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THE PERFECT SOLUTION FOR THOSE

  • Those between jobs
  • New hires and exiting employees
  • College graduates
  • Part-time workers
CONVENIENT FEATURES

  • Coverage from 30 days to 12 months
  • Single, monthly and daily rates
  • Unlimited re-applies in most states
  • $2,000,000 lifetime maximum
Available in all states except CA, MA, NY, NJ, VT, WA

What is Secure STM?
Just because you don't have health insurance right now doesn't mean you may not have health problems. Secure STM allows you and your family to purchase quality, affordable major medical coverage on a temporary basis. Coverage is provided for physician services, surgery, outpatient and inpatient care.

How are benefits covered?
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 Secured 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 lifetime maximum of $2 million

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.

Who qualifies for Secure STM?
Secure 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 (see the Secure STM Rate Calculation instructions for details).

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 usual, 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 benefits
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: Up $250 per trip
Organ Transplants: Up to $150,000 lifetime maximum
Acquired Immune Deficiency Syndrome (AIDS): Up to $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. Benefits may vary by state.
** 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, Indiana, Maine, Missouri, New Hampshire, North Carolina or North Dakota. In Kansas the maximum per Coverage Period is $75,000.

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 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.
When does my coverage start?
Your coverage will begin as early as the day following the U.S. postmark stamp on your envelope. 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 Secure STM coverage last?
HPA's Secure 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, Secure STM offers coverage for one to six months or even 12 months.*

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.

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.**

*The 12 month Coverage Option is not available in all states.
**This applies to states where association membership is required.

What services are not covered?
The following is a partial list of services or charges not covered by Secure 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 months
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.

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 Secure 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.

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 1 5%-45% off eyeglasses, contact lenses and nonprescription 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. Enhancement series benefits may vary by state.

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.

Who is the Insurance Company?
Standard Security Life Insurance Company of New York has a Best's rating of A- (Excellent), effective as of 11/07.

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.

This brochure provides a brief description of the benefits, exclusions and other provisions of the group policy Form SSL-STMP-1 104 and individual policy SSL-ISTM-1 104. 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.

©2007 HPA, Inc. All rights reserved.
Secure STM bro 11-07