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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.
Pre-existing condition limitation and definition
A pre-existing condition is defined as any medical condition or sickness for which medical advice,
care, diagnosis, treatment, consultation or medication was recommended or received from a
doctor within five years* immediately preceding the covered persons’ effective date of coverage; or
symptoms within the five years* immediately prior to the coverage that would cause a reasonable
person to seek diagnosis, care or treatment will not be a covered benefit. “Consultation” means
evaluation, diagnosis, or medical advice was given with or without the necessity of a personal
examination or visit.
*Six months in ID, KY, MI, ND, NH, NM, OH, WA, WY; 12 months in CO, CT, IN, LA, MD, ME, MS,
NC, NV, SD, VA; 24 months in FL, IL, UT; and 36 months in MT.
Usual, reasonable and customary charge
The usual, reasonable and customary charge for medical services or supplies is the lesser of: a) the
amount usually charged by the provider for the service or supply given; or b) the average charged
for the service or supply in the locality in which it is received; (c) the reasonable charge made for the
same service or supply in the same geographic area.
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 become eligible
for Medicare; you cease to be a member of the association1; the group master Policy terminates; you
enter full-time active duty in the armed forces; or 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.
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.
1Applies only to states where association membership is required.
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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.
Pre-existing condition limitation and definition
A pre-existing condition is defined as any medical condition or sickness for which medical advice,
care, diagnosis, treatment, consultation or medication was recommended or received from a
doctor within five years* immediately preceding the covered persons’ effective date of coverage; or
symptoms within the five years* immediately prior to the coverage that would cause a reasonable
person to seek diagnosis, care or treatment will not be a covered benefit. “Consultation” means
evaluation, diagnosis, or medical advice was given with or without the necessity of a personal
examination or visit.
*Six months in ID, KY, MI, ND, NH, NM, OH, WA, WY; 12 months in CO, CT, IN, LA, MD, ME, MS,
NC, NV, SD, VA; 24 months in FL, IL, UT; and 36 months in MT.
Usual, reasonable and customary charge
The usual, reasonable and customary charge for medical services or supplies is the lesser of: a) the
amount usually charged by the provider for the service or supply given; or b) the average charged
for the service or supply in the locality in which it is received; (c) the reasonable charge made for the
same service or supply in the same geographic area.
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 become eligible
for Medicare; you cease to be a member of the association1; the group master Policy terminates; you
enter full-time active duty in the armed forces; or 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.
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.
1Applies only to states where association membership is required.
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