Important Facts
The purpose of this website is to provide an overview of this Short Term Medical Plan. Below are some frequently asked questions regarding this valuable coverage.
- Q. Who needs this type of coverage?
A. Short Term Medical Insurance is an ideal, affordable type of medical insurance for those who are: unemployed, in between jobs, recent college graduates, in need of an alternative to COBRA. You will see that this coverage provides many special and unique coverage features while maintaining a very competitive premium structure.
- Q. Who is eligible for this coverage?
A. TriMed 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.
- Q. When does my coverage begin?
A. The insurance can be effective as early as 12:01 a.m. the next day after the transmission date. However, the applicant can choose a later effective date not to exceed 60 days from transmission date. Coverage ends on termination date listed in your policy.
- Q. How does this coverage work?
A. The benefit options for covered expenses are per insured person per coverage period.
Option 80/20: First, you meet your deductible. Choose from four options: $500, $1,000, $2,500 or $5,000. Then TriMed STM plan pays 80% of the next $10,000 of covered expenses. After this, STM plan pays 100% of covered expenses up to your Coverage Period maximum of $750,000*
Option 50/50: First, you meet your deductible. Choose from four options: $500, $1,000, $2,500 or $5,000. Then TriMed STM plan pays 50% of the next $10,000 of covered expenses. After this, STM plan 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.
- Q. How do I apply for this coverage?
A. First, make sure you do not live in a state where the Plan is not available. Next look up the rates that apply to you based on your gender and zip code. Then, complete the application, enter payment information, and e-sign the application. Follow instructions on the enrollment tool to complete an online application.
- Q. How is this coverage billed?
A. After submitting your enrollment form with first month's premium, you will then pay monthly. You indicate on your enrollment form how you wish to pay for your coverage. You may elect to be billed for the monthly premiums (plus the administration fee), OR you can select one of the other two payment methods: (1) Automatic Pre-authorized Bank Withdrawal; or (2) Credit Card - MasterCard, Visa and Discover are accepted. At anytime during your coverage You can cancel with written notification to policyservice@hpa-inc.com.
- Q. Can I get a refund of my premium if I am not satisfied?
A. Once you receive your Certificate of Insurance, carefully review all information. If you are not satisfied for any reason, return the Certificate (within 10 days of receipt) with your written request for cancellation to HPA. Coverage will be cancelled as of the effective date and you'll receive a full premium refund (minus administration fees and dues), no questions asked.
- Q. How long will TriMed STM coverage last?
A. HPA’s TriMed 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. STM is issued on a temporary need and terminates at the end of the period applied for. 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; 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.
- Q. How can I have additional coverage after the 12 month Coverage Period is complete?
A. 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.
- Q. Once my coverage is issued, do I have the option to select my doctors, hospitals and medical providers?
A. Yes. You have the freedom to select the doctors and hospitals of your choice. This plan is not an HMO or PPO.
- Q. Does the TriMed STM have a Preferred Provider Organizations (PPO) Network?
A. 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.
- Q. What is Lab One Select?
A. 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 TriMed STM insurance plan.
- Q. How does the Rx Drug Card work?
A. 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 TriMed STM insurance plan.
- Q. What is the optional Supplemental Accident Benefit?
A. 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.
- Q. What are the coverage limits under this plan?
A. STM pays 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 the Exclusions and Limitations section for specific terms and conditions.
- Q. Are pre-existing conditions covered?
A. Pre-existing conditions are not covered. The preexisting conditions limitation includes conditions that were treated or produced symptoms, within five years prior to the effective date of your TriMed STM Coverage Period. However, any condition covered during subsequent consecutive Secure 12x3 coverage periods will be covered, whether or not it is a pre-existing condition.
- Q. Are there expenses not covered under this plan?
A. Yes, this plan is designed to protect you in the event of an illness or injury. Short Term Medical is for temporary coverage only and therefore does not include some of the benefits a permanent health plan offers. Please refer to the Exclusions and Limitations section of this web site for full details.
- Q. What should I do if I cannot download and/or print the application found on this site?
A. Contact HPA, Inc. the Plan's Administrator, at 1-800-277-3323 between 8:30am- 5:00pm Eastern Time. Or, you may e-mail them at newsales@hpa-inc.com. They will rush an application, rates and coverage description right away.
- Q. Who is the Insurance Company?
A. Standard Security Life Insurance Company of New York Standard Security Life Insurance Company of New York is rated A (Excellent) for financial condition by A.M. Best Company. A.M. Best ratings range from A++ to D.
- Q. Who is the Association Provider?
A. Communicating for America (CFA)* is a division of Communicating for Agriculture and the Self Employed, Inc. CFA provides members with valued benefits and savings since 1972. This Short Term Medical insurance coverage is available to members of CFA.
*Communicating for America (CFA) is not affiliated with Standard Security Life Insurance Company of New York, nor is it a part of the insurance plan.
- Q. Who is the Administrator?
A. Health Plan Administrators, Inc. (HPA), Rockford, IL
Health Plan Administrators, Inc is a Fully Licensed, Full Service, Third Party Administrator servicing businesses worldwide. HPA has provided innovative health care solutions for over 60 years, meeting customer's needs with integrity, creativity and value. We strive to provide the best possible coverage in a cost effective manner. We, in conjunction with our trusted insurance carriers, share a mutual desire to provide important benefits to our customers and to meet their needs in an innovative, hassle-free manner.
1-800-277-3323
www.hpa-inc.com
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. TriMed STM is not available in all states. Association membership may be required in some jurisdictions.
©2005, 2006 HPA, Inc. All rights reserved.
