HealthEMed STM - Health Benefits Group

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Short Term Medical
Exclusive features include:
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Up to $2,000,000 Lifetime Maximum per Covered Person
Choice of Coverage Periods of up to 6 months or 11 months (Coverage periods of greater
than 6 months are not available in all states)
Urgent Care Center - Deductible waived, $50 Co-payment, after which coinsurance applies
Choice of deductibles - $250, $500, $1,000, $2,500, $5,000, $7,500
Coinsurance options of 80% or 50% up to $5,000
Freedom to choose any doctor or hospital
Child Only Coverage available - minimum age two years old
Choose to pay plan cost two convenient ways, in a single up-front payment for 30 to 337
days (up to 11 months, not available in all states), or pay by convenient monthly
installments
Choose to pay plan cost by MasterCard, Visa or Automatic bank draft.
Coventry Network
Coventry National Network is a strong, stable, and broad network covering all 50 states, Puerto Rico
and the District of Columbia. Over 98% of the U.S. has access to a network provider and the
network is particularly strong in suburban and rural areas. The network is highly credentialed, and is
credentialed every three years.
Your membership card will feature the Coventry Health Care National Network logo. Network
participating providers can be searched 24 hours a day at www.coventry-international.com.
Members should present their ID card each time they seek services from a participating provider to
ensure they receive the full value of the Coventry National Network.
Benefit Details
Why Short-Term Medical (STM)?
Circumstances in life may have caused you to lose your health insurance.
Unexpected illnesses and accidents happen every day, but you don't have to
put your financial future at risk. Purchase short-term medical insurance until
permanent insurance becomes available for you.
That's why HCC Life's HealtheMed STM is the right solution for you. It is issued for a predetermined length of time and pays benefits up to a Lifetime Maximum of $2,000,000 per Covered
Person. You can select from a wide range of deductible and coinsurance options to tailor a plan to
fit your lifestyle needs and budget!
How do I figure out what I need and where do I start?
First, Select Your Coverage Period:
• Single Payment
This option is ideal if you know the exact number of days you need coverage. The minimum
number of days you may apply for coverage is 30 days, the maximum is 337 days. Pay now
for the number of days you will need STM coverage. We accept payment by Visa,
MasterCard, or Bank Draft.
• Monthly Pay:
This is ideal if you are unsure how long coverage is needed. This "pay as you go" option
gives you the flexibility to continue coverage for as long as it's needed, or you can stop
payments to discontinue the plan once your temporary need ends. You can select coverage
of 6 or 11 months (Coverage periods of greater than 6 months are not available in all
states). We accept automatic monthly payments by Visa, MasterCard or Bank Draft.
Then, based on your lifestyle needs and budget, you select one from each of the following:
• Deductible: $250, $500, $1,000, $2,500, $5000, $7,500
The selected deductible must be paid by each Covered Person before Coinsurance benefits
are payable. (After 3 individuals meet their deductible, the deductible is deemed satisfied
for any remaining covered individuals.)
• Coinsurance Percentage: 80/20 or 50/50
Your selection of a Coinsurance Percentage represents the percent of covered expenses
that we pay and that you pay*, after the deductible has been satisfied, up to the
Coinsurance Maximum. (After 3 individuals have met their deductible, the deductible is
deemed satisfied for any remaining covered individuals.)
• Coinsurance Maximum: $5,000
Once you've reached your Coinsurance Limit of $5,000 (based on your selection), we pay
100%* up to the $2,000,000 Lifetime Maximum. For example, if your coinsurance is 80/20,
you pay 20% of the next $5,000 in covered charges ($1,000 out-of-pocket plus deductible).
Then we pay at 100% up to the Lifetime Maximum.
*Based on usual and customary charges of the geographical area in which charges are incurred.
What medical expenses are covered?
The following benefits are for Insured and each Covered Dependent subject to the plan Deductible,
Coinsurance Percentage, Coinsurance Maximum, and Lifetime Maximum of $2,000,000. Benefits
are limited to the Usual, Reasonable and Customary charge for each Covered Expense, in addition
to any specific limits stated in the policy.
