Page 6 - FL_STM_Connect STM
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Hospital and confinement definitions
Hospital means an institution which is legally constituted and operated in accordance with the
laws pertaining to Hospitals in the jurisdiction where it is located, which meets all of the following
requirements:
• It is engaged primarily in providing medical care and treatment to sick and injured persons on
an inpatient basis at the patient’s expense;
• It provides 24-hour-a-day nursing service by a nurse;
• It is under the supervision of a staff of duly-licensed physicians;
• It provides organized facilities for diagnosis and for major operative surgery either on its
premises or in facilities available on a prearranged basis; and
• Hospital does not mean primarily a clinic, nursing home, rest or convalescent home, extended
care facility, hospice or similar establishment nor, other than incidentally, a place providing
care for persons with mental illness or nervous disorders, the aged, or those suffering from
alcoholism or drug addiction.
Confinement means the time in which a covered person is a registered bed patient in a hospital
on the order of a physician for medically necessary medical treatment. Confinement in a special
unit of a hospital used primarily as a nursing, rest, or convalescent home shall be deemed to be
confinement in an institution other than a hospital.
Renewability of coverage
STM is not renewable. In some states you are allowed to apply for another STM insurance plan.
Your application is subject to eligibility, underwriting requirements and state availability of the
coverage. The next coverage period is not a continuation of the previous period; it is a new plan
with a new deductible, coinsurance and pre-existing condition limitation. Note that based on your
state, you may be limited to two or three consecutive terms only.
Coverage termination
Coverage ends on the earliest of the date: the date the policy terminates; the date you become
eligible for Medicare; the expiration date of your coverage; the premium is not paid when due, if
such payment has not been made within 31 days following such premium due date; you enter full-
time active duty in the armed forces; or Independence American Insurance Company determines
intentional fraud or material misrepresentation has been made in filing a claim for benefits or
the date of your death. A dependent’s coverage ends on the earliest of the date: your coverage
terminates; the dependent becomes eligible for Medicare; or the dependent ceases to be eligible.
Exclusions
The following list of exclusions is a partial list of services or charges not covered. Check your policy
for a full listing:
• Treatment of pre-existing conditions, as defined in the pre-existing conditions limitation
provision, shown in the policy
• Incurred prior to the effective date of a covered person’s coverage or incurred after the
expiration date, regardless of when the condition originated, except in accordance with the
extension of benefits provision
• Treatment, services & supplies for:
• complications resulting from treatment, drugs, supplies, devices, procedures or
conditions which are not covered under the policy;
• experimental or investigational services or treatment or unproven services or treatment;
• Amounts in excess of the usual, reasonable and customary charges made for covered
services or supplies or you or your covered dependent are not required to pay, or which would
not have been billed, if no insurance existed;
• Paid under another insurance plan, including Medicare, government institutions, workers’
compensation or automobile insurance
• Expenses incurred by a covered person while on active duty in the armed forces. Upon
written notice to us of entry into such active duty, the unused premium will be returned to you
on a pro-rated basis
• Physical exams or prophylactic treatment, including surgery or diagnostic testing, except as
specifically covered
• Mental illness or substance use, including alcoholism or drug addiction or loss due to
intoxication of any kind unless mandated by law
• Tobacco use cessation
6 Brochure Connect STM 1018
Hospital means an institution which is legally constituted and operated in accordance with the
laws pertaining to Hospitals in the jurisdiction where it is located, which meets all of the following
requirements:
• It is engaged primarily in providing medical care and treatment to sick and injured persons on
an inpatient basis at the patient’s expense;
• It provides 24-hour-a-day nursing service by a nurse;
• It is under the supervision of a staff of duly-licensed physicians;
• It provides organized facilities for diagnosis and for major operative surgery either on its
premises or in facilities available on a prearranged basis; and
• Hospital does not mean primarily a clinic, nursing home, rest or convalescent home, extended
care facility, hospice or similar establishment nor, other than incidentally, a place providing
care for persons with mental illness or nervous disorders, the aged, or those suffering from
alcoholism or drug addiction.
Confinement means the time in which a covered person is a registered bed patient in a hospital
on the order of a physician for medically necessary medical treatment. Confinement in a special
unit of a hospital used primarily as a nursing, rest, or convalescent home shall be deemed to be
confinement in an institution other than a hospital.
Renewability of coverage
STM is not renewable. In some states you are allowed to apply for another STM insurance plan.
Your application is subject to eligibility, underwriting requirements and state availability of the
coverage. The next coverage period is not a continuation of the previous period; it is a new plan
with a new deductible, coinsurance and pre-existing condition limitation. Note that based on your
state, you may be limited to two or three consecutive terms only.
Coverage termination
Coverage ends on the earliest of the date: the date the policy terminates; the date you become
eligible for Medicare; the expiration date of your coverage; the premium is not paid when due, if
such payment has not been made within 31 days following such premium due date; you enter full-
time active duty in the armed forces; or Independence American Insurance Company determines
intentional fraud or material misrepresentation has been made in filing a claim for benefits or
the date of your death. A dependent’s coverage ends on the earliest of the date: your coverage
terminates; the dependent becomes eligible for Medicare; or the dependent ceases to be eligible.
Exclusions
The following list of exclusions is a partial list of services or charges not covered. Check your policy
for a full listing:
• Treatment of pre-existing conditions, as defined in the pre-existing conditions limitation
provision, shown in the policy
• Incurred prior to the effective date of a covered person’s coverage or incurred after the
expiration date, regardless of when the condition originated, except in accordance with the
extension of benefits provision
• Treatment, services & supplies for:
• complications resulting from treatment, drugs, supplies, devices, procedures or
conditions which are not covered under the policy;
• experimental or investigational services or treatment or unproven services or treatment;
• Amounts in excess of the usual, reasonable and customary charges made for covered
services or supplies or you or your covered dependent are not required to pay, or which would
not have been billed, if no insurance existed;
• Paid under another insurance plan, including Medicare, government institutions, workers’
compensation or automobile insurance
• Expenses incurred by a covered person while on active duty in the armed forces. Upon
written notice to us of entry into such active duty, the unused premium will be returned to you
on a pro-rated basis
• Physical exams or prophylactic treatment, including surgery or diagnostic testing, except as
specifically covered
• Mental illness or substance use, including alcoholism or drug addiction or loss due to
intoxication of any kind unless mandated by law
• Tobacco use cessation
6 Brochure Connect STM 1018
