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Covered Expenses

Just because you don't have health insurance right now doesn't mean you may not have health problems. Secure STM allows you and your family to purchase quality, affordable major medical coverage on a temporary basis. Coverage is provided for physician services, surgery, outpatient and inpatient care.

How benefits are covered?

The benefit options for covered expenses for injury or sickness per insured person per benefit period.

Secure STM pays benefits for each covered person in the following manner: First, you meet your deductible. Choose from four options: $250, $500, $1,000 or $2,500

Then Secure STM pays 80% or 50% of the next $5,000 of covered expenses

After this, Secure STM pays 100% of covered expenses up to your lifetime maximum of $2 million

What medical expenses are covered?

After satisfying the deductible amount you've selected, Secure STM 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.

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 Secure 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 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
• Services payable by Medicare or Workerís 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 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 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.

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.

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

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.
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