Short Term Medical Insurance

The Liberty STM by Chesapeake Life Insurance Company is available in the following states. The applications and brochures can be downloaded or printed directly from the Internet using Adobe Acrobat Reader^®. Please read the following directions.

If you don't already have Adobe Acrobat Reader, you can download it by clicking HERE.

Click on the State you currently have residence in. The Application will open in a new window. Applications are State specific. If you plan on moving or traveling while you are covered, your Short Term Health coverage will follow you throughout the United States.

Complete the application and either mail or fax the application with payment made payable to: HPA, Inc.

Liberty Short Term Medical Brochures & Applications
Select Your State Below for Insurance Application
AK	FL	MD	NC	PA	WI
AL	GA	ME	ND	RI	WV
AR	IA	MI	NE	SC	WY
AZ	ID	MN	NH	SD
CA	IL	MO	NM	TN
CO	IN	MS	NV	TX
CT	KS	MT	OH	UT
DC	KY	NC	OK	VA
DE	LA	ND	OR	WA

Short Term Health Insurance is NOT available by any insurance company in the following states: MA, NJ, NY or VT.

*The Liberty STM is not currently available in ME or NH. Click Here for a plan in these states.

Note: The following information is included with the application and brochure.

If paying by Credit Card, you can fax the completed application to Long Term Consumer Care, Inc. at: (262) 523-1910

If paying by check, money order or credit card, you can mail the completed application along with payment to:

HPA Inc. - P.O. Box 15250 - Rockford, IL 61132-5250

Make all checks or money orders payable to HPA, Inc.

Get a FREE Rx Savings Plan

Simply apply through this site and we will send you a Free AdvancePCS Rx Savings Plan. NOTE: This offer is only available through this site and is not offered by, or administered by HPA, Inc. Email us to let us know that you sent in an application and we will send you the FREE Rx Savings Plan

If you have any questions, need a quote or would like to receive the application and brochure by fax or mail, please complete a request form or call toll free: (800) 544-9505

Your effective date of coverage will begin on the later of: 1) 12:01a.m. the day after your requested policy date; or 2) 12:01a.m. the day after the post mark date affixed by the U.S. Post office*, provided the following conditions are met.

Your application and the full premium payment is received by HPA, Inc.;
Your answers on the application are correct and meet the requirements for acceptance.
All policy's that meet these conditions are issued immediately upon receipt and are mailed to the applicant via first class mail.

Short Term Health Insurance from Chesapeake Life Insurance Company will cover you while traveling anywhere in the United States. If you plan on moving (within the United States) while you are covered, simply apply in the state you currently have residence in.

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