Temporary Medical Insurance - What medical expenses are covered?

• Services of licensed Physicians, Registered Nurses, Surgeons, Assistant Surgeon, and Anesthetist
• Prescription drugs up to $500 and injections
• X-rays and laboratory tests
• Ground ambulance service
• Pre-admission testing
• Hospital emergency room services
• Hospital services including outpatient department or ambulatory surgical facility services
• Hospital room and board and general nursing care while confined in a semi-private room
• Intensive care
• Chemotherapy and radiation therapy
• Intensive, cardiac, burn or other specialized care unit
• Physiotherapy
• Braces and appliances

Optional Benefit - UCSA Benefit Package $12.50/Month
The UCSA provides members with numerous quality benefits that include access to this short term medical insurance and money saving discounts for: Retail cost of prescription drugs; Dental services; Eye and vision care; Chiropractic services; Vitamin & Nutritional supplements; 24 Hour Nurse Help Line; Accudiet.com, an on-line interactive exercise and diet program; National Health Survey, discounts for Health & Lifestyle Assessment. The UCSA membership fee is $12.50 per month. A complete UCSA fulfillment kit will be mailed shortly following your enrollment.

(The UCSA is not affiliated with The Standard Security Life Insurance Company.)

Temporary Medical Insurance Coverage Termination:
Coverage will terminate on the earlier of: 1.) the Benefit Period termination date; 2.) the last day of the period through which the plan cost is paid; 3.) the date the Insured Person attains age 65 or becomes Medicare eligible; or 4.) if a dependent child, the date on which his/her eligibility terminates.

Temporary Medical Insurance Extension of Coverage 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: 1.) When Hospital Confined on the Termination Date, not to exceed 90 days after the Termination Date; or 2.) 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. The total payments made in respect of the Insured for such condition both before and after the Termination Date will never exceed the Maximum Benefit. After this "Extension of Benefits After Termination" provision has been exhausted, all benefits cease to exist, and under no circumstances will further payments be made.

This is only a general summary of the features of the Liberty STM Medical Plan. Complete details may be found in the Master Policy. Benefits and policy provisions may vary by state.

Eligibility and Effective Date of Coverage:

Short Term Health Insurance Eligibility:
You and your spouse (to 64 years and 11 months) who are members of UCSA* (membership in the UCSA - United Consumer Savings Association is included in the cost of insurance) and your unmarried dependent children (between age 15 days to 19 or 23 if a full-time student) that live with you may apply for coverage. To be considered for coverage, proposed Insureds must not: a.) have other hospital, major medical, health, governmental, or medical insurance coverage in force that will not terminate prior to the Effective Date of the plan; b.) be pregnant or the expectant father of an unborn child on the Effective Date; c.) have been declined for insurance due to health reasons; or d.) have received consultation or treatment, within the past five years, for any conditions identified on the application. 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 15 days old. The application must be completed and signed by the parent or legal guardian.

* Except in the states of CO,CT,GA,ID,IN,KS,MD,MN,NV,ND,OR,SD,WA where membership is optional.

Effective Date of Coverage:
The temporary health 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 termination date listed in your policy.

If payment is by credit card, the hard copy application does not have to be mailed to HPA, but the applicant should print a hard copy for his/her records. The double-keying of the applicant’s name for credit card payment suffices as a signature under e-commerce law.

If payment is by automatic check withdrawal, the hard copy of the application does not have to be mailed to HPA. However, the initial payment must be mailed in by check along with a voided check. Please note social security number on initial payment check. The initial payment must be received within 10 days from the transmission date or coverage is void.

Coverage under this policy will end on the termination date listed in the Schedule of Benefits. Temporary health insurance coverage will be considered void is payment is not received.