Liberty Select Short Term Health Insurance Covered Expenses

Just because you don't have health insurance right now doesn't mean you may not have health problems. Liberty STM allows you and your family to purchase quality, affordable major medical coverage on a temporary basis. Coverage is provided for physician services, surgery, outpatient and inpatient care.

How benefits are covered?

The benefit options for covered expenses for injury or sickness per insured person per benefit period.

Liberty STM pays benefits for each covered person in the following manner: First, you meet your deductible. Choose from four options: $250, $500, $1,000 or $2,500

Then Liberty STM pays 80% or 50% of the next $5,000 of covered expenses

After this, Liberty STM pays 100% of covered expenses up to your coverage period maximum of $2 million

What medical expenses are covered?

After satisfying the deductible amount you've selected, Liberty STM will pay the coinsurance you selected for covered expenses, up to a lifetime maximum of $2 million per insured person per coverage period.* Benefits are limited to the reasonable and customary charge for a covered expense in addition to any specific limits.

• Hospital Charges: average semi-private room rate, medical care and treatment
• Outpatient Hospital or Ambulatory Surgical Center charges
• Physician Services for treatment and diagnosis
• Surgeon Services in the hospital or ambulatory Surgical Center
• Assistant Surgeon Services: up to 20% of the surgeons benefit
• Anesthesia Services: up to 20% of the surgeons benefits
• Intensive Care: up to three times the average semi-private room rate
• X-Ray Exams, Laboratory tests and analysis
• X-Ray and Radioactive isotope therapy, anesthesia, oxygen, casts, splints, crutches, braces, surgical dressings, artificial limbs or eyes, rental of medical supplies
• Blood or blood derivatives and their administration
• Ambulance Services: $250 per emergency
• Organ Transplants: $50,000 lifetime maximum
• Acquired Immune Deficiency Syndrome (AIDS): **$10,000 lifetime maximum
• Mammography, pap smear and screens

* Benefits for gallbladder surgery are limited to a $2,500 lifetime maximum per insured person. Benefits for injury or disorders of the knees are limited to a $2,500 lifetime maximum per insured person.

** The AIDS maximum of $10,000 per Coverage Period does not apply to Policies/Certificates of Insurance issued to residents of Arizona, California, District of Columbia, Idaho, Missouri, North Carolina or North Dakota. In Kansas the maximum per Coverage Period is $75,000.

Benefits may vary by state.

What is a family deductible?

With a family deductible benefit your insured family is only required to satisfy a maximum of three (3) deductibles during the coverage period.

What is a usual, reasonable and customary charge?

A "usual, reasonable and customary charge" is the charge typically made by physicians or suppliers of medical services, medicines and supplies within a specific geographic area as determined by us.Usual, Reasonable and Customary means with respect to fees or charges, fees for medical services or supplies which are usually charged by the provider for the service or supply given and the average charge for the service or supply in the locality in which the service or supply is received; whichever is less, or with respect to treatment or medical services, treatment which is reasonable in relationship to the service or supply given and the severity of the condition. In reaching a determination as to what amount should be considered as Usual, Reasonable and Customary for services and supplies; we may use and subscribe to a standard industry reference source that collects data and makes it available to its member companies.

Do I need precertification?

Pre-admission certification prior to eligible inpatient hospitalization or surgery by the covered individual within 48 hours is required. This is not a guarantee of benefits. Failure to precertify will result in a benefit reduction of 50%. Call 1-800-367-9938 for precertification.

When does coverage terminate?

Coverage ends when the premium is not paid when due; you enter full-time active duty in the Armed Forces; you become eligible for Medicare; the elected coverage period expires; Standard Security Life Insurance Company of New York determines fraud or misrepresentation has been made in filing a claim for benefits; or a dependent ceases to be eligible; you cease to be a member of the association or the group master policy terminates..

Can I continue coverage?

If your need for temporary health insurance continues, you may apply for another Liberty STM plan. Your application is subject to eligibility, underwriting requirements and state availability of the coverage. The next coverage period is not continuous and any condition incurred during the last coverage period will be excluded as a pre-existing condition.

This website provides a brief description of the benefits, exclusions and other provisions of the policy Form SSL-STMP-1104. For complete listing, see the Policy/Certificate of Insurance. Benefits may vary by state. Liberty STM is not available in all states.
Association membership may be required in some jurisdictions.
2005 HPA, Inc. All rights reserved.
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