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SECURE STM A Review of Standard Security Life "Secure STM" Short Term Medical Insurance  

January 1, 2010

related articles:
Review of "Secure Lite STM" (1-12 month coverage)
Review of "Secure 12x3 STM" (12-36 month coverage)

Contents:
Intended Use
General Eligibility
Medical Eligibility
Approved States
Covered Charges
Exclusions
PPO Network Providers
Referrals
Pre-certification
Deductibles
Co-payment
Co-insurance
Length of Coverage
Insurance Company
Plan Administrator
Financial Strength and Ratings
Consumer Complaints
Consumer Reviews
Price
Billing Method
Payment Method

To Cancel Coverage
Online Quote and Application
Brochure
Paper Application
Fax Application
Policy Issue Time
Child Only Applications
ID Cards
Enrollment Support
Billing Support
Claims
Comments
 

Intended Use
Most people are covered by employer-provided health insurance, but many millions of workers change employers year, leaving a temporary gap in coverage. Self-employed workers and their dependants do not have access to group coverage at all and recent high school and college graduates are forced out of family insurance plans. Even an accident like a broken bone or a torn muscle can cost thousands of dollars, so this insurance provides an affordable protection for the unexpected.

General Eligibility
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 seven health questions on the application.  Children age 19 and over should apply separately.
Child-only coverage is available for ages 2 through 18.

Medical Eligibility
Applicants must be able to answer "no" to the following seven questions:

1.  Will there be any other health insurance in force on the policy date?
2.  Is the proposed insured, spouse, or any dependent child now pregnant ?

3.  Is any proposed insured currently eligible for Medicaid?

4.  Has any person proposed for coverage been declined for health insurance in the past 12 months? (Missouri residents do not have to answer)

5.  Within the past 5 years have you or any person proposed for coverage been aware of, diagnosed, treated by a member of the medical profession, or taken medication for cancer or tumor, stroke, heart disease including heart attack, chest pain or had heart surgery, COPD (chronic obstructive pulmonary disease) or emphysema, liver  disorder, degenerative disc disease or herniation/bulge, rheumatoid arthritis, degenerative joint disease of the knee, insulin -dependant diabetes (not applicable to DC residents) alcohol abuse or chemical dependency?

6.  Have you or any person proposed for coverage been diagnosed or treated for Acquired Immune Deficiency Syndrome (AIDS), AIDS related complex, or any other immune system disorder? Answer this question "no" if you have tested positive for HIV but have not developed symptoms of the disease AIDS


7.  Has any person proposed for coverage not been a legal resident of the United States for the last 12 consecutive months?

Approved States
The following states have approved this coverage as of the date of this article:
Alabama, Alaska, Arizona, Arkansas, California, Connecticut, Delaware, D.C., Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kentucky, Maine, Michigan, Mississippi, Missouri, Nebraska, Nevada, New Mexico, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.

The following states have not approved this insurance:
Idaho, Kansas, Louisiana, Minnesota, Maryland, Montana, New Hampshire, Oregon, South Dakota,
Washington, New Jersey, New York, Massachusetts, and Vermont.

Covered Charges
Secure STM covers ordinary and necessary medical treatment for accidents and illnesses up to $2 million per person. 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 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: $150,000 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.

Included with your coverage is Communicating for America (CFA) STM Enhancement Series*which provides members with discounts for the following services and or purchases:
Vitamins, herbs and nutritional supplements - 10% off already low prices
Nurse-on-call - access to a registered nurse 24 hours a day, seven days a week
Chiropractic services - 30%-50% off at more than 3,000 private chiropractors
Prescription drugs - up to 40% off on generic or name-brand drugs at over 55,000 pharmacies nationwide
Vision eyewear care - up to 60% off eyeglasses, contact lenses and nonprescription
sunglasses through a network of more than 10,000 retail optical locations, including Pearle
Vision, JC Penney's, Wal-Mart and Lens Crafters

Dental services - save an average of 28% and up to 50% on dental expenses from 53,000 dentists in
Aetna Dental Access


Exclusions
The policy does not cover medical expenses that were incurred before the policy started or after the policy ended. The policy does not cover the cost of treating pre-existing medical conditions. Pre-existing conditions are defined as a medical any condition or complication that was treated or produced symptoms five years prior to your policy date.  This Short Term Medical insurance does not cover: 
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 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.


PPO Network Providers
This insurance plan does not use network providers. The same level of benefits is paid to all providers regardless of their PPO network affiliations. There is no "out-of-network" reduction in benefits.

Referrals
This plan does not require referrals for treatment. Treatment provided by any doctor or hospital in the United States may be covered

Pre-certification
This insurance requires pre-certification within 48 hours of an in-patient hospital admission.

Deductibles
This policy uses a single "per person" deductible that is selected at the time of application. A maximum of three deductibles is applied per family.  The deductible choices are $250, $500, $1000, and $2500. There is no "most popular" policy deductible; all of these available deductible choices are elected by policyholders at similar rates.

Co-payments
This policy does not use co-payments.  Co-payments are more common in HMOs and managed care plans.  This insurance uses the less complicated method of a single policy deductible rather than multiple co-payments.

