What Short-Term Health Insurance Actually Covers (and What It Never Does)
The covered core
A typical STM policy covers: hospital room and board, emergency care, ambulance, surgery and anesthesia, doctor visits, diagnostic imaging and labs, and sometimes urgent care with a copay. Coinsurance-style plans pay a percentage (usually 70-100%) after your deductible, up to a term maximum that ranges from $250,000 to $2 million.
The standard exclusion wall
Every STM application screens for pre-existing conditions, and every policy excludes them — usually with a 5-year look-back definition. Also excluded in most filings: maternity, mental health inpatient care, preventive care beyond a telemedicine visit, dental and vision (except accidents), and anything related to a condition diagnosed before the effective date.
| Status | Service | Condition |
|---|---|---|
| Covered | Hospitalization, ER, surgery, imaging, labs | Subject to deductible/coinsurance |
| Covered | Urgent care, doctor visits | Copay or fixed benefit |
| Gray zone | Outpatient therapy, Rx | Caps and riders apply |
| Never | Pre-existing conditions, maternity, dental | Excluded in all states |
FAQ
Is an MRI covered?
Yes, when medically necessary and ordered by a physician — subject to deductible and coinsurance.
What about a pregnancy that starts mid-term?
Excluded. Pregnancy is treated as a pre-existing condition in virtually all STM filings.
Are annual physicals covered?
Generally no — STM is built for unexpected illness, not prevention.