Simple STM – Frequently Asked Questions (FAQ’s)

 

Here are answers to the most frequently asked questions about our Short Term Medical plan.  Your questions, concerns, and feedback are important to us!  If you do not find your answers to your question(s) below, please contact us and we will be happy to assist.

 Q. What is Short Term Medical Insurance?

 A. Short Term Medical Insurance is an ideal type of medical insurance for those who are: unemployed, in between jobs, recent college graduates, in need of an alternative to COBRA. You will see that this coverage provides many features while maintaining a very competitive premium structure.

 

Q. Who is eligible for this coverage?

 A. You and your spouse under age 65 (and not eligible for Medicare) and you and your spouse's unmarried dependent children under age 19 (or under age 25 if a full-time student) who have a social security number and can answer "No" to the seven health questions on the application. Children age 19 and over should apply separately.

 

Child-only coverage is available for ages 2 through 18. The application must be completed and signed by the parent or legal guardian.

 

Q. How does this coverage work?

 A. The benefit options for covered expenses are per insured person per coverage period. First, you meet your deductible. Choose from four options: $250, $500, $1,000 or $2,500. Then we pay 80% of the next $5,000 of covered expenses.

After this, we pay 100% of covered expenses up to your lifetime maximum of $1 million per certificate.

 



 Q. Do I have the option to select my doctors, hospitals and medical providers?
 

A. Yes. You have the freedom to go to any of the doctors and hospitals of your choice. This plan is not an HMO or PPO.

 

Q. How long may I be insured under this plan?

 A. Simple STM is issued on a temporary need and expires at the end of the period applied for. If the need for temporary health insurance continues, you may apply for another new STM* coverage period. Your application is subject to the eligibility and underwriting requirements. Furthermore the coverage is not continuous. Any condition that incurred expense during the last coverage period will be treated as a Pre-Existing Condition, and excluded under the next coverage period. Applicants over the age of 64 are not eligible to re-apply for coverage.


*Only if an STM Plan is available in your resident state at that time; plan benefits, premium and features may vary. 

 

Q. What are the coverage limits under this plan?

 A. This plan pays a lifetime maximum of $1,000,000 per plan. Please refer to the Exclusions and Limitations section on this for all limitations.

This plan does not cover "pre-existing conditions". A pre-existing condition is any medical condition for which the covered person required medical treatment, consultation, or expense during the 5 years immediately prior to his/her coverage effective date or which provides symptoms within 5 years immediately prior to his/her effective date of Insurance. The pre-existing condition limitation may vary by state.

 

Q. Are pre-existing conditions covered?
 

A. This plan does not provide benefits for pre-existing conditions, work related conditions, and preventive care. If you or a dependent have an existing health condition, you may want to consult with your independent insurance agent prior to applying for or changing health/medical insurance. Insurance fraud is a crime. Any person who, with intent to defraud or knowingly facilitates a fraud against an insurer, submits an application or files a claim containing false, deceptive and/or incomplete information is subject to civil and criminal prosecution.

 

Q. Are there expenses not covered under this plan?
 

A. Yes, this plan is designed to protect you in the event of an illness or injury and is not meant to cover routine exams and preventive care. Short Term Medical is for temporary coverage only and therefore does not include some of the benefits a permanent health plan offers. Please refer to the Exclusions and Limitations section of this web site.

 

Q. Do I need precertification?

 A. 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 1-800-874-2378 for precertification.

 

Q. How can I apply for this plan?

 A. First, make sure you do not live in a state where the Plan is not available. Next look up the rates that apply to you based on your gender and zip code. Then, complete the application, e-sign it, and send payment to the administrator along with your initial premium payment to the address below.
 

Mail and make check payable to:

Simple STM
P.O. Box 1086
Janesville, WI 53547-1086

 

Q. What should I do if I cannot download and/or print the application?
 

A. Contact your agent on this website.  She/He will be able to send you a brochure, rate, and application in the mail.

 

Q. Can I get a refund of my premium if I am not satisfied with this plan?

 A. Once you receive your Certificate of Insurance, carefully review all information. If you are not satisfied for any reason, return the Certificate of Insurance (within 10 days of receipt) with your written request for cancellation to SAS Insurance Development. Coverage will be cancelled as of the effective date and you'll receive a full premium refund (minus admin fees and dues), no questions asked.

