Simple Short Term Medical is designed to be an affordable way to protect you and your family from the high cost of unexpected illnesses and accidents.
Freedom to choose your own doctors and hospitals
$1 Million Lifetime Maximum Coverage
In-Hospital and Out-patient benefits
Physician Services – diagnosis and treatment
Surgery in a Hospital or Ambulatory Surgical Center
Intensive Care
X-Ray and Laboratory
Ambulance Services
Spinal Manipulation/Adjustment
Mammography, Pap smear and screens
*Benefits vary by state. Refer to your coverage document for specific terms and conditions.
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.
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.
Simple STM pays benefits based on the following diagram:
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.
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 policy expires; the elected coverage period expires; The
Insurance Company determines fraud or misrepresentation has been made in
filing a claim for benefits; or a dependent ceases to be eligible.
Exclusions & Limitations
This Short Term Medical insurance is a temporary plan for up to 180 days and it does not cover: preexisting conditions*; any services that are not medically necessary; Eye exams, eyeglasses, hearing aids and related surgeries; Dental or orthodontic services; Treatment of feet conditions; Conditions resulting from an act of war, suicide attempt or high-risk sports; Maternity and newborn treatment prior to discharge, any infertility treatments or sterilization treatments; Services performed by family members or for which a charge would otherwise not be incurred; Services payable by Medicare or Worker's Compensation coverage; Cosmetic surgery; Services for mental, nervous, alcohol or drug treatment; Routine physical exams and tests, preventive care and immunizations for children over age 16; Experimental or investigational services; Obesity treatments; Sleep disorders; Over-the counter-medications and prescription drugs; Certain surgeries during the first six months. This is not a complete list of the limitations and exclusions. Please see the detailed list in policy certificate you will receive when you purchase Short Term Medical Insurance.
Is there a pre-existing condition limitation?
Pre-existing conditions are not covered. This includes any condition or
complication that was treated or produced symptoms five years prior to
your Simple STM effective date.
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.
Child Only Directions
Child(ren) alone can apply and are to use the 0-24 premium rate (male or female, based on their gender) for the youngest child; and the per child rate for each of the child siblings to be insured. The minimum age for a child only coverage is 2 years old. The application must be completed and signed by the parent or legal guardian.
Payment Options & Methods
Simple STM - Short Term Medical let’s you choose the payment option (single or monthly payment) and payment method (automatic bank draft, credit card, or personal check) that’s most convenient for you. Additionally, once coverage commences, premium rates are guaranteed for the length of the Benefit Period! Note - If you prefer to make payment(s) by personal check or money order, you must mail your completed application form and initial payment.
Payment Options
Single Payment - If you know the exact length of time you’ll need this coverage and prefer to make one single payment for the entire Benefit Period, this payment option is ideal. Simply enter the exact total number of days you need coverage and pay for that Benefit Period (30 day minimum / 180 day maximum).
Monthly Payment - If you are unsure how long you’ll need this coverage or prefer the convenience of making monthly installment payments, this option is ideal. Each monthly payment is for 30 days of coverage, up to the 180 day maximum Benefit Period. If your need for this coverage ceases before your 180 day Benefit Period expires, simply send/fax a letter requesting cancelation.
Personal Check: You will receive payment coupons with your Policy or Certificate. The 1st payment coupon will reflect a credit equal to your initial payment. Subsequent monthly payments, must be received by SASid on or before the payment due dates shown on payment coupons.
Automatic Bank Draft or Credit Card: Your initial payment and subsequent monthly payments will be automatically debited (on or immediately following the payment due dates) from your bank account or your MasterCard / VISA that is identified on the Electronic Payment Authorization form. If you wish to discontinue coverage before your Benefit Period expires, simply mail or fax your written request for termination to and we will discontinue future automated electronic debits.
Note - 5 days advance written and signed notice from the Primary Insured is required to ensure future credit card debits are discontinued.
