Who needs
this type of coverage?
Short Term Medical Insurance is an
ideal, affordable type of medical insurance for those who are:
unemployed, self-employed, 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.
Who qualifies for the Secure
Saver STM?
Short-Term Medical is offered to
members of Communicating for America*, their spouses under 65 and
eligible dependents under age 26 who have a social security number
and can answer 'no' to the health questions on the application.
Child-only coverage is available for ages 2 through 18.
*CA membership does not apply to residents in ID, IN, KS, LA, ME,
MD, MN, MT, ND, NH, NV, or SD
When does my coverage start?
Your coverage can begin as early as
the day following the U.S. postmark stamp on your envelope. If you
apply online, coverage can begin the day following your online
application submission. You can request a later effective date,
but no more than 60 days after the application date. All coverage
is subject to approval and payment of the first premium.
How are benefits covered?
Short Term Medical pays benefits
for each covered person in the following manner (subject to
specific benefit maximums). When you incur covered medical
expenses, you pay for the cost of service up to your chosen daily
deductible.
1. Choose from four daily deductible options: $250, $500, $750,
$1,000. After one covered person satisfies their daily deductible,
covered charges that exceed the daily deductible amount on that
same day are covered at 100%.
2. The daily deductible family maximum is deemed satisfied for the
remainder of that day when two covered persons each satisfy their
individual daily deductible.
3. The $4,000 coinsurance limit is deemed satisfied when one
covered person satisfies their individual coinsurance limit for
the coverage period. After this, Short Term Medical pays 100% of
covered expenses up to the coverage period maximum of $2,000,000.
The daily deductible is included in the coinsurance limit. The
coinsurance limit does not include copays, pre-certification
penalty amounts and other expenses not covered.
Do I have the option to select
my doctors, hospitals, and medical providers?
Yes. You have the freedom to select
the doctors and hospitals of your choice. This plan is not an HMO
or PPO.
How long will STM coverage last?
Secure STM is specifically designed
to fill a temporary insurance need. Coverage stops at the end of
the period for which you apply. Depending on the payment option
you select, coverage can continue for one to six or up to 12
months. The 12-month coverage option is not available in all
states.
Can I continue coverage?
If your need for temporary health
insurance continues, you may apply for another Short Term Medical
plan. Your application is subject to eligibility, underwriting
requirements and state availability of the coverage. The next
coverage period is not a continuation of the previous period
meaning, amongst other things, a new pre-existing condition
limitation will apply.
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; a dependent ceases to be eligible for
coverage as defined in the policy; you cease to be a member of the
association*; or the group master policy terminates.
*Applies only to states where association membership is
required.
What medical expenses are
covered*?
All of the following benefits are
subject to the daily deductible and coinsurance. Covered expenses
are subject to the usual, reasonable and customary charge and the
maximum benefit limit, if applicable.
- Hospital room and board charges
are paid at the 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 primary surgeons benefit
- Anesthesia services up to 20% of
the primary surgeons benefit
- Intensive or specialized care
unit charges are paid up to three times the most common
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 equipment
- Blood or blood derivatives and
their administration
- Ambulance ground or air services
- Gallbladder surgery
- Knee injury or disorder
- Inpatient prescription drugs
- Organ, tissue, bone marrow
transplants are covered up to $150,000 for all covered
expenses per coverage period.
- Acquired Immune Deficiency
Syndrome (AIDS) up to $10,000 coverage period maximum***
- Mammography, Pap smear and
screens
* Benefits may vary by state. ***
The AIDS maximum of $10,000 per coverage period does not apply to
policies/certificates issued to residents of AZ, CA, CO, DC, ID,
IN, MD, ME, MO, NH, NC or ND.
The maximum benefit in KS is $75,000 per coverage period.
How can I save money and
maximize my benefits?
Through the STM plan, you have
access to discounted medical services through two national
Preferred Provider Networks (PPOs): ACS and MultiPlan. The network
providers have agreed to provide their services at a negotiated
fee and pass these discounts on to you. While you have the
flexibility to choose any health care provider, the discounts
available through network providers for covered services will help
to lower your out-of-pocket cost. The discount will be reflected
in your final bill and you will not owe the network providers for
the difference between their retail rate and the negotiated fee.
You will still be responsible for paying your share of the covered
expenses, including any deductible, copay and coinsurance. Your
coinsurance amount will be based upon the negotiated fee. Using a
network provider is voluntary. If you are unable to find a network
provider, we will attempt to negotiate a discount for you from
your provider. While we can’t guarantee the outcome, if we
successfully obtain a discount it will be passed on to you. To
search for a health care provider or facility, please visit the
Web sites listed below. At the time of services, simply present
your identification card to the network provider.
• ACS is a comprehensive network of 2,500 ancillary
service providers at over 25,000 sites, representing providers of
outpatient services, including lab and diagnostic testing, except
physicians. www.anci-care.com
• MultiPlan is one of the nation’s largest networks
with more than 500,000 members in 50 states, including physicians,
and inpatient and outpatient facilities. www.multiplan.com or
888-342-7427.
ACS and MultiPlan are not affiliated with Standard Security
Life Insurance Company of New York, nor are they part of this
insurance plan.