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Exclusions & Limitations

Is there a pre-existing condition limitation?

Pre-existing conditions are not covered. This includes any condition or complication that was treated or produced symptoms five years prior to your STM effective date.

The pre-existing condition limitation may vary by state.

What are the plan exclusions and limitations?

The following is a partial list of services or charges not covered by Secure Lite STM:

• Any services that are not medically necessary
• Eye exams, eyeglasses, hearing aids and surgery
• Dental or orthodontic services
• Treatment of foot conditions
• Conditions resulting from an act of war
• Maternity and newborn treatment prior to discharge, any infertility treatments or sterilization treatments
• Spinal manipulation or adjustment
• Services performed by family members or for which a charge would otherwise not be incurred
• Medical care received outside of the United States, Canada or it’s possessions
• Services payable by Medicare or Worker’s Compensation coverage
• Cosmetic surgery, treatment for acne, hair loss or varicose veins
• Transplant services to the transplant donor
• Routine physical exams and tests, preventive care and immunizations
• Experimental or investigational services
• Learning disorders, attention deficit disorder, hyperactivity or autism
• Mental or nervous disorders, depression or suicide attempt
• Alcohol or drug dependency and disorders
• Obesity treatments
• Sleep disorders
• Over-the counter-medications and prescription drugs
• Participation in school or organized competitive sports or any high risk sport
• Certain surgeries during the first six months 

The limitations and exclusions may vary by state. Please see the Policy/Certificate of Insurance for detailed information about these and other plan limitations and exclusions.

Can I continue coverage?

If your need for temporary health insurance continues, you may apply for another Secure Lite 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.

What is a usual, reasonable and customary charge?

A "usual, reasonable and customary charge" is the charge typically made by physicians or suppliers of medical services, medicines and supplies within a specific geographic area as determined by us.Usual, Reasonable and Customary means with respect to fees or charges, fees for medical services or supplies which are usually charged by the provider for the service or supply given and the average charge for the service or supply in the locality in which the service or supply is received; whichever is less, or with respect to treatment or medical services, treatment which is reasonable in relationship to the service or supply given and the severity of the condition. In reaching a determination as to what amount should be considered as Usual, Reasonable and Customary for services and supplies; we may use and subscribe to a standard industry reference source that collects data and makes it available to its member companies.

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; the elected coverage period expires; Standard Security Life Insurance Company of New York 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.

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.

Eligibility and Effective Date of Coverage:

Eligibility:

Secure Lite STM is offered to members, 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.

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. Secure Lite STM is not available in all states. Association membership may be required in some jurisdictions. ©2007 HPA, Inc. All rights reserved. SM STM-1 3/05