurance is an appointed, authorized broker for UnitedHealthcare. We are an independent agency, not UnitedHealthcare. Tri-term plans are not ACA plans and are sold only in some states. Plans and availability vary by state.
Tri-Term Plan Basics and Terms
Start here to learn how a UnitedHealthcare tri-term plan works. Then see how its terms continue and end.
β What is UnitedHealthcare TriTerm Medical insurance?
TriTerm Medical is short-term health insurance that can last nearly 3 years from one application.
It covers care from minor injuries to major hospital stays. In addition, the plan may cover preexisting conditions after you have been on it for 12 months.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Who is the insurance company behind TriTerm Medical?
Golden Rule Insurance Company, a UnitedHealthcare company, underwrites TriTerm Medical.
United Healthcare Services, Inc. administers the plans. Also, Golden Rule holds an "A" (Excellent) rating from A.M. Best.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β How is TriTerm Medical different from a regular short-term health plan?
TriTerm is still short-term, limited-duration insurance, but one application gives you three back-to-back terms.
Together, those terms add up to nearly 3 years. Also, the plan may cover preexisting conditions after you have been on it for 12 months.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Is TriTerm Medical the same as an ACA or Obamacare plan?
No, TriTerm is a short-term, limited-duration policy, not comprehensive coverage.
It has fewer benefits and federal protections than HealthCare.gov plans. Also, it does not have to cover all essential health benefits.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Can a TriTerm Medical plan turn me down because of my health?
Yes, TriTerm is medically underwritten, so your health history can affect approval.
By contrast, ACA Marketplace plans cannot deny you for preexisting conditions.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical count as minimum essential coverage?
No, TriTerm does not qualify as minimum essential coverage under the ACA.
Some states charge a tax penalty for not having it. So check your state rules before relying on TriTerm.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical have an out-of-pocket limit like ACA plans?
Not in the same way as ACA plans, which cap yearly out-of-pocket costs for essential benefits.
TriTerm does have a coinsurance maximum. However, copays and non-covered costs are extra, so your total can be higher.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Who is TriTerm Medical designed for?
TriTerm fits people who need coverage that lasts longer than a few months.
The plan targets individuals and families in times of transition and change. However, it is medically underwritten, so approval depends on your health answers.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Which states sell UnitedHealthcare TriTerm Medical?
You can buy UnitedHealthcare TriTerm Medical in 15 states.
They are AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN and WV.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β How long does a UnitedHealthcare TriTerm plan last?
A TriTerm plan lasts nearly 3 years from a single application.
You get three terms that add up to one day less than 3 years. Term 1 is 364 days. Then Terms 2 and 3 are 365 days each.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Do I have to reapply or answer health questions again for TriTerm terms 2 and 3?
No, you apply once for all three TriTerm terms.
In fact, the brochure describes it as one application for nearly 3 years of coverage.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Can I renew TriTerm Medical after the three terms end?
No, TriTerm is non-renewable, and Golden Rule issues it for a set period.
Instead, coverage stays in force until the termination date in your certificate or policy.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does my TriTerm deductible reset each term?
Yes, your TriTerm deductible resets with each new term.
The deductible, coinsurance maximum and office visit copay count are all per person, per term. So a new term starts these amounts over.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Can Golden Rule cancel my TriTerm plan in the middle of a term?
Golden Rule can cancel mid-term only for fraud or material misrepresentation in a claim.
Otherwise, coverage stays in force until the termination date, unless another termination event applies.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What happens when my TriTerm Medical plan ends?
Your TriTerm coverage stops on the termination date.
However, losing this coverage may not let you enroll in an ACA plan right away. Instead, you might have to wait for the next open enrollment period.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
Eligibility, Enrollment and Preexisting Conditions
These answers explain who can apply and when coverage starts. Also, see how preexisting conditions affect your plan.
β How soon can TriTerm Medical coverage start?
TriTerm coverage can start as early as 5 days after Golden Rule receives your application.
You can also request a later start date.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What has to happen for my TriTerm application to take effect?
Your application and first premium must arrive within 15 days of signing.
The application must also be complete and approved. In addition, you must live in a state where TriTerm is available. Your account is also charged right away.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Can my TriTerm coverage start on the 29th, 30th or 31st?
The 29th, 30th and 31st may not be eligible start dates for TriTerm coverage.
