Health Plan Administrators, Inc

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Covered Expenses

Anytime you are without insurance, you are running a risk. You may not have a health problem now, but insurance is for the unexpected. Secure 12x3 STM allows you and your family to purchase affordable short-term medical coverage for physician services, surgery, outpatient and inpatient care for a temporary period.

How does the plan work?

Secure 12x3 STM pays benefits for each covered person in the following manner (subject to specific benefit limits):

1. You are responsible for eligible expenses until the deductible is satisfied. Choose from four options: $500, $1,000, $2,500 or $5,000 (maximum of 3 deductibles per family)
2. For most covered services, Secure 12x3 STM then pays 80% or 50% of the next $10,000 of covered expenses.
3. After this, Secure 12x3 STM pays 100% of covered expenses up to your Coverage Period maximum of $750,000*

*Certain conditions have limited maximum benefits; see “What services/conditions are limited or excluded from coverage?” Refer to your coverage document for specific terms and conditions.

How long will Secure 12x3 STM coverage last?

HPA’s Secure 12x3 STM insurance is specifically designed to fill temporary health insurance needs. You can apply for three consecutive 12 month coverage periods, up to a maximum of 36 months in all.

What medical expenses are covered?

After satisfying the deductible amount you've selected, Secure 12x3 STM will pay the coinsurance you’ve selected for covered expenses, up to a maximum of $750,000 per Insured person per Coverage Period.*

The Benefits are limited to the usual, reasonable and customary charge for a covered expense in addition to any specific limits.

• 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.

***Limitation not applicable in the states of AZ, CA, DC, MO and NC

How can I have additional coverage after the 12 month Coverage Period is complete? 

When your Coverage Period is almost over, you will receive an application form to apply for another 12 month

Coverage Period.* If you re-apply within 30 days prior to the termination date of your coverage, and your application is approved in underwriting, a new Coverage Period will be issued, effective day following the termination date of your Coverage Period. We will issue you a new Certificate of Insurance and new deductible and coinsurance will apply. However, the pre-existing conditions limitation will not apply to any condition(s) that were covered during a prior Coverage Period. Any other pre-existing conditions will remain subject to the pre-existing conditions limitation as described in the Certificate of Insurance.

*The coverage and rates may be different and are subject to state availability. You must be under age 65 to reapply for coverage.

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?

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.

Does the STM have a Preferred Provider Organizations (PPO) Network?

In addition to your insurance plan, you’ll also enjoy discounts provided through nationwide access to one of the premier PPOs through Private HealthCare Systems (PHCS). PHCS provides you the opportunity to reduce your expenses for provider and facility services. The program is voluntary, so there is no penalty for not using a PHCS participating provider; but you can reduce your out-of-pocket medical expenses by using the program. Simply call PHCS at 1-800-678-7427 or visit PHCS on the web at www.phcs.com to verify that your doctor or hospital is part of the PHCS Healthy Directions Network. At the time of service present your Short Term Medical Insurance Identification Card with the PHCS logo on it and your provider will bill you at the reduced network rate for services if applicable.*

What is Lab One Select?

In addition to your insurance plan, you’ll be able to take advantage of low-cost laboratory testing by having lab tests performed by LabOne. Using LabOne Select can save you up to 40% over other providers!*

* PHCS and LabOne are not affiliated with the Standard Security Life Insurance Company of New York nor are they a part of the Secure 12x3 insurance plan.

How does the Rx Drug Card work?

In addition to your insurance plan, you’ll also enjoy access to discounts on prescription drugs through our Rx Drug Card in over 42,000 pharmacies nationwide.* The Rx Drug Card is not an insurance benefit and therefore there is no deductible, no claim forms and no pre-existing conditions.* The Rx Drug Card is intended to help you find low cost medications within the same therapeutic class as a drug you may currently be taking. With this formulary program you pay up to $10 for Generic Drugs. Savings on Brand Name and Select Generic Drugs are as high as 45% off retail cost.

*The Rx Drug Card is not affiliated with the Standard Security Life Insurance Company of New York nor is it a part of the Secure 12x3 STM insurance plan.

What is the optional Supplemental Accident Benefit?

If purchased, the Supplemental Accident Benefit covers $500 of covered expenses caused by an accidental injury. The first treatment must be within 72 hours of the accident and only expenses within 90 days after the accident are covered. After the $500, the balance of the expenses is subject to the plan deductible and coinsurance. How long will Secure 12x3 STM coverage last? HPA’s Secure 12x3 STM insurance is specifically designed to fill temporary health insurance needs. You can apply for three consecutive 12 month coverage periods, up to a maximum of 36 months in all.

When does coverage terminate?

Coverage ends when the premium is not paid when due; or you cease to be a member of the association; or the group master policy terminates; 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 determines fraud or misrepresentation has been made in filing a claim for benefits; or a dependent ceases to be eligible.

Is there an extension of benefits after the plan terminates?

If a member, or insured dependent is receiving benefits for a hospital confinement on the date that the Certificate of Insurance terminates (for other than non payment of premium), benefits will continue in accordance with the terms of the Certificate of Insurance for as long as that confinement remains. However, in no event will coverage continue beyond the end of 90 days following the date the coverage terminates when the Insured becomes eligible for other coverage for the same conditions or the maximum benefitshave been reached. Benefits payable are subject to a new Deductible Amount and satisfaction of Coinsurance Limit.

This website provides a brief description of the benefits, exclusions and other provisions of the group Master Policy Form SSL-STMP-1104. For complete listing, see the Policy/Certificate of Insurance. Benefits may vary by state. Secure 12x3 STM is not available in all states.

Association membership may be required in some jurisdictions.

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