Secure 12x3 STM Temporary Health
Insurance - FAQ
Does the Secure 12x3 STM have coverage
limits ?
The Secure 12x3 STM is a limited medical
plan. Please read the coverage information and limits
below. After satisfying the deductible amount you've selected,
Secure 12x3 STM will pay the coinsurance you’ve selected for covered
expenses, up to a maximum of $750,000 per Insured person per Coverage
Period.*
Please Note:
The Benefits are limited to the usual, reasonable and customary charge
for a covered expense in addition to any specific limits.
- Doctors Office Visit: up to $25 per
visit up to four visits per coverage period. After the office visit,
the balance of the charge is subject to the plan deductible and
coinsurance up to $1,000 per Coverage Period.
- In-Hospital regular care charges: up
to $1,000 per day; includes daily room and board and all miscellaneous
charges**
- In-Hospital Intensive or Critical
Care charges: 3 times the average semi-private room rate up to $1,250
per day; includes daily room and board and all miscellaneous charges**
- Outpatient Hospital Surgery &
Ambulatory Surgical Center charges: up to $1,000 per day includes cost
of operating room and all miscellaneous charges**
- Out-Patient Emergency Room: up to
$500 per day includes the emergency room physician charge, 24 hour
surveillance and all miscellaneous charges**
- In-Hospital Doctors visits: up to
$500 maximum per hospital stay
- Surgeon and Anesthesiologist: up to
$2,500 per procedure up to $5,000 maximum per Coverage Period
- Out-Patient or Doctors Office
miscellaneous charges**: up to $1,000 per Coverage Period
- Ambulance Services: up to $250 per
emergency
- Organ Transplants: $150,000 maximum
per Coverage Period
- Acquired Immune Deficiency Syndrome
(AIDS): ***$10,000 maximum per Coverage Period
- Mammography, are covered subject to
deductibles, coinsurance and any specific limits
- Pap Smear and Screens (includes PSA)
are covered subject to deductibles, coinsurance and any specific
limits
*Benefits for gall bladder surgery are
limited to a $2,500 per Coverage Period per insured person. Benefits for
injury or disorders of the knees are limited to a $2,500 per Coverage
Period per insured person. Benefits may vary by state.
**Miscellaneous charges where indicated
includes: X-rays, scans, laboratory, blood, therapy, oxygen, casts,
splints, medicines, injections, chemotherapy and medical supplies.
***The AIDS maximum of $10,000 per Coverage
Period does not apply to Certificates of Insurance issued to residents of
Arizona, District of Columbia or Missouri.
Are pre-existing conditions covered?
Pre-existing conditions are not covered.
The preexisting conditions limitation includes conditions that were
treated or produced symptoms, within five years prior to the effective
date of your Secure 12x3 STM Coverage Period. However, any condition
covered during subsequent consecutive Secure 12x3 STM coverage periods
will be covered, whether or not it is a pre-existing condition.
Is there a free look period?
If you are not completely satisfied with
this coverage, and you have not filed a claim, you may return the
Certificate of Insurance within 10 days and receive a premium refund.
What services are not covered?
The following is a partial list of services
or charges not covered by Secure 12x3 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 Certificate of Insurance for detailed information
about these and other plan limitations and exclusions.
How can I have additional coverage after
the 12 month Coverage Period is complete?
When your Coverage Period is almost over,
you will receive an application form to apply for another 12 month
Coverage Period.* If you re-apply within 30 days prior to the termination
date of your coverage, and your application is approved in underwriting, a
new Coverage Period will be issued, effective day following the
termination date of your Coverage Period. We will issue you a new
Certificate of Insurance and new deductible and coinsurance will apply.
However, the pre-existing conditions limitation will not apply to any
condition(s) that were covered during a prior Coverage Period. Any other
pre-existing conditions will remain subject to the pre-existing conditions
limitation as described in the Certificate of Insurance.
*The coverage and rates may be different
and are subject to state availability. You must be under age 65 to reapply
for coverage.
When does coverage terminate?
Coverage ends when the premium is not paid
when due; or you cease to be a member of the association; or the group
master policy terminates; or you enter full-time active duty in the Armed
Forces; or you become eligible for Medicare; or the elected Coverage
Period expires; or 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.
What is a usual, reasonable and
customary charge?
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.
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.
Is there an extension of benefits after
the plan terminates?
If a member, or insured dependent is
receiving benefits for a hospital confinement on the date that the
Certificate of Insurance terminates (for other than non payment of
premium), benefits will continue in accordance with the terms of the
Certificate of Insurance for as long as that confinement remains. However,
in no event will coverage continue beyond the end of 90 days following the
date the coverage terminates when the Insured becomes eligible for other
coverage for the same conditions or the maximum benefits have been
reached. Benefits payable are subject to a new Deductible Amount and
satisfaction of Coinsurance Limit.
Q. Who needs this type of 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 coverage provides many special and unique coverage features while
maintaining a very competitive premium structure.
Q. Who is eligible for this
coverage?
A. Secure 12x3 STM is offered to members and their spouses under age 65
and their dependent children under age 19 (or under age 25 if a full-time
student) who can answer “No” to seven health questions on the
application. Children age 19 and over should apply separately. Child-only
coverage is available for ages 2 through 18.
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. How does this coverage work?
A. The benefit options for covered expenses are per insured person
per coverage period.
Option 80/20: First, you meet your
deductible. Choose from four options: $500, $1,000, $2,500 or $5,000.
Then Secure 12x3 STM plan pays 80% of the next $10,000 of covered
expenses. After this, STM plan pays 100% of covered expenses up to your
Coverage Period maximum of $750,000*
Option 50/50: First, you meet your
deductible. Choose from four options: $500, $1,000, $2,500 or $5,000.