If so, your coverage starts on the 1st of the following month.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Is there an application fee for TriTerm Medical?
Yes, in most states TriTerm has a $40 application fee.
However, some states differ. For example, Mississippi charges $6, and West Virginia has no fee. Also, a few states refund the fee if coverage is not issued.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Can I cancel TriTerm Medical and get a refund?
Yes, you can cancel during the 30-day free look and get a refund.
To do so, return the certificate or policy within 30 days after it is issued. Then you get back the premium you paid.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Can I cancel my TriTerm plan later on?
Yes, you can cancel your TriTerm plan later on.
Coverage then ends on the date Golden Rule receives your request to terminate.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Can my employer pay for my TriTerm plan?
No, your TriTerm coverage ends if you accept any employer contribution toward the premium.
It also ends if you and your employer treat it as employer-provided insurance, including for taxes.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What are the age limits for TriTerm Medical?
The primary applicant must be at least 19 and younger than 64 when applying.
However, Missouri requires a minimum age of 20.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Can I keep TriTerm Medical after I turn 65?
No, TriTerm Medical ends on the primary insured's 65th birthday.
So that is the time to look at Medicare.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Can I add my spouse and kids to a TriTerm plan?
Yes, in most states you can cover your lawful spouse and eligible children.
Children must be unmarried and under 26 at application in most states. However, Missouri allows individual coverage only.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β How does the TriTerm deductible work for a family?
Each person has their own TriTerm deductible, per term.
However, a family pays a maximum of two deductibles per term.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, TN, WV, IA
β What happens to my family's TriTerm plan if the primary insured dies?
A covered spouse can continue the coverage if the primary insured dies.
Otherwise, if there is no covered spouse, the youngest covered child can continue it.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does moving to another state end my TriTerm plan?
Yes, if everyone on the plan moves out of the state where it was issued.
Coverage then ends on that date.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What is FACT, and why does TriTerm require it?
In these states, TriTerm is an association group plan for FACT members.
FACT stands for the Federation of American Consumers and Travelers. You can join FACT with your TriTerm application. However, FACT and Golden Rule are separate organizations.
π Where this applies: AL, AR, AZ, FL, IA, IN, MS, NE, SC, TN, WV
β Does FACT membership cost extra with TriTerm Medical?
Yes, FACT does charge membership dues.
However, you can pay them with your regular premium instead of as a separate payment.
π Where this applies: AL, AR, AZ, FL, IA, IN, MS, NE, SC, TN, WV
β What perks come with FACT membership?
FACT perks include an accidental death benefit and dental, vision and prescription discounts.
Members also get ID theft protection, travel discounts and online wellness classes. However, FACT may change these benefits at any time.
π Where this applies: AL, AR, AZ, FL, IA, IN, MS, NE, SC, TN, WV
β Do I need to join FACT for TriTerm in Georgia, Kentucky, Louisiana or Missouri?
No, the Georgia, Kentucky, Louisiana and Missouri brochures show no FACT requirement.
Instead, Golden Rule issues TriTerm as an individual policy in these states.
π Where this applies: Georgia, Kentucky, Louisiana and Missouri
β Does TriTerm Medical cover preexisting conditions?
Not at first, because TriTerm pays no benefits for preexisting conditions in the first 12 months.
After 12 months on the plan, however, TriTerm may cover those expenses.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What counts as a preexisting condition on TriTerm Medical?
Generally, it is a condition you got care or advice for in the 24 months before coverage.
It also includes symptoms that should have been checked in the prior 12 months. In addition, a pregnancy that exists when coverage starts counts.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Which TriTerm states use a shorter preexisting condition look-back?
Georgia and Mississippi use a 6-month preexisting condition look-back.
Meanwhile, Indiana and Louisiana look back 12 months. Other states use the standard 24-month look-back.
π Where this applies: Georgia, Mississippi, Indiana and Louisiana
β If I had Golden Rule coverage before, will TriTerm cover my existing conditions right away?
No, TriTerm excludes your existing conditions for the first 12 months.
That rule still applies even if a prior Golden Rule plan covered them.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Is there a waiting period for certain conditions on TriTerm Medical?
Yes, some conditions are not covered for the first 6 months on TriTerm.
