This plan does not provide benefits for pre-existing conditions, work related conditions, and preventive care. If you or a dependent have an existing health condition, you may want to consult with your independent insurance agent prior to applying for or changing health/medical insurance.

Insurance fraud is a crime. Any person who, with intent to defraud or knowingly facilitates a fraud against an insurer, submits an application or files a claim containing false, deceptive and/or incomplete information is subject to civil and criminal prosecution.

Question. Who should I discuss my insurance needs with?

Answer. Contact your independent insurance agent.

Question. Who can answer my questions regarding this plan?

Answer. If you have not applied for this plan and are not currently insured under this plan, contact your independent insurance agent.

If you have applied for this plan or you are currently insured under this plan, contact your independent insurance agent or the Customer Service Department at 1-800-753-1000 (Monday through Friday / 8:30am to 5:00pm EST). Note – Important contact information is listed on the insurance information card(s) issued to approved applicants.

Question. What does this plan cover?

Answer. Please refer to the Coverage Information section of this site for plan covered expense highlights. It is important to note that plan benefits and covered expenses vary by state and are described in detail in the Policy or Certificate issued by The Fairmont Specialty Group - FSG to approved applicants.

Question. What is not covered by this plan?

Answer. Please refer to the Coverage Information section of this site for plan limitation and exclusion highlights. It is important to note that plan limitations and exclusions vary by state and are described in detail in the Policy or Certificate issued by The Fairmont Specialty Group - FSG to approved applicants.

Question. What portion of covered expenses must I pay?

Answer. First, you are responsible for satisfying the Benefit Period deductible ($250; $500; $1000; or $2000) you selected. The deductible amount will be automatically deducted from benefit payment(s) until it has been fully satisfied. Following deductible satisfaction, the plan then pays *80% (you pay *20%) of the next $5000 in covered expenses - this is called coinsurance. Any additional covered expenses, in excess of the deductible and coinsurance, are then paid by the plan at *100% up to the benefit and/or plan maximums. Deductible, coinsurance and plan maximums are per person per Benefit Period.

*Unless otherwise stated in the Policy or Certificate

Question. Does this plan use a Pre-Admission Notification service?

Answer. Yes. This plan uses a hospital Pre-Admission Notification service which ensures that you and your covered dependents receive the most appropriate and cost effective inpatient care available. Trained medical professionals work with you and your healthcare providers to review the course of treatment and advise you of your eligibility for benefits.

Question. What healthcare providers and facilities can I receive treatment from?

Answer. This plan is not an HMO or PPO managed care plan. Should you become sick or injured, you have the freedom to choose your own healthcare providers and facilities.

Question. How long can I keep this coverage?

Answer. Coverage is available in 30 day increments up to the 180 day maximum. You select the Benefit Period that best suits your temporary needs: 30 days; 60 days; 90 days; 120 days; 150 days; or 180 days. The Benefit Period you select is the maximum length of time that your coverage will stay in force.

Question. What if I need further treatment after my Benefit Period expires?

Answer. Please refer to the Plan Highlights section of this site for extension of benefits after termination information.

Question. After my Benefit Period expires, can I re-apply for coverage?

Answer. This plan is not renewable nor intended to be permanent coverage. Coverage will terminate upon expiration of your Benefit Period. However, you may be eligible to apply for another Benefit Period following the expiration of your previous Benefit Period. If a new Benefit Period is applied for and issued by The Fairmont Specialty Group - FSG, there is no continuous coverage between any previous and current Benefit Period. Any condition or symptom which occurred under a previous Benefit Period may be treated as a pre-existing condition under a subsequent Benefit Period. Note – In no event will The Fairmont Specialty Group - FSG issue successive Benefit Periods totaling more than 360 days.

Question. When does my coverage begin and end?

Answer. Please refer to the Plan Highlights section of this site for coverage effective and termination date information.

Question. Can I change my Benefit Period?

Answer. No. Once your application has been submitted, the Benefit Period cannot be changed.

Question. Can I change my coverage effective date?

Answer. No. Once your application has been submitted, the effective date cannot be changed.

Question. Can I change my deductible?

Answer. No. Once your application has been submitted, the deductible cannot be changed.

Question. Can I add or delete family members from my coverage?

Answer. No. Once your application has been submitted, you cannot add or delete family members (spouse; children), unless otherwise required by law.

Question. If I select the monthly pay option, how will I be billed?

Answer. If you made your initial payment by:

Check or money order - Payment coupons will be enclosed with your Policy or Certificate. Each payment coupon is for a 30 day coverage period and identifies the payment due date, amount due, and address where to send your payment. Your payment(s) for the exact amount(s) due must be received by The Fairmont Specialty Group - FSG on or before the indicated due date(s).

Credit card – Your monthly payment for each 30 day coverage period will be automatically debited from the MasterCard or VISA you identified in the “Payment By Credit Card Authorization” form.

Important – If your initial payment is dishonored by the bank or credit card issuer, coverage will be canceled and cannot be reinstated. If a payment (after the initial payment) is dishonored by the bank or credit card issuer, coverage may be terminated and cannot be reinstated.

Question. Can I change my payment method?

Answer. Yes. Only if you selected the monthly payment option and made your initial payment by credit card. Important – To make future monthly payments by check or money order, you must send written notification to The Fairmont Specialty Group - FSG stating that you wish to discontinue monthly credit card debits and make future monthly payments by check or money order.

If you made your initial payment by check or money order, future monthly payments cannot be made by credit card.

Question. If my age changes after coverage begins, will my premium change?

Answer. No.

Question. If I move after coverage begins, will my premium change?

Answer. No.

Question. Can I cancel my coverage and receive a refund?

Answer. Yes - only if you return the Policy or Certificate to The Fairmont Specialty Group - FSG, within 10 days of delivery, with your written request for cancellation. Coverage will be canceled/void as of the effective date and your initial payment will be fully refunded. If you made your initial payment by credit card, we will issue a credit to that credit card account. If you made your initial payment by check or money order, we will issue a refund check to the primary applicant.

After the “10 day free look period” expires, no refund is available.

The Policy and Certificates issued under it, will be deemed amended to conform to the minimum requirements of the laws of the state in which coverage is issued.

Question. Is this plan subject to the federal Health Insurance Portability and Accountability Act (HIPAA) of 1996?

Answer. No. Under HIPAA, short term limited duration plans are exempt from this legislation. This plan is not: guaranteed issue; guaranteed renewable; and the pre-existing condition limitation is not waived for federally eligible individuals.

Question. Is this plan considered "creditable coverage" under HIPAA?

Answer. Yes. Under HIPAA, short term medical plans are considered creditable coverage.