Short-Term Medical Lite (STM)

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.

Who qualifies for STM?

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 the health questions on the application. Children age 19 and over should apply separately. Child only coverage is available for ages 2 through 18.

When does my coverage start?

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. All coverage is subject to approval of your application and payment of the first premium.

How are benefits covered?

STM pays benefits for each covered person in the following manner:

• First, you meet your deductible. Choose from four options: $500, $1,000, $2,500, or $5,000
• Then STM pays 80% or 50% of the next $10,000* of covered expenses
• After this, STM pays 100% of covered expenses up to your lifetime maximum of $750,000*
  *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.

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.

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?

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, STM offers coverage from 30 days up to 6 months.

Can I continue coverage?

If your need for temporary health insurance continues, you may apply for another 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.

When does coverage terminate?

Coverage ends when the premium is not paid when due; 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; or a dependent ceases to be eligible; or you cease to be a member of the association or the group master policy terminates.**
**This applies to states where association membership is required.

What medical expenses are covered?

After satisfying the deductible amount you've selected, STM will pay the coinsurance you selected for covered expenses, up to a maximum of $750,000 per insured person per Coverage Period.*
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 Policies/Certificates of Insurance issued to residents of Arizona, California, District of Columbia, Idaho, Missouri, North Carolina or North Dakota. In Kansas the maximum per Coverage Period is $75,000.
Benefits may vary by state.

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%. (Preauthorization in Texas.)

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.

What are my payment options?

Choose from two convenient payment options.

• You can pay for coverage in Monthly payments for up to 6 months or 12 months at a time.* We accept monthly payments by check, money order, credit card or automatic bank withdrawal. If you select the Monthly pay option, and your need for insurance ends before your coverage period ends, you can cancel at any time with prior written notification to our Policy Service Department.
• The Single payment option is ideal if you know the exact number of days coverage is needed because this option has a special reduced rate and you only pay for the coverage you need in 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.

How do I apply for this coverage?

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, e-sign it, and send payment to the administrator along with your initial premium payment to the address below.

Make checks payable to:
Health Plan Administrators, Inc.
P.O. Box 15900
Rockford, IL 61132-5250

What services are not covered?

The following is a partial list of services or charges not covered by 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 onthsThe 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.

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 STM effective date.
The pre-existing condition limitation may vary by state.

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 Policy/Certificate of Insurance within 10 days and receive a premium refund (minus administration fees and dues).

Who is the Association?

Communicating for America, Inc.** (CA) provides many benefits and 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., providing members valued benefits and savings since 1972.
CA membership does not apply to residents of the following states: ID, KS, LA, ME, MD, MN, MT, ND, NH, NV or SD.

What is the STM Enhancement Series?

Included with your coverage is Communicating for America (CA) Healthy Lifestyle Enhancement Series* which provides members with discounts for the following services and or purchases:

• Vitamins, herbs and nutritional supplements—10-30% off already low prices
• Nurse—on-call access to a registered nurse 24 hours a day, seven days a week
• Chiropractic services—10%-30% off at more than 28,000 private chiropractors and alternative health services
• Prescription drugs—up to15-60% off on generic or name brand drugs at more than 45,000 pharmacies nationwide
• Vision eyewear care—up to 15%-45% off eyeglasses, contact lenses and non prescription sunglasses through a network of more than 40,000 retail optical locations, including Pearle Vision, Target Optical, Sears Optical and LensCrafters
• Dental Services—20%-60% on dental expenses from 34,000 dentists in CAREINGTON International

  *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 or a part of the STM insurance plan. CA provides access to discount services administered by CAREINGTON International.
  **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., providing members valued benefits and savings since 1972.
  CA membership does not apply to residents of the following states: ID, KS, LA, ME, MD, MN, MT, ND, NH, NV or SD.

What is My E Wellness?

My E Wellness provides you with your own comprehensive exercise program that aims to help you achieve your personal goals regardless of your age or gender, your access to equipment or your level of experience. These are the same core workouts used by hundreds of professional athletes who train with our experts. Along with workout tips, you'll also receive current, unbiased nutrition, weight-loss and exercise information, updated daily, from a staff of health professionals. It's easy to use and will help you make wellness part of your daily life. Your group affiliation will qualify you for access to this exclusive wellness program.
Access the www.myewellness.com site with your temporary username/password.

Your username and password are your last name and the last four digits of your social security number, combined, i.e. John Doe, 123456789 would have both a username and a password of doe6789. **The My E Wellness plan is not affiliated with Standard Security Life Insurance Company of New York, nor is it a part of the STM insurance plan.

Who is the Insurance Company?

Standard Security Life Insurance Company of New York has a Be⁳ts rating of A- (Excellent).
A.M. Best ratings range from A++ to D.

Who is the Administrator?

Health Plan Administrators, Inc. (HPA) is a fully licensed, full service Third Party Administrator servicing business worldwide. HPA provides state of the art industry leading insurance services.

Why buy from us?

HPA has provided innovative health care solutions for over 60 years, meeting the needs of our customers with integrity, creativity and value. We strive to provide the best possible insurance coverage in a cost effective manner.

HPA is a customer-driven company differentiating itself through knowledge and experience. We, in conjunction with our trusted insurance carriers and licensed agents, share a mutual desire to provide important benefits to our customers and to meet their needs in an innovative, hassle-free manner.

HPA has a professional team of customer support, marketing, underwriting, claims and compliance specialists. State-of-the-art computer systems and reporting capabilities allow HPA to provide superior service and flexibility to agent distributors and clients. Licensed and approved nationally, HPA has always met or exceeded all state-mandated requirements including financial security, surety bonds, insurance coverage, and licensing.