These are tonsils, adenoids, middle ear disorders, hemorrhoids, hernia and reproductive organ disorders. However, emergency treatment is the exception.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Can I get TriTerm Medical if I have a serious health condition?
Approval depends on medical underwriting, and preexisting conditions are not covered for 12 months.
By contrast, an ACA plan cannot deny you for health history. A licensed agent can help you compare.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
Deductibles, Copays and Plan Costs
Here you can see how deductibles, copays and coinsurance work on tri-term plans. Plus, learn what affects the price.
β What TriTerm Medical plan options are there?
TriTerm Medical comes in three plan designs: Value, Copay Select Max and Plan 100 Max.
Value has 30% coinsurance. Copay Select Max has 30% coinsurance plus copays. By contrast, Plan 100 Max pays 100% after the deductible. However, Iowa offers only Copay Select Max.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What deductibles can I choose on TriTerm Medical?
TriTerm Value offers deductibles from $2,500 to $15,000.
Copay Select Max offers $2,500 to $12,500. Plan 100 Max, by contrast, offers $5,000 to $12,500. Also, each deductible is per person, per term, and options may vary by how you buy.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What coinsurance do I pay on TriTerm Medical?
After the deductible, you pay 30% coinsurance on Value and on Copay Select Max.
By contrast, you pay 0% on Plan 100 Max.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What is the coinsurance maximum on TriTerm Medical?
The TriTerm coinsurance maximum is $10,000 on Value and $4,500 on Copay Select Max.
It is $0 on Plan 100 Max. Each amount is per person, per term. However, copays do not count toward it.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What is the maximum benefit on TriTerm Medical?
Most TriTerm plans pay up to $2 million per person, lifetime.
In Indiana, however, it is $2 million per person, per term. Also, the Iowa plan pays up to $750,000.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What is TriTerm Plan 100 Max?
Plan 100 Max charges nothing after the deductible for doctor visits, urgent care, ER, hospital care and prescriptions.
Deductibles run $5,000 to $12,500. Also, coinsurance is 0%.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What is TriTerm Copay Select Max?
Copay Select Max has a $50 copay for the first 4 doctor visits per term.
Plus, urgent care is $75, and Tier 1 drugs are $25. Other care is 30% after the deductible, up to a $4,500 coinsurance maximum.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, TN, WV, IA
β What is TriTerm Value?
TriTerm Value offers deductibles from $2,500 to $15,000.
You pay 30% after the deductible, up to $10,000. However, it has no prescription or preventive coverage.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, WV
β Is the TriTerm Value plan available in every state?
No, TriTerm Value plans are not available in Tennessee or Iowa.
π Where this applies: Tennessee and Iowa
β What does a doctor visit cost on TriTerm Medical?
On Copay Select Max, the first 4 visits per term have a $50 copay.
After that, deductible and coinsurance apply. On Plan 100 Max, visits are no charge after the deductible. By contrast, Value is 30% after the deductible.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Can I use the TriTerm $50 office copay for a checkup?
No, the TriTerm office visit copay is for illness and injury.
So you cannot use it for preventive services, except those required by state law.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, TN, WV, IA
β How much is urgent care on TriTerm Medical?
Urgent care center visits are a $75 copay on Value and Copay Select Max.
On Plan 100 Max, however, they are covered with no charge after the deductible.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, TN, WV, IA
β How is emergency room care covered on TriTerm Medical?
ER visits are 30% after the deductible on Value and Copay Select Max.
By contrast, Plan 100 Max is no charge after the deductible. Also, illness ER visits add a $500 deductible unless you are admitted.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, TN, WV, IA
β How are hospital stays and surgery covered on TriTerm Medical?
Inpatient care, outpatient surgery, labs and x-rays are 30% after the deductible on Value and Copay Select Max.
On Plan 100 Max, by contrast, they are no charge after the deductible.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, TN, WV, IA
β Do copays count toward the TriTerm deductible?
No, copays do not count toward the TriTerm deductible.
They also do not apply to the coinsurance or coinsurance out-of-pocket maximum.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What affects the price of a TriTerm Medical plan?
TriTerm rates depend on the plan, age, sex, benefit level, tobacco use and underwriting class.
How long the plan has been in force and where you live also count. In addition, higher benefits mean a higher premium.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
Networks, Doctors and Member Support
These answers cover networks, doctors and emergency care. In addition, you will find how to manage your plan.
