- Important Information
- Who should I discuss my insurance needs with?
- Who can answer my questions regarding this plan?
- What does this plan cover?
- What portion of covered expenses must I pay?
- Does this plan use a Pre-Admission Notification service?
- What healthcare providers and facilities can I receive treatment from?
- How long can I keep this coverage?
- What if I need further treatment after my Coverage Period expires?
- After my Coverage Period expires, can I re-apply for coverage?
- When does my coverage begin and end?
- Can I change my Coverage Period?
- Can I change my coverage effective date?
- Can I change my deductible?
- Can I add or delete family members from my coverage?
- If I select the monthly pay option, how will I be billed?
- Can I change my payment method?
- If my age changes after coverage begins, will my premium change?
- If I move after coverage begins, will my premium change?
- Can I cancel my coverage and receive a refund?
- Is this plan subject to the federal Health Insurance Portability and Accountability Act (HIPAA) of 1996?
- Is this plan considered "creditable coverage" under HIPAA?

Question. Who should I discuss my insurance needs with?

Answer. Contact your independent insurance agent.

 

Question. Who can answer my questions regarding this plan?

Answer. If you have not applied for this plan and are not currently insured under this plan, contact your independent insurance agent.  If you have applied for this plan or you are currently insured under this plan, contact your independent insurance agent or the Customer Service Department at 1-800-753-1000 (Monday through Friday / 8:30am to 5:00pm EST). Note - Important contact information is listed on the insurance information card(s) issued to approved applicants.

 

Question. What does this plan cover?

Answer. Please refer to the Plan Highlights section of this site for plan covered expense highlights. It is important to note that plan benefits and covered expenses vary by state and are described in detail in the Policy or Certificate issued by Fairmont Specialty to approved applicants.

Question. What portion of covered expenses must I pay?

Answer. First, you are responsible for satisfying the Coverage Period deductible ($250; $500; $1,000; or $2,500) you selected. The deductible amount will be automatically deducted from benefit payment(s) until it has been fully satisfied. Following deductible satisfaction, the plan then pays the next $5000 in covered expenses at the benefit level (*80% or *50%) you selected -- this is called coinsurance. Any additional covered expenses, in excess of the deductible and coinsurance, are then paid by the plan at *100% up to the benefit and/or plan maximums. Deductible, coinsurance and plan maximums are per person per Coverage Period.

*Unless otherwise stated in the Policy or Certificate

 

Question. Does this plan use a Pre-Admission Certification service?

Answer. Yes.  This plan requires a Pre-Admission Certification by a Professional Review Organization prior to in-patient Hospitalization or surgery.  Trained medical professionals will review the proposed plan of medical care for appropriateness and advise you of any available options that you may wish to consider.  This service is designed to help you make more informed decisions about the care you receive.  A Covered Person or their Attending Physician must call the Professional Review Organization: 1. For elective or non-emergency Hospitalization or surgery, at least 10-days prior to the date of proposed Hospitalization; 2. Within 48-hours of an emergency admission; or 3. Within 48-hours of delivery for complicated childbirth.  Non-compliance with the Pre-Admission Certification procedure will result in a reduction in benefits of 50%, unless the Covered Person is incapacitated and unable to contact the Professional Review Organization. In such cases, the Covered Person must contact us as soon as possible.

  

Question. What healthcare providers and facilities can I receive treatment from?

Answer. This plan is not an HMO or PPO managed care plan. Should you become sick or injured, you have the freedom to choose your own healthcare providers and facilities.

Question. How long can I keep this coverage?

Answer. If you select the monthly payment option, coverage is available in: a) 30-day increments up to the 180-day maximum Coverage Period, or b) monthly increments up to the 12-month maximum Coverage Period.  If you select the single payment option, enter the exact total number of days you need coverage for (30 day minimum Coverage Period / 180 day maximum Coverage Period).  The Coverage Period you select is the maximum length of time that your coverage will stay in force.

 

Question. What if I need further treatment after my Coverage Period expires?

