Secure Med - Temporary Health Insurance FAQ

Secure STM Short Term Major Medical

Covered Expenses - Secure STM Temporary Health Insurance

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.

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

Standard Security Life Insurance Company - AM Best Rating (A) Excellent.

Below are some frequently asked questions regarding this valuable coverage.

Q. Who needs this type of temporary health coverage?

A. Short Term Medical Insurance is an ideal, affordable type of medical insurance for those who are: unemployed, in between jobs, recent college graduates, in need of an alternative to COBRA. You will see that this comprehensive coverage provides many special and unique coverage features while maintaining a very competitive premium structure.

Q. Who is eligible for short term health insurance coverage?

A. 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. Communicating for America (CFA) STM Enhancement Series

* Included with your coverage is Communicating for America (CFA) STM Enhancement Series* which provides members with discounts for the following services and or purchases:

vitamins, herbs and nutritional supplements - 10% off already low prices
Nurse-on-call - access to a registered nurse 24 hours a day, seven days a week
Chiropractic services - 30%-50% off at more than 3,000 private chiropractors
Prescription drugs - up to 40% off on generic or name-brand drugs at over 55,000 pharmacies nationwide Vision eyewear care - up to 60% off eyeglasses, contact lenses and non-prescription sunglasses through a network of more than 10,000 retail optical locations, including Pearle Vision, JC Penney's, Wal-Mart and Lens Crafters
Dental services - save an average of 28% and up to 50% on dental expenses from 53,000 dentists in Aetna Dental Access**
Low rate home mortgages - up to $500 credit at closing, competitive interest rates, and extended lock rate option Low rate student loans - Federal Stafford and alternative loan options at some of the lowest rates in the industry.

The Communicating for America (CFA) is not affiliated with Standard Security Life Insurance Company of New York, nor is it a part of the STM insurance plan. Communicating for America, Inc. (CFA) is a division of Communicating for Agriculture and the Self-Employed, Inc. (CA) a 501c5 non-profit association headquartered in Fergus Falls, Minn., providing members valued benefits and savings since 1972.

Q. How does this coverage work?

A. The benefit options for covered expenses are per insured person per coverage period.

Option A: First, you meet your deductible. Choose from four options: $250, $500, $1,000, $2,500 or $5,000. Then STM plan pays 80% of the next $5,000 of covered expenses. After this, STM plan pays 100% of covered expenses up to your lifetime maximum of $2 million.

Option B: First, you meet your deductible. Choose from four options: $250, $500, $1,000, $2,500 or $5,000. Then STM plan pays 50% of the next $5,000 of covered expenses. After this, STM plan pays 100% of covered expenses up to your lifetime maximum of $2 million.

Q. Once my coverage is issued, do I have the option to select my doctors, hospitals and medical providers?

A. Yes. You have the freedom to select the doctors and hospitals of your choice. This plan is not an HMO or PPO.

Q. How long may I be insured under this plan?

A. STM is issued on a temporary need and terminates at the end of the period applied for. If the need for temporary health insurance continues, you may apply for another new STM* coverage period. Your application is subject to the eligibility and underwriting requirements. Furthermore the coverage is not continuous. Any condition that incurred expense during the last coverage period will be treated as a Pre-Existing Condition, and excluded under the next coverage period. Applicants over the age of 64 are not eligible to re-apply for coverage. *Only if an STM Plan is available in your resident state at that time; plan benefits, premium and features may vary.
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.

Q. What are the coverage limits under this plan?

A. This plan pays a lifetime maximum of $2,000,000 for each insured. Please refer to the Exclusions and Limitations section for all limitations.

Q. Are pre-existing conditions covered?

A. 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.
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.

Q. Are there expenses not covered under this plan?

A. Yes, this plan is designed to protect you in the event of an illness or injury and is not meant to cover routine exams and preventive care. Short Term Medical is for temporary coverage only and therefore does not include some of the benefits a permanent health plan offers. Please refer to the Exclusions and Limitations section of this web site.

Q. How do I apply for this coverage?

A. First, make sure you do not live in a state where the Plan is not available. Next look up the rates that apply to you based on your gender and zip code. Then, complete the application, e-sign it, and send payment to the administrator along with your initial premium payment to the address below.

Mail and make check payable to:
Health Plan Administrators, Inc.
P.O. Box 15900
Rockford, IL 61132-5250

Q. What should I do if I cannot download and/or print the application found on this site?

A. Contact Long Term Consumer Care, Inc., at 1-800-544-9505 between 8:30am- 5:00pm Central Time. They will rush an application, rates and coverage description right away.

Q. Can I get a refund of my premium if I am not satisfied?

A. Once you receive your Certificate or Policy, carefully review all information. If you are not satisfied for any reason, return the Certificate (within 10 days of receipt) with your written request for cancellation to HPA. Coverage will be cancelled as of the effective date and you'll receive a full premium refund (minus admin fees and dues), no questions asked.

Q. How is this coverage billed?

A. After submitting your enrollment form with first month's premium, you will then pay monthly or you can choose to prepay. You indicate on your enrollment form how you wish to pay for your coverage. You may elect to be billed for the monthly premiums (plus the administration fee), OR you can select one of the other two payment methods: (1) Automatic Pre-authorized Bank Withdrawal; or (2) Credit Card - MasterCard, Visa and Discover are accepted.

Q. When does my coverage begin?

A. 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.

Q. Who is the Insurance Company?

A. Standard Security Life Insurance Company of New York Standard Security Life Insurance Company of New York is rated A (Excellent) for financial condition by A.M. Best Company, as of 06/04. A.M. Best ratings range from A++ to D.

Q. Who is the Administrator?

A. Health Plan Administrators, Inc.
HPA, Inc., dually headquartered in Rockford, Illinois for administration and Tampa, Florida for marketing, is a national and international Third Party Administrator. HPA has provided innovative health care solutions for over 60 years, meeting customer's needs with integrity, creativity and value. We strive to provide the best possible coverage in a cost effective manner. We, in conjunction with our trusted insurance carriers, share a mutual desire to provide important benefits to our customers and to meet their needs in an innovative, hassle-free manner. HPA has met or exceeded all state-mandated requirements, bringing you stability and security.

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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