β What network does TriTerm Medical use?
TriTerm uses the UnitedHealthcare Choice or Choice Plus network, depending on your state and plan.
In fact, the network has over 1.7 million providers and over 7,000 hospitals.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Do I need a referral to see a specialist on TriTerm Medical?
No, you can see any network doctor or specialist across the nation without a referral.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Will a network doctor balance bill me on TriTerm Medical?
No, network providers will not charge more than the network-negotiated rate.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β How do I find a TriTerm network doctor?
Go to UHOne.com and select Find A Doctor to search for network providers in your state.
Members can also look up doctors and hospitals in UHC Member Hub.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical pay for out-of-network doctors?
TriTerm out-of-network coverage depends on your state and plan.
Choice network plans pay nothing for non-emergency out-of-network care. By contrast, Choice Plus plans pay reduced out-of-network benefits.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What does out-of-network care cost on a TriTerm Choice Plus plan?
You pay charges above the eligible expense, plus a 25% penalty.
That penalty does not count toward the deductible. Also, your deductible doubles. Finally, there is no out-of-pocket maximum out of network.
π Where this applies: Alabama, Arkansas, Arizona, Georgia and Kentucky, plus the Florida Value plan
β Which TriTerm states use the Choice Plus network?
All TriTerm plans in Alabama, Arizona, Arkansas, Georgia and Kentucky use Choice Plus.
In Florida, however, only the Value plan uses Choice Plus.
π Where this applies: AL, AR, AZ, GA, KY, FL
β Which TriTerm states use the Choice network with no out-of-network benefits?
Indiana, Iowa, Louisiana, Mississippi, Missouri, Nebraska, South Carolina, Tennessee and West Virginia use Choice for all plans.
Florida Max plans also use Choice.
π Where this applies: IA, IN, LA, MO, MS, NE, SC, TN, WV, FL
β Is out-of-network emergency care covered on TriTerm Medical?
Yes, emergency treatment from a non-network provider is treated as network care.
However, you may owe the difference between the provider's bill and what the plan pays.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What counts as an emergency on TriTerm Medical?
In most states, an emergency is a sudden condition with acute symptoms.
Without care within 24 hours, it could cause death or serious disability. However, several states use a broader prudent-layperson definition.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What if I get Medicare or other coverage while on TriTerm Medical?
TriTerm Medical coordinates benefits so all plans together never pay more than 100% of covered expenses.
The plan also considers medical coverage from auto insurance.
π Where this applies: AL, AR, AZ, FL, IA, IN, MS, NE, SC, TN, WV
β How do I manage my TriTerm Medical plan online?
You can manage your plan online by registering at UHC Member Hub (uhcmemberhub.com).
Once registered, you can view your ID card and plan documents, pay premiums and submit claims. You can also find network doctors and send non-urgent questions.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Can I add dental, vision or accident coverage to TriTerm Medical?
Yes, you can add them to TriTerm Medical as separate plans.
Options include DentalWise, VisionWise, accident plans and CriticalGuard critical illness. However, each one needs its own application and premium.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
Prescription Drug Coverage
Drug benefits on tri-term plans have their own rules. So review drug lists and pharmacy rules before you enroll.
β Does TriTerm Medical cover prescriptions?
Most TriTerm plans cover prescriptions, including Copay Select Max and Plan 100 Max.
However, the Value plan does not cover outpatient prescriptions. Instead, it provides a discount card.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β How much are prescriptions on TriTerm Copay Select Max?
On Copay Select Max, Tier 1 drugs are a $25 copay.
Tiers 2 to 4 have a $500 Rx deductible per term. After that, you pay $55, $75 or 50%. Also, the plan caps covered drug expenses at $5,000 per person, per term.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β How are prescriptions covered on TriTerm Plan 100 Max?
On Plan 100 Max, prescriptions are no charge after the deductible.
However, the plan caps covered drug expenses at $5,000 per person, per term.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β How do I pay for prescriptions on TriTerm Medical?
Just show your member ID card at the pharmacy.
Then you pay at the point of sale at the lowest price available.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Which drug list does TriTerm Medical use?
TriTerm covers drugs on the Prescription Drug List from OptumRx.
Also, a UnitedHealthcare committee sets drug tiers, which may change, usually quarterly.
