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Secure Lite STM Plan Details

Anytime you are without insurance, you are running a risk. You may not have a health problem now, but insurance is for the unexpected. The Short Term Medical (STM) allows you and your family to purchase affordable short-term medical coverage for physician services, surgery, outpatient and inpatient care for a temporary period. - View the Secure Lite STM Brochure

Who needs this type of coverage?

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.

How are benefits covered?

Secure Lite STM pays benefits for each covered person in the following manner (subject to specific benefit limits):

1. You are responsible for eligible expenses until the deductible is satisfied. Choose from four options: $500, $1,000, $2,500 or $5,000 (maximum of 3 deductibles per family)


2. For most covered services, SecureLite STM then pays 80% or 50% of the next $10,000 of covered expenses


3. After this, SecureLite STM pays 100% of covered expenses up to your Coverage Period maximum of $750,000*

Office Copay

The $50 copay applies to the physician’s consultation charge. After the copay, the plan pays 100 percent of the consultation charge balance. Other covered services performed during the office visit are subject to deductible and coinsurance. The number of office visits available is determined by the selected plan duration. Office visits above the allotted number are subject to deductible and coinsurance.

*Certain conditions have limited maximum benefits; see “What medical expenses are covered?” and “What Services are not covered?” Refer to your coverage document for specific terms and conditions.

Who qualifies for 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. The membership is included in the rates for all other states

What medical expenses are covered?

After satisfying the deductible amount you’ve selected, Secure Lite STM will pay the coinsurance you’ve selected for covered expenses, up to a maximum of $750,000 per insured person per coverage period.*
The Benefits are limited to the usual, reasonable and customary charge for a covered expense in addition to any specific limits.

  • Physician Office Visit: $50 Copay. The Copay applies to each Doctor office visit charge. After the Copay, the balance of the Doctor office visit charge is covered at 100%.
  • 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**
  • Outpatient Emergency Room: Up to $500 per day includes the emergency room physician charge, 24-hour surveillance and all miscellaneous charges**
  • In-Hospital Physician 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
  • Outpatient or Physician Office Miscellaneous Charges:** Up to $1,000 per Coverage Period
  • Ambulance Services: Up to $250 per trip
  • Organ Transplants: Up to $150,000 lifetime maximum
  • Acquired Immune Deficiency Syndrome (AIDS): Up to $10,000 lifetime maximum***
  • 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 Policies/Certificates of Insurance issued to residents of AZ, CA, CO, DC, ID, IN, MD, ME, MO, NH, NC or ND. In KS the maximum per Coverage Period is $75,000.
****Benefits are covered subject to coinsurance and any specific limits including outpatient or doctor’s office miscellaneous limits.

 

Lab Card Select Discount Lab Services?

Take advantage of high-quality, low-cost laboratory testing (save up to 40%) by utilizing Lab Card Select. Simply visit a Lab Card Select provider or instruct your physician to send you lab work to a Lab Card Select provider. A complete list of Lab Card Select providers can be found at www.labcardselect.com (be sure to select “Lab Card Select”Network).


Private Health Care Systems (PHCS) PPO Network?

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 with 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.*
*PHCS and Lab Card Select are not affiliated with the Standard Security Life Insurance Company of New York nor are they a part of the Secure Lite STM insurance plan.


Is there a pre-existing condition limitation?

Secure Lite will not provide benefits for any loss caused by or resulting from a pre-existing condition. A pre-existing condition is any medical condition or sickness for which medical advice, care, diagnosis, treatment, consultation or medication was recommended or received from a doctor within five years immediately preceding the covered persons effective date of coverage; or symptoms existed within the 5-years immediately prior to the covered persons effective date of coverage which would cause a reasonable person to seek diagnosis, care or treatment. The pre-existing condition limitation may vary by state.


What is the 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.


What are my payment options?

Choose from two convenient payment options.

  • You can pay for coverage in monthly payments for up to 6 months at a time. We accept monthly payments by check, money order, credit card or automatic bank withdrawal. If you select this option, and your need for insurance ends before your coverage period ends, you can cancel at any time throughwritten notification to our Policy Service Department.
  • The single payment option is ideal if you know the exact number of days coverage is needed. This option has a special reduced rate and you only pay for the coverage you need through one, single payment. You can pay in full for any number of days, from a minimum of 30 days to a maximum of 180 days of coverage by check, money order or credit card or ACH online.
Your subsequent monthly credit card/ach premium deductions will occur based upon the effective date of coverage. If your coverage effective date is the 1st - 14th, your premium will be deducted on the 1st of the month. If your coverage effective date is the 15th - 31st, your premium will be deducted on the 15th of the month.

