Covered Expenses - Secure Med Temporary Medical Insurance
Just because you don't have Medical insurance right
now doesn't mean you may not have Medical problems. Secure Med 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 benefits are covered under the Secure
Med medical insurance plan?
The benefit options for covered expenses for injury or sickness per
insured person per benefit period.
Secure Med 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 Med STM pays 80% or 50% of the next
$5,000 of covered expenses
After this, Secure Med STM pays 100% of covered
expenses up to your lifetime maximum of $2 million
What medical expenses are covered?
After satisfying the deductible amount you've selected, Secure Med 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: $50,000 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. 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 reasonable and customary charge?
A "reasonable and customary charge" is the charge typically made
by physicians or suppliers of medical services, medicines and supplies
within a specific geographic area.
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%. Call 1-800-367-9938 for precertification.
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, this
applies to states where association membership is a requirement; the
elected coverage period expires; Standard Security Life Insurance Company
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.
** This applies to states where association
membership is required.
Can I continue coverage?
If your need for temporary Medical insurance continues, you may apply for
another Secure Med 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.
Exclusions & Limitations
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 Med STM effective date.
The pre-existing condition limitation may vary by state.
What are the plan exclusions and limitations?
The following is a partial list of services or charges not covered by
Secure Med 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
- Services payable by Medicare or
Workerís 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.
Can I continue coverage?
If your need for temporary medical insurance continues, you may apply for
another Secure Med 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.
What is a reasonable and customary charge?
A "reasonable and customary charge" is the charge typically made
by physicians or suppliers of medical services, medicines and supplies
within a specific geographic area.
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, this
applies to states where association membership is a requirement; the
elected coverage period expires; Standard Security Life Insurance Company
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.
**This applies to states where association
membership is required.
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 Med 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 |