π Where this applies: AL, AR, AZ, FL, IA, IN, MS, NE, SC, TN, WV
β Do I have to use a network pharmacy with TriTerm Medical?
Yes, TriTerm does not cover drugs from a non-member pharmacy unless it is an emergency.
The same applies to drugs bought without your prescription card. Also, some specialty drugs must come from a designated pharmacy.
π Where this applies: AL, AR, AZ, FL, IA, IN, MS, NE, SC, TN, WV
β Can I use drug manufacturer coupons on TriTerm Medical?
Not always, because certain manufacturer coupons may not count toward your deductible.
They also may not count toward your copays, coinsurance or out-of-pocket maximum.
π Where this applies: AL, AR, AZ, FL, IA, IN, MS, NE, SC, TN, WV
β What if my medication is not on the TriTerm drug list?
A non-formulary drug may be covered at normal cost-sharing if listed drugs are not appropriate for you.
It may also apply if you used it 6 months before it was dropped.
π Where this applies: AL, AR, AZ, FL, IA, IN, MS, NE, SC, TN, WV
β What prescriptions does TriTerm Medical not cover?
TriTerm excludes drugs with an over-the-counter equivalent and experimental drugs.
It also excludes most erectile dysfunction drugs, immunization agents and nutritional products. In addition, it excludes amounts above supply limits.
π Where this applies: AL, AR, AZ, FL, IA, IN, MS, NE, SC, TN, WV
β Does TriTerm Value cover chemotherapy pills?
The sample Value benefits list chemotherapy as covered whether given orally, by IV or by injection.
However, Value does not cover other outpatient prescriptions. So check your policy for your state.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, WV
What Tri-Term Plans Cover
These answers list the care tri-term plans cover, including preventive visits. Still, your certificate is the final word on benefits.
β Does TriTerm Medical cover preventive care?
Copay Select Max covers preventive care with a $50 copay.
Plan 100 Max covers it at no charge after the deductible. Also, the plan caps this benefit at $200 per person, per term. However, Value does not cover preventive care.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Is there a waiting period for preventive care on TriTerm Medical?
Yes, preventive care on TriTerm has a 6-month waiting period.
However, it applies in Term 1 only.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What preventive services does TriTerm Medical include?
Examples include immunizations, blood tests, bone density screenings, EKGs and mammograms.
Pap smears, HPV screenings and vaccines are also included. However, routine CT, MRI and PET scans are not.
π Where this applies: AL, AR, AZ, FL, GA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover a yearly physical?
In most states, TriTerm excludes routine physical exams.
However, Iowa is different. Its preventive benefit includes routine physicals with a $100 office visit copay.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Are children's checkups and shots covered on TriTerm Medical?
Yes, TriTerm covers children's preventive health services, subject to deductible and coinsurance.
However, qualifying childhood immunizations have no deductible, copay or coinsurance.
π Where this applies: AL, AR, AZ, FL, IA, IN, MS, NE, SC, TN, WV
β Does TriTerm cover prostate and colon cancer screenings?
Yes, in these states TriTerm covers prostate and colon cancer screenings.
The plan covers one prostate exam and one PSA test per term without the deductible. Also, colorectal cancer exams follow American Cancer Society guidelines.
π Where this applies: AL, AR, AZ, FL, IA, IN, MS, NE, SC, TN, WV
β Does TriTerm Medical cover maternity or pregnancy?
No, TriTerm Medical excludes normal pregnancy from coverage.
Also, a pregnancy that exists when coverage starts is preexisting. However, complications of pregnancy are an exception. By contrast, an ACA plan covers maternity care.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover a newborn's hospital care?
In these states, TriTerm covers routine in-hospital newborn care for up to 5 days after birth.
However, coverage stops sooner if the mother is discharged first.
π Where this applies: AL, AR, AZ, FL, IA, IN, MS, NE, SC, TN, WV
β Does TriTerm Medical cover mental health care?
TriTerm mental health coverage varies by state, and many states exclude it.
For example, Georgia, Kentucky, Louisiana and Missouri Max plans cover up to $5,000 per term. Iowa, by contrast, covers 15 inpatient days and 30 outpatient visits per term.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical include dental or vision?
No, TriTerm Medical does not include routine dental or vision care.
However, dental injury to natural teeth is covered if treated within 6 months. Also, TriTerm excludes eyeglasses, contacts and eye exams for them.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Are hearing aids covered on TriTerm Medical?