 

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.


When does my coverage start?

Your coverage will begin as early as the day following online submission. You can request a later effective date, but no more than 60 days after the application date. All coverage is subject to approval of your application and payment of the first premium.


How long will STM coverage last?

HPA’s Secure Lite STM is specifically designed to fill temporary insurance needs and coverage stops at the end of the period applied for. Depending on the payment option you select, SecureLite STM offers coverage for 30 to 364 days.**


Can I continue coverage?

If your need for temporary health insurance continues, you may apply for another Secure Lite 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.
*Some states may restrict re-application to another STM coverage period.


When does coverage terminate?

Coverage ends on the earliest of the date 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 of New York determines fraud or misrepresentation has been made in filing a claim for benefits. A dependent’s coverage ends on the earliest of the date your coverage terminates; or the dependent becomes eligible for Medicare; or the dependent ceases to be eligible.
*Applies only to states where association membership is required.


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 nonpayment 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.


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. Enrollment and Administrative fees are non-refundable.


Do I need pre-certification?

You must notify the pre-certification service 10 days prior to a non-emergency hospital admission or surgery and 48 hours (or as soon as reasonably possible) following an emergency admission to the hospital for pre-certification of admission. Failure to pre-certify will result in a benefit reduction of 50%. Pre-certification is not a guarantee of benefits.


What services are not covered?

Following is a partial list of services or charges not covered by Secure LIte 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 their 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
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.

 

What is the enhancement series? *

In addition to offering you an association-endorsed short-term medical plan, CA provides additional consumer benefits and services you can use to stay healthy and reduce your medical expenses. These benefits include:

  • Coaches and Advocates: For information on providers in your area, the latest consumer health reports and assistance with benefits.
  • TelaDoc: TelaDocTM is a national network of board-certified physicians providing cross-coverage consultations 24 hours a day, 365 days a year. This service is free of charge to members. Note that you will need to register online before using this service. Dependents must be 10 years of age or older to use TelaDoc.
  • Discount Prescription Drug Card: All members receive a FREE discount prescription drug card.
  • Discounted Services:

    Remote file sharing service: that allows you to easily share large computer files, photos and videos with clients or colleagues.
    Remote PC access: The ability to remotely access you office PC from home, or your home computer at work.
    Remote meeting: Live video meeting service that allows you to converse with clients over the Internet.
    Remote backup: Automatic backup of your personal PC over the Internet for safer file storage at remote location.

 

*The Communicating for America (CA) Healthy Lifestyle Enhancement Series is not an insurance benefit, nor is it affiliated with Standard Security Life Insurance Company of New York, nor is it a part of the STM insurance plan. The Enhancement Series is not available to residents in the states where the CA membership is not required.

Who is the Association?

Communicating for America, Inc.*** (CA) provides many discounts to its members. Your enrollment as a member of CA is completed upon receipt of the association annual dues. Your membership information will be mailed shortly thereafter.
***CA is not affiliated with Standard Security Life Insurance Company of New York, nor is it a part of the insurance coverage. CA is a 501c5 non-profit association headquartered in Fergus Falls, Minn., with an office in D.C., providing members valued benefits and savings since 1972. CA membership does not apply to residents of the following states: ID, IN, KS, LA, ME, MD, MN, MT, ND, NH, NV or SD.


Who is the Insurance Company?

The Secure Lite is insured by Standard Security Life Insurance Company of New York (Standard Security), a member of the IHC Group. Standard Security is rated A- (Excellent) by A.M. Best Company, a widely recognized rating agency that rates insurance companies on their relative financial strength and ability to meet their obligations to their insureds. Standard Security has chosen Health Plan Administrators, Inc. (HPA), also a member of the IHC Group, to provide service for your Secure Lite STM plan.
The IHC Group is an insurance organization comprised of Independence Holding Company (NYSE: IHC) and its operating subsidiaries. The IHC Group has been providing life, health and stop-loss insurance solutions for over 25 years.

This brochure provides a brief description of the benefits, exclusions and other provisions of the group policy Form SSL-STMP-1104 and individual policy SSL-ISTM-1104 (may vary by state). For complete listing, see the Policy/Certificate of Insurance. Benefits may vary by state. Secure STM is not available in all states. Membership in the Communicating for America Association may be required in some jurisdictions. Ask your sales representative. The coverage is available in other states on an individual insured basis.

For more information on the short term health insurance plans, Visit www.ConsumerBenefits.net