Co-insurance
This policy offers two co-insurance options: a typical "80/20 to $5,000" formula and a lower cost "50/50 to $5000" option.  (Co-insurance may no longer be meaningful to policy holders since the majority of medical service providers in the U.S. now accept private insurance as full payment after the policyholder pays the policy deductible.  Check with your service providers for billing practices).


Length of Coverage
The minimum length of coverage is 30 days. The maximum policy length is either 180 days (6 months) or 360 days (12 months), depending on your state.  Re-application is allowed to extend coverage to 12 consecutive months. The most popular choice is 180 days because the coverage is less expensive than the longer policies and many applicants simply re-apply for a second subsequent policy to extend the period of coverage.

Insurance Company
Standard Security Life Insurance Company of New York.
    Address: New York, NY 10022-5872
Telephone: 212-355-4141

Plan 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.  Telephone 1-800-277-3323

Financial Strength and Ratings
Standard Security Life Insurance Company of New York is rated A (Excellent) for financial condition by A.M. Best Company, as of 06/04.

Consumer Complaints
The National Association of Insurance Commissioners (NAIC) collects data on consumer complaints against insurance companies and publishes compiled information on its Web site at www.NAIC.org . The NAIC assigns an "average complaint ratio" as 1.0 measurement. Standard Security Life received a 0.0 complaint ratio for 2004 which means that their were statistically no significant number consumer complaints filed against this insurance company.

Consumer Reviews
Since this is a new insurance product, consumer reviews are not yet available. Reviews will be posted at www.MedSave.com in the near future. If you have a comment or product review, send an e-mail to Health Insurance at OnlineAdviser@medsave.com.

Price
Price is based on age, location (zip code) and sex of each applicant. Premium rates are available online at the link listed below. Monthly premium rates start at about $60 for young adults, depending on coverage options selected, and go much higher for older adults.

Billing Method
The policy may be issued either as a single payment or on a month-to-month basis. The single payment is ideal if you know exactly how long you need coverage. The month-to-month billing offers more flexibility and allows you to call at any time to cancel coverage prior to the next month's billing. The most popular method is month-to-month billing.

Payment Method
Premiums may be paid by credit card, debit card, EFT, money order or personal check. Payment may not be made by business check because this would be a violation of many states' business insurance laws. The most common method of payment is online credit card.

 

To Cancel Coverage
If you wish to discontinue coverage before your Benefit Period expires, simply call, mail or fax your written request for termination to HPA and they will discontinue future automated electronic debits.  At least five days advance written and signed notice from the Primary Insured is required to ensure future credit card debits are discontinued.


Online Quote and Application
Most short term medical insurance policies are priced and issued directly online. This policy is available through MedSave.com. The direct enrollment link is https://www.hpa-inc.com/tools/securemed/index.cfm?agent=KymberlyMorrison&action=welcome

Brochure
A product brochure in PDF format is available for download from MedSave.com. The direct link is http://www.medsave.com /images/Securestm_broch.pdf


Paper Applications
Applications may be downloaded and then printed from the enrollment site above and are also available by fax from the enrollment adviser. Applications are not available by mail.

Fax Application
Faxed applications are accepted when paying with a credit card or pre-authorized electronic funds transfer (EFT). Applications may be faxed directly to (800) 609-0683
with assurance of privacy and security of data. Receipt of the application should be manually confirmed by telephone or e-mail.
 

Policy Issue Time
An online application is approved immediately at the time you apply for coverage and an acceptance e-mail is sent for confirmation of coverage, subject to the payment being approved.  In most cases the policy and ID cards are mailed in the next business day.

Child-Only Applications
Child(ren) alone can apply and are to use the 0-24 premium rate (male or female, based on their gender) for the youngest child; and the per child rate for each of the child siblings to be insured. The minimum age for a child only coverage is 2 years old. The application must be completed and signed by the parent or legal guardian.


ID Cards
This policy uses paper ID cards are available at the time of application by following the link on the confirmation e-mail.
 

Enrollment Support
Professional enrollment support is provided by Health Insurance under the OnlineAdviser terms of service either by telephone or e-mail. Use free this service for all questions prior to obtaining a policy number. E-mail support is available at onlineadviser@medsave.com .


Billing Support

Billing support for issued policies is 1-800-277-3323. The mailing address for customer service is  15436 N. Florida Avenue, Suite 105 Tampa FL 33613.

Claims
Claims may be submitted by either the policyholder or a medical service provider.  Secure STM is subject to the same 10 day response time laws and claim payment procedures as other health insurance companies. If a medical service provider wants to receive the payment directly from the insurer then an "Assignment of Claim" form signed by the policyholder is required. Otherwise all benefits payments are made to the policyholder.  The claims department number is 1-800-277-3323.  The mailing address for claims is Secure STM Claims, 15436 N. Florida Avenue, Suite 105
Tampa FL 33613.


Comments
This policy usually has the lowest rates for younger applicants and offers the best quality coverage for older applicants for a slightly higher price than competitive products.


 


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