Then Secure 12x3 STM plan pays 50% of the next $10,000 of covered
expenses. After this, STM plan pays 100% of covered expenses up to your
Coverage Period maximum of $750,000*
*Certain conditions have limited maximum
benefits; see “What services/conditions are limited or excluded from
coverage?” Refer to your coverage document for specific terms and
conditions.
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, enter payment information,
and e-sign the application. Follow instructions on the enrollment tool to
complete an online application.
Q. How is this coverage billed?
A. After submitting your enrollment form with first month's premium,
you will then pay monthly. 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. At anytime
during your coverage You can cancel with written notification to
policyservice@hpa-inc.com
Q. Can I get a refund of my
premium if I am not satisfied?
A. Once you receive your Certificate of Insurance, 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 administration fees and
dues), no questions asked.
Q. How long will Secure 12x3 STM
coverage last?
A. HPA’s Secure 12x3 STM insurance is specifically designed to
fill temporary health insurance needs. You can apply for three consecutive
12 month coverage periods, up to a maximum of 36 months in all. STM is
issued on a temporary need and terminates at the end of the period
applied for. 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; 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.
Q. How can I have additional
coverage after the 12 month Coverage Period is complete?
A. When your Coverage Period is almost over, you will receive an
application form to apply for another 12 month Coverage Period.* If you
re-apply within 30 days prior to the termination date of your coverage,
and your application is approved in underwriting, a new Coverage Period
will be issued, effective day following the termination date of your
Coverage Period. We will issue you a new Certificate of Insurance and new
deductible and coinsurance will apply. However, the pre-existing
conditions limitation will not apply to any condition(s) that were covered
during a prior Coverage Period. Any other pre-existing conditions will
remain subject to the pre-existing conditions limitation as described in
the Certificate of Insurance.
*The coverage and rates may be different
and are subject to state availability. You must be under age 65 to reapply
for coverage.
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. Does the Secure 12x3 STM have a
Preferred Provider Organizations (PPO) Network?
A. In addition to your insurance plan, you’ll also enjoy discounts
provided through nationwide access to one of the premier PPOs through
Private HealthCare Systems (PHCS). PHCS provides you the opportunity to
reduce your expenses for provider and facility services. The program is
voluntary, so there is no penalty for not using a PHCS participating
provider; but you can reduce your out-of-pocket medical expenses by using
the program. Simply call PHCS at 1-800-678-7427 or visit PHCS on the web
at www.phcs.com to verify that your doctor or hospital is part of the PHCS
Healthy Directions Network. At the time of service present your Short Term
Medical Insurance Identification Card with the PHCS logo on it and your
provider will bill you at the reduced network rate for services if
applicable.*
Q. What is Lab One Select?
A. In addition to your insurance plan, you’ll be able to take
advantage of low-cost laboratory testing by having lab tests performed by
LabOne. Using LabOne Select can save you up to 40% over other providers!*
* PHCS and LabOne are not affiliated with
the Standard Security Life Insurance Company of New York nor are they a
part of the Secure 12x3 STM insurance plan.
Q. How does the Rx Drug Card work?
A. In addition to your insurance plan, you’ll also enjoy access to
discounts on prescription drugs through our Rx Drug Card in over 42,000
pharmacies nationwide.* The Rx Drug Card is not an insurance benefit and
therefore there is no deductible, no claim forms and no pre-existing
conditions.* The Rx Drug Card is intended to help you find low cost
medications within the same therapeutic class as a drug you may currently
be taking. With this formulary program you pay up to $10 for Generic
Drugs. Savings on Brand Name and Select Generic Drugs are as high as 45%
off retail cost.
*The Rx Drug Card is not affiliated with
the Standard Security Life Insurance Company of New York nor is it a part
of the Secure 12x3 STM insurance plan.
Q. What is the optional
Supplemental Accident Benefit?
A. If purchased, the Supplemental Accident Benefit covers $500 of
covered expenses caused by an accidental injury. The first treatment must
be within 72 hours of the accident and only expenses within 90 days after
the accident are covered. After the $500, the balance of the expenses is
subject to the plan deductible and coinsurance.
Q. What are the coverage limits
under this plan?
A. STM pays covered expenses up to your Coverage Period maximum of
$750,000*
*Certain conditions have limited maximum
benefits; see “What services/conditions are limited or excluded from
coverage?” Refer to the Exclusions and Limitations section for specific
terms and conditions.
Q. Are pre-existing conditions
covered?
A. Pre-existing conditions are not covered. The preexisting
conditions limitation includes conditions that were treated or produced
symptoms, within five years prior to the effective date of your Secure
12x3 STM Coverage Period. However, any condition covered during subsequent
consecutive Secure 12x3 coverage periods will be covered, whether or not
it is a pre-existing condition.
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. 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 for full details.
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. A.M. Best ratings range from A++
to D.
Q. Who is the Association
Provider?
A. Communicating for America (CFA)* is a division of Communicating for
Agriculture and the Self Employed, Inc. CFA provides members with valued
benefits and savings since 1972. This Short Term Medical insurance
coverage is available to members of CFA.
*Communicating for America (CFA) is
not affiliated with Standard Security Life Insurance Company of New
York, nor is it a part of the insurance plan.
Q. Who is the Administrator?
A. Health Plan Administrators, Inc. (HPA), Rockford, IL
Health Plan Administrators, Inc is a Fully Licensed, Full Service, Third
Party Administrator servicing businesses worldwide. 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.
This website provides a brief description
of the benefits, exclusions and other provisions of the group Master
Policy Form SSL-STMP-1104. For complete listing, see the
Policy/Certificate of Insurance. Benefits may vary by state. Secure 12x3
STM is not available in all states. Association membership may be required
in some jurisdictions
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