• Inpatient and outpatient charges made by a hospital, including inpatient prescription drugs
• Urgent Care Center - Deductible waived, $50 Co-payment, after which coinsurance applies
• Eligible charges made by a physician, surgeon, radiologist, anesthesiologist, and any other
medical specialist to whom the physician has referred the case
• Charges made for dressings, sutures, casts of other supplies prescribed by the attending
physicians or specialist
• Charges for diagnostic testing using radiology ultrasonographic or laboratory services
• Charges for oxygen and other gases and anesthetics and their administration
• Charges made by a licensed extended care facility upon direct transfer from an acute care
hospital
• Emergency local ambulance transport in connection with a covered injury of sickness
resulting in inpatient hospitalization
• Charges for physical therapy that is prescribed in advance by a physician in relation to a
covered injury of sickness
Note: This is a brief description of the plan benefits, which may vary by state.
Does the plan require Pre-Certification?
This plan requires a pre-certification for hospitalizations, other Inpatient care, and Surgeries or
Surgical Procedures. HCC must be contacted as soon as possible before the expense is to be
incurred. If the Covered Person does not comply with the Pre-certification requirements as stated in
the insurance certificate, the Eligible Medical Expenses will be reduced by 50%.
How does Usual and Customary affect my benefits?
We may use and subscribe to a standard industry reference source that collects data and makes it
available to its member companies in order to determine the amount that should be considered as
Usual and Customary for services and supplies.
The policy defines Usual and Customary charges as:
1. A usual fee is defined as the charge made for a given service by a Doctor to the majority of
his or her patients; and
2. A customary fee is one that is charged by the majority of Doctors within a community for
the same services.
All benefits are limited to Usual and Customary charges.
Do I have the option to use any doctor or hospital?
HCC Life Short Term Medical customers have the freedom to choose doctors and hospitals without
facing out-of-network penalties. However, you can access the Corporate Medical Network providers
for medical care at negotiated prices.
What if I change my mind after I purchase the STM Coverage?
If you are not 100% satisfied with your coverage, and you have not already used any of your
insurance benefits, return the certification to us within 10 days of receipt or within 30 days for
members in Indiana. Coverage will be cancelled as of the effective date and your plan cost will be
returned. No questions asked! Association fees will be returned in the following states: CA, CO, CT,
IA, ND, NM, OH, RI, VA
What is the Pre-Existing Conditions Limitation?
A pre-existing condition is a condition for which medical advice, diagnosis, care, or treatment
(including receiving services and supplies, consultations, diagnostic tests or prescription medicines)
was recommended or received within the 60 months immediately preceding the Effective date; or
that had manifested itself in such a manner that would have caused an ordinarily prudent person to
seek medical advice, diagnosis, care, or treatment within the 12 months immediately preceding
such person's Effective Date. (The Pre-Existing Conditions Limitation varies by state and may be less
than 60 months.)
Who is eligible to apply for this insurance?
HealtheMed STM is available to members and their spouses, who are between 18 and 64 years old
and their dependent unmarried children under 19 years old or under 25 if a full time student in an
accredited school (This may vary by jurisdiction); and can answer "No" to all of the questions in the
application for insurance. Child-only coverage is available for ages two though eighteen.
When does coverage start?
You can select your insurance to be effective as early 12:01 a.m. the day following the transmission
date of your application. However, you can choose a later effective date, but not to exceed 45 days
from the date of transmission. All coverage is subject to approval of your application and receipt of
your first payment.
When does the STM coverage terminate?
HealtheMed STM will automatically terminate on the earliest of the following dates: The Expiration
date of your coverage; the date the Group Policy Terminates; the date the insurance under the
Group Policy is discontinued; the due date of a payment, if it is not paid by the end of the 31 day
grace period; the date you become eligible for Medicare; your dependent's coverage ends when
your coverage terminates or the dependent becomes eligible for Medicare; or the dependent
ceases to be eligible; the date you enter full-time active duty in the armed forces of any country or
international organization; or the date we determine fraudulent statements or material
misrepresentation have been made by you or with your knowledge in filing a claim for benefits.
Who is HCC Life Insurance Company?
HCC Life's short-term medical insurance is backed by the financial stability of its parents company,
HCC Insurance Holdings, Inc. (NYSE: HCC). HCC Life holds a financial strength rating of AA (Very
strong) by Standard & Poor's and Fitch Ratings and A+ (Superior) by A.M. Best Company.
Underwritten by:
Legal Disclaimer:Not
all coverages or products may be available in all jurisdictions. The description of coverage on this site
Disclaimer:
is for informational purposes only. Actual Coverages will vary based on local law requirements and the terms and
conditions of the policy issued. The information described herein does not amend, or otherwise affect the terms and
conditions of any insurance policy issued by HCC Life Insurance Company. Full details of the coverage are contained in
policy form number HCCL STTMM IND
If you have any questions about the content at this website please contact us at 1-877-376-5831 or email
[email protected]
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