Mail or fax notice to:
Simple STM
PO Box 1086
Janesville, WI 53547-1086
FAX 608-755-7955
If you submit the application form and initial payment via:
Internet or facsimile, the earliest date that coverage can begin (if approved) is 12:01 a.m. on the day after receives the completed application form and valid electronic payment information. A later effective date may be requested, but no more than 30 days following the application date. Note - payment must be made by automatic bank draft or MasterCard / VISA.
U.S. Mail, the earliest date that coverage can begin (if approved) is 12:01 a.m. on the day after the postmark date stamped by the U.S.P.S. on the envelope in which receives the completed application form and payment for the total amount due. If the U.S.P.S. postmark date is not legible or present, the earliest date that coverage can begin is the day after the completed application form and payment for the correct plan cost are received. A later effective date may be requested, but no more than 30 days following the application date.
IMPORTANT – The coverage Effective Date is determined by administrator and will be shown in the Policy or Certificate that is issued. No agent or agency has the authority to bind, modify or issue coverage. Issuance of coverage is subject to carrier's acceptance of the submitted application form and your initial payment for the Simple STM – Short Term Medical.
Coverage will terminate on the earliest of the following dates:
The last day of the period through which the premium is paid; The date the Insured ceases to be eligible; or The Benefit Period expiration date.
Extension of Benefits after Termination
If an Insured incurs medical expenses after the Termination Date from a covered Injury or Sickness for which benefits were paid before the Termination Date, Covered Medical Expenses for such Injury or Sickness will continue to be paid as long as the condition continues:
When Hospital Confined on the Termination Date, not to exceed 90 days after the Termination Date.
When not Hospital Confined on the Termination Date, not to exceed 30 days after the Termination Date. The Insured Person must: a) have met his or her Deductible during the Benefit Period; and b) be being treated for complications of or follow-up treatment for an Injury or Sickness which commenced during the Benefit Period.
Note - Benefit payments for such condition both before and after the Termination Date are subject to all applicable benefit maximum limits. Once the "Extension of Benefits After Termination" provision has been exhausted, all benefits cease to exist, and under no circumstances will further payments be made.
Cancellation procedures for a monthly payment option:
A written statement must be faxed to our office and it needs to include:
Name ● Date of Birth ● Social Security Number ● Policy Number with Termination Date ● Signature
This must be faxed to 608-755-7955. Once the fax is received the policy will be canceled. To avoid being charged for another month we must receive the fax 5 days prior to the billing date. Your billing date is the date of your application. A letter confirming the cancellation will be mailed. A refund will be issued if the policy is within the 10-day free look. However, the fees are non-refundable. If the policy is beyond the 10-day free look, no refund is due.
Cancellation procedures for a single payment option:
A written statement must be faxed to our office and it needs to include:
Name ● Date of Birth w Social Security Number ● Policy Number w Termination Date ● Signature
This must be faxed to 608-755-7955. A refund will be issued if the policy is within the 10-day free look. However, the fees are non-refundable. If the policy is beyond the 10-day free look, no refund is due.
Simple STM - Short Term Medical is not renewable nor intended to be permanent coverage. Coverage will terminate upon expiration of your Benefit Period. However, you may be eligible to apply for another Benefit Period following the expiration of your previous Benefit Period. If a new Benefit Period is applied for and issued, there is no continuous coverage between any previous and current Benefit Period. Any condition or symptom which occurred under a previous Benefit Period may be treated as a pre-existing condition under a subsequent Benefit Period. Note – In no event will US Fire Insurance Company issue successive Benefit Periods totaling more than 360 days.
Immediately
following receipt and approval of your submitted application form,
a Policy or Certificate will be issued and mailed to your residence/home
address. Please read the Policy or Certificate carefully. It is
important to us that you understand and are satisfied with the
Simple STM – Short Term Medical insurance plan. If you are not
satisfied that this coverage will meet your insurance needs, simply
return the Policy or Certificate with your written and signed request
for cancellation within 10 days after you receive it. Coverage will be
canceled as of the effective date and you will receive a refund of
your initial premium payment – no questions asked!