Do I need pre-certification?

You must notify the pre-certification service 10 days prior to a non-emergency hospital admission or surgery and 48 hours (or as soon as reasonably possible) following an emergency admission to the hospital for pre-certification of admission. Failure to pre-certify will result in a benefit reduction of 50%. Pre-certification is not a guarantee of benefits.

What is the 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 this option, and your need for insurance ends before your coverage period ends, you can cancel at any time throughwritten notification to our Policy Service Department. (The 12month coverage option is not available in all states.)
• The single payment option is ideal if you know the exact number of days coverage is needed. This option has a special reduced rate and you only pay for the coverage you need through 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 or ACH online.

Your subsequent monthly credit card/ach premium deductions will occur based upon the effective date of coverage. If your coverage effective date is the 1st - 14th, your premium will be deducted on the 1st of the month. If your coverage effective date is the 15th - 31st, your premium will be deducted on the 15th of the month.

How can I save money and maximize my benefits?

Through the STM plan, you have access to discounted medical services through two national Preferred Provider Networks (PPOs): ACS and MultiPlan. The network providers have agreed to provide their services at a negotiated fee and pass these discounts on to you. While you have the flexibility to choose any health care provider, the discounts available through network providers for covered services will help to lower your out-of-pocket cost. The discount will be reflected in your final bill and you will not owe the network providers for the difference between their retail rate and the negotiated fee. You will still be responsible for paying your share of the covered expenses, including any deductible, copay and coinsurance. Your coinsurance amount will be based upon the negotiated fee.
Using a network provider is voluntary. If you are unable to find a network provider, we will attempt to negotiate a discount for you from your provider. While we can’t guarantee the outcome, if we successfully obtain a discount it will be passed on to you.
To search for a health care provider or facility, please visit the Web sites listed below. At the time of services, simply present your identification card to the network provider.
• ACS is a comprehensive network of 2,500 ancillary service providers at over 25,000 sites, representing providers of outpatient services, including lab and diagnostic testing, except physicians. www.anci-care.com
• MultiPlan is one of the nation’s largest networks with more than 500,000 members in 50 states, including physicians, and inpatient and outpatient facilities. www.multiplan.com or 888-342-7427.
ACS and MultiPlan are not affiliated with Standard Security Life Insurance Company of New York, nor are they part of this insurance plan.


What services are not covered?

Following is a partial list of services or charges not covered by Secure STM:**

• Any services that are not medically necessary, as defined in the policy
• Eye exams, eyeglasses, hearing aids
• Dental or orthodontic services
• Prescription or legend drugs and medications
• 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 its 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
• Participation in school or organized competitive sports or any high risk sport

**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?

Secure STM will not provide benefits for any loss caused by or resulting from a pre-existing condition. A pre-existing condition is any medical condition or sickness for which medical advice, care, diagnosis, treatment, consultation or medication was recommended or received from a doctor within five years immediately preceding the covered persons effective date of coverage; or symptoms existed within the 5-years immediately prior to the covered persons effective date of coverage which would cause a reasonable person to seek diagnosis, care or treatment. 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 Certificate of Insurance within 10 days and receive a premium refund. Enrollment and Administrative fees are non-refundable.

Who is the Association?

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

What is the Enhancement Series*?

In addition to offering you an association-endorsed short-term medical plan, CA provides additional consumer benefits and services you can use to stay healthy and reduce your medical expenses. These benefits include:

• Coaches and Advocates: For information on providers in your area, the latest consumer health reports and assistance with benefits.
• TelaDoc: TelaDocTM is a national network of board-certified physicians providing cross-coverage consultations 24 hours a day, 365 days a year. This service is free of charge to members. Note that you will need to register online before using this service. Dependents must be 10 years of age or older to use TelaDoc.
• Discount Prescription Drug Card: All members receive a FREE discount prescription drug card.
• Discounted Services:
  
  Remote file sharing service: that allows you to easily share large computer files, photos and videos with clients or colleagues.
  Remote PC access: The ability to remotely access you office PC from home, or your home computer at work.
  Remote meeting: Live video meeting service that allows you to converse with clients over the Internet.
  Remote backup: Automatic backup of your personal PC over the Internet for safer file storage at remote location.

*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, nor is it a part of the STM insurance plan. The Enhancement Series is not available to residents in the states where the CA membership is not required.

Who is the Insurance Company?

The Secure STM is insured by Standard Security Life Insurance Company of New York (Standard Security), a member of the IHC Group. Standard Security is rated A- (Excellent) by A.M. Best Company, a widely recognized rating agency that rates insurance companies on their relative financial strength and ability to meet their obligations to their insureds. Standard Security has chosen Health Plan Administrators, Inc. (HPA), also a member of the IHC Group, to provide service for your Secure Lite STM plan.
The IHC Group is an insurance organization comprised of Independence Holding Company (NYSE: IHC) and its operating subsidiaries. The IHC Group has been providing life, health and stop-loss insurance solutions for over 25 years. For more information on Independence Holding Company and the IHC Group, visit www.ihcgroup.com.

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 70 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.