Page 6 - FL_STM_Connect PLus
P. 6
Utilize a network provider and save
With your short-term medical plan, you have the freedom to choose any provider. In certain
markets, you also have access to discounted medical services through national preferred provider
organizations (PPOs). These network providers have agreed to negotiated prices for their services
and supplies.
At the time of service, simply present your identification card, which will include the network
information needed for the provider to correctly process covered billed charges. If this provider
discount is not available, then benefits are paid at the usual, reasonable and customary charge.
Precertification
Precertification is required prior to each inpatient confinement for injury or illness and outpatient
chemotherapy or radiation treatment, at least seven days prior to receiving treatment. Emergency
inpatient confinements must be pre-certified within 48 hours following the admission, or as soon
as reasonably possible. Precertification may also be conducted for a continued stay review for an
ongoing inpatient confinement. Benefits are not paid for days of inpatient confinement which extend
beyond the number of days deemed medically necessary. Failure to complete precertification will
result in a benefit reduction of 50 percent which would have otherwise been paid unless the covered
person is incapacitated and unable to contact the administrator. Precertification is not a guarantee
of benefits. Precertification is not required in some states.
10-day right to return period
If for any reason you are not satisfied with the policy, you may return it to us within 10-days after you
receive it and you will be issued a refund. The refund will include any premium paid minus the
enrollment and administrative fees. These fees may vary by state. Your coverage issued under the
policy will then be void, as though coverage had not been issued.
Renewability of coverage
STM is not renewable. In some states you are allowed to apply for another STM 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, unless applied to the limited pre-existing condition benefit, shown in the policy
schedule of benefits
• 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 and 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
6 Brochure Connect Plus 1018
With your short-term medical plan, you have the freedom to choose any provider. In certain
markets, you also have access to discounted medical services through national preferred provider
organizations (PPOs). These network providers have agreed to negotiated prices for their services
and supplies.
At the time of service, simply present your identification card, which will include the network
information needed for the provider to correctly process covered billed charges. If this provider
discount is not available, then benefits are paid at the usual, reasonable and customary charge.
Precertification
Precertification is required prior to each inpatient confinement for injury or illness and outpatient
chemotherapy or radiation treatment, at least seven days prior to receiving treatment. Emergency
inpatient confinements must be pre-certified within 48 hours following the admission, or as soon
as reasonably possible. Precertification may also be conducted for a continued stay review for an
ongoing inpatient confinement. Benefits are not paid for days of inpatient confinement which extend
beyond the number of days deemed medically necessary. Failure to complete precertification will
result in a benefit reduction of 50 percent which would have otherwise been paid unless the covered
person is incapacitated and unable to contact the administrator. Precertification is not a guarantee
of benefits. Precertification is not required in some states.
10-day right to return period
If for any reason you are not satisfied with the policy, you may return it to us within 10-days after you
receive it and you will be issued a refund. The refund will include any premium paid minus the
enrollment and administrative fees. These fees may vary by state. Your coverage issued under the
policy will then be void, as though coverage had not been issued.
Renewability of coverage
STM is not renewable. In some states you are allowed to apply for another STM 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, unless applied to the limited pre-existing condition benefit, shown in the policy
schedule of benefits
• 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 and 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
6 Brochure Connect Plus 1018