Generally no, because TriTerm excludes hearing aids and fittings.
However, Arkansas, Louisiana and Nebraska add limited hearing aid benefits.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover ambulance rides?
Yes, TriTerm covers ground ambulance to the nearest hospital that can treat you.
The plan also covers air ambulance when police or medical authorities request it. That also applies when ground transport cannot reach you.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover cancer treatment?
Yes, TriTerm covers radiation and chemotherapy, plus breast reconstruction after mastectomy.
One wig up to $500 and one mastectomy bra per year are also covered. However, cancer existing before coverage is preexisting.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover diabetes supplies?
Yes, TriTerm covers diabetes equipment, supplies and services, along with self-management training.
However, a diabetes diagnosis before coverage starts is a preexisting condition for the first 12 months.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover back and spine treatment?
Yes, but Max plans cap outpatient spine care at $5,000 per term in most states.
Value covers only inpatient and surgical spine treatment. However, some states remove the cap.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover physical therapy?
TriTerm covers rehab therapy in a rehab or extended care facility after a qualifying hospital stay.
However, it covers occupational therapy only after traumatic hand injuries. Also, home health benefits include licensed therapists.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover rehab or a skilled nursing stay?
Yes, TriTerm covers a rehab or skilled nursing stay, with limits.
Care must start within 14 days of a hospital stay of 3 or more days for the same condition. It is also limited to 60 combined days per person, per term.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover home health care?
Yes, TriTerm covers home health care through a licensed home health agency.
Aide visits are limited to 7 per week and 365 lifetime. Also, private-duty nursing is limited to 1,000 lifetime hours and $75 per visit.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover hospice?
Yes, TriTerm covers hospice for a terminally ill member in a state-licensed hospice.
Inpatient hospice is limited to 180 days lifetime. Also, the plan covers bereavement counseling up to $250.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover durable medical equipment?
TriTerm covers rental of a standard wheelchair, hospital bed, walker, wheelchair cushion or ventilator.
It also covers one CPM machine after a covered joint surgery. However, the plan generally excludes other DME.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover prosthetics?
Yes, TriTerm covers artificial eyes or larynx, breast prostheses and orthotic or prosthetic devices.
However, replacement is limited, usually once every 3 years unless medically necessary.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover autism treatment?
In most states, yes, TriTerm covers autism diagnosis and evidence-based treatment.
The plan covers outpatient ABA therapy up to $50,000 per person, per term. However, Georgia caps ABA at $35,000 for ages 20 and under.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover telehealth visits?
Yes, in these states TriTerm covers telemedicine the same as it would cover the service in person.
π Where this applies: AL, AR, AZ, FL, IA, IN, MS, NE, SC, TN, WV, MO
β Does TriTerm Medical cover organ transplants?
TriTerm covers cornea and some grafts like any illness.
Listed transplants are limited to 2 per person over the 36-month maximum duration. However, without a Center of Excellence, the limit is 1 transplant and $100,000.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What extra help does TriTerm give for transplants at a Center of Excellence?
At a designated Center of Excellence, TriTerm covers organ acquisition costs.
It also covers travel and lodging up to $5,000 per transplant.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover joint replacement?
TriTerm covers joint replacement only if it relates to an injury the plan covers.
Otherwise, the plan excludes joint replacement.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover TMJ treatment?
In most states, TriTerm excludes TMJ treatment.
However, Georgia, Kentucky, Louisiana and Missouri cover TMJ surgery. Louisiana and Missouri cap it at $10,000 lifetime. Also, Nebraska covers up to $2,500 lifetime.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Is a Friday or Saturday hospital admission covered on TriTerm Medical?
Room and board is not covered if you are admitted on a Friday or Saturday.
However, emergencies and medically necessary surgery scheduled for the next day are exceptions.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
Exclusions and Limits
Every tri-term plan has services it will not pay for. For that reason, check these limits before you buy.
β What does TriTerm Medical not cover?
Key TriTerm exclusions include preexisting conditions for 12 months, normal pregnancy and weight-loss surgery.
The plan excludes fertility treatment as well. Also, it excludes cosmetic care, routine dental and vision, and acupuncture.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover weight-loss surgery?
No, TriTerm excludes weight modification and surgical treatment of obesity.
