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Secure> STM
Covered Expenses
Secure STM health insurance allows you and your family to
purchase quality, affordable major medical
health insurance coverage on a temporary basis.
Coverage is
provided for physician services, surgery,
outpatient and inpatient care
and prescription drugs.
How benefits are covered?
The benefit options for covered expenses for injury or
sickness per insured person per benefit period.
Secure STM pays benefits for
each covered person in the following manner: First, you meet
your deductible. Choose from four options: $250, $500,
$1,000 or $2,500
Then Secure STM pays 80% or
50% of the next $5,000 of covered expenses
After this, Secure STM pays
100% of covered expenses up to your coverage period maximum
of $2 million
What medical expenses are covered?
After satisfying the deductible amount you've selected,
Secure STM will pay the coinsurance you selected for covered
expenses, up to a lifetime maximum of $2 million per insured
person per coverage period.* Benefits are limited to the
reasonable and customary charge for a covered expense in
addition to any specific limits.
- Hospital Charges:
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 surgeons benefit
- Anesthesia Services: up
to 20% of the surgeons benefits
- Intensive Care: up to
three times the 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 supplies
- Blood or blood
derivatives and their administration
- Ambulance Services: $250
per emergency
- Organ Transplants:
$150,000 lifetime maximum
- Acquired Immune
Deficiency Syndrome (AIDS): **$10,000 lifetime maximum.
- Mammography, pap smear
and screens
* Benefits for
gallbladder surgery are limited to a $2,500 lifetime maximum
per insured person. Benefits for injury or disorders of the
knees are limited to a $2,500 lifetime maximum per insured
person.
** 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.
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.
What is a usual, reasonable and customary charge?
A "usual, reasonable and customary charge" is the charge
typically made by physicians or suppliers of medical
services, medicines and supplies within a specific
geographic area as determined by us. 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 pre-certification?
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 pre-certify will result in a benefit reduction of
50%. Call 1-800-367-9938 for pre-certification.
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; or a dependent ceases to be
eligible; you cease to be a member of the association or the
group master policy terminates..
Can I continue coverage?
If your need for temporary health insurance continues, you
may apply for another Secure 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.
This website provides a brief
description of the benefits, exclusions and other provisions
of the policy Form SSL-STMP-1104. For complete listing, see
the Policy/Certificate of Insurance. Benefits may vary by
state. Secure STM is not available in all states.
Association membership may be required in some
jurisdictions.
2005 HPA, Inc. All rights reserved.
SM STM-1 3/05
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