Page 5 - Comparative-Benefits-STM-Plans
P. 5
** The time restriction for pre-existing condition is based on State you reside in. Currently, plans offered for:
Florida and Texas has time restriction for 24 months. However, Connect Plus plan is available for limited coverage of benefits for
pre-existing condition to cap at $25,000 per coverage period of the plan.
Virginia has restriction for 12 months. However, no plan is currently available to cover for benefits of pre-existing condition.
Renewability and Continuity: STM is not renewable. The next coverage period is not in continuation of the previous period; it is the new
plan with a new deductible, coinsurance, and pre-existing condition limitations. However, one can purchase next plan policy 60 days in
advance to ensure continuity.
Exclusions: Note exclusions to the benefits in the brochure for the plan.
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 must be obtained from Loomis customer service by notifying them with medical documentation that hospitalization is required. When
precertification cannot be obtained due to emergent circumstances, have the hospital staff call the claims department of the insurance company.
Typically, the hospitals staff assists with insurance when they take patient’s information for admission. Disclosure of insurance to hospital staff protects
the patient upfront.
Hospital Confinement
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.
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
Florida and Texas has time restriction for 24 months. However, Connect Plus plan is available for limited coverage of benefits for
pre-existing condition to cap at $25,000 per coverage period of the plan.
Virginia has restriction for 12 months. However, no plan is currently available to cover for benefits of pre-existing condition.
Renewability and Continuity: STM is not renewable. The next coverage period is not in continuation of the previous period; it is the new
plan with a new deductible, coinsurance, and pre-existing condition limitations. However, one can purchase next plan policy 60 days in
advance to ensure continuity.
Exclusions: Note exclusions to the benefits in the brochure for the plan.
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 must be obtained from Loomis customer service by notifying them with medical documentation that hospitalization is required. When
precertification cannot be obtained due to emergent circumstances, have the hospital staff call the claims department of the insurance company.
Typically, the hospitals staff assists with insurance when they take patient’s information for admission. Disclosure of insurance to hospital staff protects
the patient upfront.
Hospital Confinement
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.
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