That exclusion also includes intestinal bypass.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover fertility treatment or sterilization?
No, TriTerm Medical excludes drugs and procedures meant to promote conception.
It also excludes sterilization and the reversal of sterilization.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Are sports injuries covered on TriTerm Medical?
TriTerm Medical excludes injuries from professional, semi-professional or intercollegiate sports.
It also excludes injuries from skydiving, hang gliding, bungee jumping, rodeo and motor racing. In addition, the plan excludes injuries from scuba diving 60 feet or deeper.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Are work injuries covered on TriTerm Medical?
No, not if workers' compensation covers or is required to cover the injury.
This rule still applies even if you settled away your right to future workers' comp medical benefits.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Am I covered outside the United States on TriTerm Medical?
TriTerm Medical covers you outside the United States only for emergency treatment.
However, the plan does not cover any other care you receive outside the U.S.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover help to quit smoking?
No, TriTerm Medical excludes diagnosis and treatment of nicotine addiction.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β Does TriTerm Medical cover chiropractic-style or alternative care?
TriTerm Medical excludes alternative treatments unless the certificate covers them.
For instance, the exclusion includes acupuncture, acupressure, massage therapy, hypnotism, aromatherapy and rolfing.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
Tri-Term Rules by State
Tri-term rules and benefits change from state to state. As a result, each answer shows where it applies.
β How is TriTerm Medical different in Florida?
Florida TriTerm Medical plans can cover children who are under 30 at application.
Also, a dependent child with a disability stays eligible regardless of age. Value plans use the Choice Plus network, while Max plans use Choice.
π Where this applies: Florida
β What happens to Florida TriTerm coverage if the master policy ends during a hospital stay?
If a new master policy replaces the old one with no gap, benefits continue for that hospital stay.
Then those benefits end when the stay ends or when they would otherwise stop.
π Where this applies: Florida
β Are mammograms treated differently on TriTerm in Alabama?
Yes, Alabama TriTerm plans have no 6-month wait for mammography screenings.
In addition, these screenings do not count toward the $200 preventive maximum. However, neither change applies to Value plans.
π Where this applies: Alabama
β Does TriTerm cover hearing aids in Arkansas?
Yes, Arkansas TriTerm plans cover hearing aids from a state-licensed dispenser.
The benefit pays up to $1,400 per ear every 3 years. Plus, no deductible, copay or coinsurance applies.
π Where this applies: Arkansas
β Are there state variations for TriTerm in Arizona or South Carolina?
No, the brochures list no TriTerm state variations for Arizona or South Carolina.
π Where this applies: Arizona and South Carolina
β How is TriTerm Medical different in Georgia?
Georgia TriTerm plans use a 6-month preexisting look-back and remove the $5,000 spine limit.
In addition, TMJ care has no $10,000 cap. Value plans also add outpatient spine care.
π Where this applies: Georgia
β Is the TriTerm application fee refundable in Georgia, Kentucky or Iowa?
Yes, you get the application fee back if coverage is not issued.
You also get it back if you return the policy during the free look period.
π Where this applies: Georgia, Kentucky and Iowa
β How is TriTerm Medical different in Kentucky?
Kentucky TriTerm plans cover surgical and non-surgical TMJ care without the $10,000 cap.
However, home health care has a limit of 60 visits per term. Value plans also add one routine mammogram per term and bone density testing at 35+.
π Where this applies: Kentucky
β How long are TriTerm terms in Indiana?
In Indiana, all three TriTerm terms are 364 days each.
Also, the $2 million maximum benefit applies per person, per term.
π Where this applies: Indiana
β What else is different about TriTerm in Indiana?
Indiana TriTerm plans use a 12-month preexisting look-back.
Also, you get the application fee back if coverage is not issued or you do not take it.
π Where this applies: Indiana
β How is TriTerm Medical different in Mississippi?
Mississippi TriTerm plans charge a $6 application fee and use a 6-month preexisting look-back.
They also add yearly low-dose mammograms at 35+. Plus, they cover dental anesthesia in certain cases.
π Where this applies: Mississippi
β How is TriTerm Medical different in Nebraska?
Nebraska TriTerm plans add hearing aids up to $3,000 per ear for children under 19.
They also add TMJ care up to $2,500. In addition, the preventive cap does not limit annual mammograms.