Answer. Please refer to the Plan Highlights section of this site for extension of benefits after termination information.

 

Question. After my Coverage Period expires, can I re-apply for coverage?

Answer. This plan is not renewable nor intended to be permanent coverage. Coverage will terminate upon expiration of your Coverage Period. However, you may be eligible to apply for another Coverage Period following the expiration of your previous Coverage Period. If a new Coverage Period is applied for and issued by Fairmont Specialty, there is no continuous coverage between any previous and current Coverage Period. Any condition or symptom which occurred under a previous Coverage Period may be treated as a pre-existing condition under a subsequent Coverage Period. Note - In no event will Fairmont Specialty issue successive Coverage Periods totaling more than 365 days (unless otherwise limited by state law).

Question. When does my coverage begin and end?

Answer. Please refer to the Plan Highlights section of this site for coverage effective and termination date information.

Question. Can I change my Coverage Period?

Answer. No. Once your application has been submitted, the Coverage Period cannot be changed.

 

Question. Can I change my coverage effective date?

Answer. No. Once your application has been submitted, the effective date cannot be changed.

 

Question. Can I change my deductible?

Answer. No. Once your application has been submitted, the deductible cannot be changed.

 

Question. Can I add or delete family members from my coverage?

Answer. No. Once your application has been submitted, you cannot add or delete family members (spouse; children), unless otherwise required by law.

Question. If I select the monthly pay option, how will I be billed?

Answer. If you made your initial payment by:

 

Personal Check - Payment coupons will be enclosed with your Policy or Certificate. Each payment coupon is for a 30-day or 1-month period and identifies the payment due date, amount due, and address where to send your payment. Your payment(s) for the exact amount(s) due must be received by Co-ordinated Benefit Plans, Inc. on or before the indicated due date(s).

 

Automatic Bank Draft or Credit Card - Your monthly payment for each 30-day or 1-month period will be automatically debited from the bank account or MasterCard / VISA you identified in the "Electronic Payment Authorization" form.

 

Important - If your initial payment is dishonored by the bank or credit card issuer, coverage will be canceled and cannot be reinstated. If a payment (after the initial payment) is dishonored by the bank or credit card issuer, coverage may be terminated and cannot be reinstated.

 

Question. Can I change my payment method?

Answer. Yes. Only if you selected the monthly payment option and made your initial payment by automatic bank draft or credit card. Important - To make future monthly payments by personal check, you must send written notification to Co-ordinated Benefit Plans, Inc. stating that you wish to discontinue monthly electronic payment debits and make future monthly payments by personal check.  If you made your initial payment by check or money order, future monthly payments cannot be made by credit card.

 

Question. If my age changes after coverage begins, will my premium change?

Answer. No.

 

Question. If I move after coverage begins, will my premium change?

Answer. No.

 

Question. Can I cancel my coverage and receive a refund?

Answer. Yes - only if you return the Policy or Certificate to Co-ordinated Benefit Plans, Inc., within 10 days of delivery, with your written request for cancellation. Coverage will be canceled/void as of the effective date and your initial payment will be fully refunded. If you made your initial payment by credit card, we will issue a credit to that credit card account. If you made your initial payment by automatic bank draft or personal check, we will issue a refund check to the primary applicant.  After the "10 day free look period" expires, no refund is available (unless otherwise mandated by law).

The Policy and Certificates issued under it, will be deemed amended to conform to the minimum requirements of the laws of the state in which coverage is issued.

 

Question. Is this plan subject to the federal Health Insurance Portability and Accountability Act (HIPAA) of 1996?

Answer. No. Under HIPAA, short term limited duration plans are exempt from this legislation. This plan is not: guaranteed issue; guaranteed renewable; and the pre-existing condition limitation is not waived for federally eligible individuals.

 

Question. Is this plan considered "creditable coverage" under HIPAA?

Answer. Yes*. Under HIPAA, short term medical plans are generally considered creditable coverage.  *State reform legislation may vary.