Temporary Health Insurance - What medical expenses are covered?

After satisfying the deductible amount you've selected, Liberty Select will pay the coinsurance you selected for covered expenses, up to a lifetime maximum of $2 million per insured person per coverage period.* Benefits are limited to the reasonable and customary charge for a covered expense in addition to any specific limits.

• Hospital Charges: average semi-private room rate, medical care and treatment
• Outpatient Hospital or Ambulatory Surgical Center charges
• Physician Services for treatment and diagnosis
• Surgeon Services in the hospital or ambulatory Surgical Center
• Assistant Surgeon Services: up to 20% of the surgeons benefit
• Anesthesia Services: up to 20% of the surgeons benefits
• Intensive Care: up to three times the average semi-private room rate
• X-Ray Exams, Laboratory tests and analysis
• 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 derivatives and their administration
• Ambulance Services: $250 per emergency
• Organ Transplants: $50,000 lifetime maximum
• Acquired Immune Deficiency Syndrome (AIDS): $10,000 lifetime maximum
• Mammography, pap smear and screens

* Benefits for gallbladder surgery are limited to a $2,500 lifetime maximum per insured person. Benefits for injury or disorders of the knees are limited to a $2,500 lifetime maximum per insured person.
Benefits may vary by state.

What is a family deductible?

With a family deductible benefit your insured family is only required to satisfy a maximum of three (3) deductibles during the coverage period.

What is a reasonable and customary charge?

A "reasonable and customary charge" is the charge typically made by physicians or suppliers of medical services, medicines and supplies within a specific geographic area.

Do I need precertification?

Pre-admission certification prior to eligible inpatient hospitalization or surgery by the covered individual within 48 hours is required. This is not a guarantee of benefits. Failure to precertify will result in a benefit reduction of 50%. Call 1-800-367-9938 for precertification.

When does coverage terminate?

Coverage ends when the premium is not paid when due; you enter full-time active duty in the Armed Forces; you become eligible for Medicare, this applies to states where association membership is a requirement; the elected coverage period expires; Standard Security Life Insurance Company determines fraud or misrepresentation has been made in filing a claim for benefits; or a dependent ceases to be eligible; **you cease to be a member of the association or the group master policy terminates.

** This applies to states where association membership is required.

Can I continue coverage?

If your need for temporary health insurance continues, you may apply for another Secure STM plan. Your application is subject to eligibility, underwriting requirements and state availability of the coverage. The next coverage period is not continuous and any condition incurred during the last coverage period will be excluded as a pre-existing condition.

This website provides a brief description of the benefits, exclusions and other provisions of the policy Form SSL-STMP-1104. For complete listing, see the Policy/Certificate of Insurance. Benefits may vary by state. Secure STM is not available in all states.
Association membership may be required in some jurisdictions.
2005 HPA, Inc. All rights reserved.
SM STM-1 3/05

This is only a general summary of the features of the Liberty STM Medical Plan. Complete details may be found in the Master Policy. Benefits and policy provisions may vary by state.

Eligibility and Effective Date of Coverage:

Temporary Health Insurance Eligibility:
Liberty Select - Secure STM is offered to CFA members (by enrolling in this plan, you automatically become a member of the Communicating for America Association), their spouses and their dependent children under age 19 (or under age 25 if a full-time student) who have a social security number and can answer "no" to the health questions on the application. Children age 19 and over should apply separately. Child-only coverage is available for ages 2 through 18.

Child Only Coverage:

When applying for coverage ONLY on the child(ren), the minimum age is 2 years old. The 2-19 premium rate (male or female, based on the gender of the child applicant) for the youngest child is used; then the per child rate for each of the other siblings to be insured on the plan. Please enter the youngest child as the applicant, and all other child(ren) as the dependents. The parent or legal guardian must sign and date the application. Children age 19 and older must apply separately.

Effective Date of Coverage:

The insurance can be effective as early as 12:01 a.m. the next day after the transmission date. However, the applicant can choose a later effective date not to exceed 60 days from transmission date. Coverage ends on termination date listed in your policy.

If your payment is by credit card, the hard copy application does not have to be mailed to HPA, but the applicant should print a hard copy for his/her records. The acknowledgment of the applicant's name for credit card payment suffices as a signature under e-commerce law.

If your payment is by check, money order, or automatic check withdrawal, the hard copy of the application does not have to be mailed to HPA. However, the initial payment must be mailed in by check along with a voided check. Please note social security number on initial payment check. The initial payment must be received within 10 days from the transmission date or coverage is void.

Coverage under this policy will end on the termination date listed in the Schedule of Benefits.

Coverage will be considered void if payment is not received.