π Where this applies: Nebraska
β How is TriTerm Medical different in Tennessee?
Tennessee has no TriTerm Value plan and no $5,000 spine limit.
It also adds mammogram screening by age. In addition, it covers transplants beyond the listed ones.
π Where this applies: Tennessee
β How is TriTerm Medical different in West Virginia?
West Virginia TriTerm plans have no application fee and no $5,000 spine limit.
Also, a dependent child with a disability stays eligible regardless of age.
π Where this applies: West Virginia
β What does the Iowa TriTerm plan look like?
Iowa offers one TriTerm plan, called Copay Select Max.
Deductibles run $2,500 to $12,500, with 30% coinsurance. In addition, the plan caps total out-of-pocket costs at $20,000 per term, excluding prescriptions.
π Where this applies: Iowa
β How are prescriptions covered on TriTerm in Iowa?
On Iowa TriTerm, Tier 1 drugs have a $25 copay.
Other tiers have a $1,000 Rx deductible, then $55, $75 or 50%. Prescription costs also have a separate $10,000 out-of-pocket maximum per term.
π Where this applies: Iowa
β What is the lifetime maximum on TriTerm in Iowa?
The Iowa TriTerm plan pays up to $750,000 per person, lifetime.
π Where this applies: Iowa
β How is TriTerm Medical different in Louisiana?
Louisiana TriTerm plans use a 12-month preexisting look-back and remove the spine limit.
They also add prosthetics up to $50,000 per limb. In addition, they add hearing aids for children under 18.
π Where this applies: Louisiana
β Does TriTerm coverage end in Louisiana if I get other insurance?
Yes, in Louisiana a person's coverage ends if they become covered under other medical expense insurance.
π Where this applies: Louisiana
β Can I add family members to TriTerm in Missouri?
No, Missouri TriTerm is individual coverage only.
So you cannot add a spouse or dependents. Also, the minimum issue age is 20.
π Where this applies: Missouri
β What extra benefits does Missouri TriTerm include?
Missouri adds a low-dose mammogram each term, lead testing, eating disorder treatment and osteoporosis care.
The plan also covers telehealth and certain cancer clinical trial costs. However, inpatient mental health has a limit of 90 days per term.
π Where this applies: Missouri
β Where is UnitedHealthcare TriTerm Medical sold, per the product grid?
Per the product grid, you can buy TriTerm Medical in the following states.
Those states are Alabama, Arizona, Arkansas, Florida, Georgia, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, South Carolina, Tennessee and West Virginia. South Carolina and West Virginia are new plan options. Also, the plan runs three terms.
π Where this applies: AL, AR, AZ, FL, GA, IA, IN, KY, LA, MO, MS, NE, SC, TN, WV
β What network do Florida short-term and TriTerm plans use?
Florida Short Term Medical and TriTerm plans use the UnitedHealthcare Choice network.
However, Florida TriTerm Value and Hospital & Surgical plans use Choice Plus. Both are association group plans for FACT members.
π Where this applies: Florida
β Is TriTerm Medical available in Texas?
No, UnitedHealthcare does not offer TriTerm Medical in Texas.
Texas Short Term Medical is limited to 3 months plus a 1-month extension in a rolling 12-month period.
π Where this applies: Texas
π More Tri-Term and Short-Term Guides
These answers cover the basics of each UnitedHealthcare tri-term plan. When you want more depth, these guides from our licensed agents compare tri-term, short-term and ACA options. Then, if a question comes up, call 888-730-6001 anytime.
π Tri-Term and Short-Term Guides
𧩠More UnitedHealthcare FAQ Libraries
π Questions About a UnitedHealthcare Tri-Term Plan?
These answers cover the most common tri-term questions, but every state and family is different. Therefore, our licensed agents compare UnitedHealthcare tri-term, short-term and ACA options for free.
Best of all, our help costs you nothing. Request a free quote online, or call 888-730-6001 to speak with an agent today. You can also reach us through our contact page.
- π 888-730-6001
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- π Deerfield Beach, Florida
Official resources: the UnitedHealthOne website, HealthCare.gov, and the National Association of Insurance Commissioners.
Vivna Insurance is an appointed, authorized broker for UnitedHealthcare. We are an independent agency, not UnitedHealthcare. Tri-term plans are not ACA plans and are sold only in some states. Plans and availability vary by state.