 

SAS Insurance Development

PO Box 1086

Janesville, WI  53545

 

Q. How is coverage billed?
 

A. After submitting your enrollment form with first month's premium, you will then be billed monthly or you can choose to prepay. You indicate on your enrollment form how you wish to pay for your coverage. You may elect to be billed for the monthly premiums (plus the administration fee), OR you can select one of the other two payment methods: (1) Automatic Pre-authorized Bank Withdrawal; or (2) Credit Card – MasterCard and Visa are accepted.

 

Q. When does my coverage begin?
 

A. The insurance can be effective as early as 12:01 a.m. the next day after the transmission date. However, the applicant can choose a later effective date not to exceed 60 days from transmission date. Coverage ends on expiration date listed in your coverage document.

 

Q. Who do I call for policyholder services?
 

A. The plan's administrator's are SAS Insurance Development (SASid) and International Funding Ltd. (IFL). 

SASid provides the following administration for Simple STM:

  • Policyholder services and customer support

  • Policyholder Billing

  • Agent Services, marketing, and commission

 

For Policyholder services call 1-800-279-2290.  Fax number for SASid is 608-755-7955.  Email is stmdept@sasid.com

 

IFL provides claims administration for Simple STM.

 

For claims services, please call 1-888-516-7667.

 

Q. Can I change my deductible?

 

A. No, Deductible changes cannot be made after the policy has been issued.

 

Q. Can I add additional family members?

 

A. No, to add additional family members you need to have the new family members apply on a separate policy.

 

Q. Can I change the effective date?

 

A. No, once the policy has been issued you cannot change the effective date.

 

Q. If my age changes after coverage begins will the rates change?

 

A. Your rates will not change.

 

Q. Are there co-pay’s with this plan?

 

A. There are no co-pays with this plan.  The out of pocket expenses consist of deductibles and coinsurance.

 

Q. How long may I purchase coverage?

 

A. The minimum amount of days you can purchase is 30.  You may purchase coverage for up to 6 months.  After the 6 months you may apply for a new short term medical plan.

 

Q. What is the difference from monthly payment option compared to single payment option?

 

A. Month-to-month coverage is available for persons who do not know how long they will need coverage.  Coverage is provided month-to-month until you terminate coverage (written request) or you reach the 6 month maximum coverage.

 

Q. After my coverage ends, may I apply again for additional months?

 

A. Simple STM plan is not renewable.

 

However, if your temporary need continues beyond your policy period, you may apply for a new plan under the following circumstances: 

• No claims were incurred under a previous Short Term Medical plan.

• There has been no significant change in your health.

Any previous or current health condition or symptom will be considered a pre-existing medical condition that will not be covered under a new plan. There is no continuous coverage between plans -- therefore your new plan will not provide benefits for any condition or symptom which began during a previous plan. In addition, no benefits are available for any period in which you are not covered by a Short Term Medical plan.

 

To obtain an additional plan, you must complete a new enrollment form. If the enrollment form is approved, a new plan will be issued.

 

Q. Will routine check ups be covered under this plan?

 

A. No, short term medical does not provide coverage for non-medically necessary situations.  Short term medical is designed to protect you from future unforeseen accidents and illnesses.

 

Q. Are Short Term Medical plans affected by the Federal Health Insurance Portability and Accountability Act (HIPAA) of 1996?

 

A. No. Under HIPAA, short term limited duration policies are generally exempt from this legislation. This means that when issuing a Short Term Medical policy, insurance carriers do not have to: guarantee renewability, guarantee issue or waive the pre-existing condition limitation for federally eligible individuals.*

 

Q. Is a Short Term Medical plan considered "creditable coverage" under HIPAA?

 

A. Under HIPAA, Short Term Medical coverage is generally considered creditable coverage to help satisfy any pre-existing condition period.* Previous creditable coverage includes: 

  • A group health plan

  • Health insurance coverage

  • Part A or Part B of title XVIII of the Social Security Act (Medicare)

  • Title XIX of the Social Security Act, other than coverage consisting solely of benefits under section 1928 (Medicaid)

  • Chapter 55 of title 10, United States Code (Champus)

  • A medical care program of the Indian Health Service or of a tribal organization

  • A state health benefits risk pool

  • A health plan offered under chapter 89 of title 5, United States code (Federal Employee Health Benefit Plan)

  • A public health plan (as defined in regulations)

  • A health benefit plan under section 5(e) of the Peace Corps Act

 * State reform legislation may vary; consult your state for specific rights and requirements.