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Temporary
Health Insurance Plan
Highlights
Instant Online Approval
We offer the fastest way to apply for health
insurance because the plans offered on our website can be submitted and
signed electronically. Our online process enables consumers to go through
the entire purchasing process electronically, replacing the health
insurance industry's traditional paper-based application process.
Processing time is reduced because your application is immediately
subjected to the insurance carriers underwriting guidelines for instant
approval. There's no need to manually print and mail the applications for
these plans. At the conclusion of this application, you will be able to
print out your insurance documents for your personal records. Your policy
will not be considered in-force until payment is received and processed.
If payment is not received by date specified policy will be voided.
Covered Expenses
Just because you don't have health insurance right
now doesn't mean you may not have health problems. Liberty Select 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.
Liberty Select 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 Liberty Select pays 80% or 50% of the next $5,000
of covered expenses
After this, Liberty Select 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, 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
- Inpatient prescription drugs and injections
- 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 Liberty Select 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 Liberty Select 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 Liberty Select:
- 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 Workers 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 Liberty Select 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. Liberty Select is not available in all states.
Association membership may be required in some jurisdictions.
SM STM-1 3/05
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