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NC Short Term Health Insurance

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Who needs this type of coverage?

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

Who qualifies for STM?

Short-Term Medical is offered to members of Communicating for America*, their spouses under 65 and eligible dependents under age 26 who have a social security number and can answer 'no' to the health questions on the application. Child-only coverage is available for ages 2 through 18.
*CA membership does not apply to residents in ID, IN, KS, LA, ME, MD, MN, MT, ND, NH, NV, or SD

When does my coverage start?

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 termination date listed in your policy. All coverage is subject to approval of your application and payment of the first premium.

How are benefits covered?

Secure STM pays benefits for each covered person in the following manner (subject to specific benefit limits):
1. First, you meet the deductible you selected. Choose from four options: $1,000, $2,500 or $5,000 
2. Next, the Secure STM plan pays at the coinsurance level you selected, 80% or 50% of the next $10,000 of covered expenses.
3. After this, Secure STM pays 100% of covered expenses up to your coverage period maximum of $2 million.

What is a family deductible?

When 3 covered persons each satisfy their deductible, the deductibles for any remaining covered persons are deemed satisfied for the remainder of the coverage period.

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

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

How long will STM coverage last?

Secure STM is specifically designed to fill a temporary insurance need. Coverage stops at the end of the period for which you apply. Depending on the payment option you select, coverage can continue for one to six months.

What medical expenses are covered*?

All of the following benefits are subject to the plan deductible and coinsurance. Benefits are limited to the Usual, Customary and Reasonable charge for each covered expense, in addition to any specific limits stated in your policy.

• Hospital charges paid at the 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 primary surgeons benefit
• Anesthesia services up to 20% of the primary surgeons benefit
• 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
• Ground ambulance services up to $500 per occurrence
• Air ambulance services up to $1,000 per occurrence
• Gallbladder surgery
• Injury or disorders of the knees
• Inpatient prescription drugs
• Organ, tissue or bone marrow transplants up to $150,000 coverage period maximum
• Acquired Immune Deficiency Syndrome (AIDS) up to $10,000 coverage period maximum**
• Mammography, Pap smear and screens

*Benefits may vary by state. 
** The AIDS maximum of $10,000 per coverage period does not apply to policies/certificates issued to residents of AZ, CA, CO, DC, ID, IN, MD, ME, MO, NH, NC or ND. The maximum benefit in KS is $75,000 per coverage period.

Do I need pre-certification?

You must notify the pre-certification service 10 days prior to a non-emergency hospital admission or surgery and 48 hours (or as soon as reasonably possible) following an emergency admission to the hospital for pre-certification of admission. Failure to pre-certify will result in a benefit reduction of 50%. Pre-certification is not a guarantee of benefits.

What are my payment options?

Choose from two convenient payment options.

• You can pay for coverage in monthly payments for up to 6 months at a time. We accept monthly payments by check, money order, credit card or automatic bank withdrawal. If you select this option, and your need for insurance ends before your coverage period ends, you can cancel at any time throughwritten notification to our Policy Service Department.
• The single payment option is ideal if you know the exact number of days coverage is needed. This option has aspecial reduced rate and you only pay for the coverage you need through one, single payment. You can pay in full for any number of days, from a minimum of 30 days to a maximum of 180 days of coverage by check, money order or credit card or ACH online.

Your subsequent monthly credit card/ach premium deductions will occur based upon the effective date of coverage. If your coverage effective date is the 1st - 14th, your premium will be deducted on the 1st of the month. If your coverage effective date is the 15th - 31st, your premium will be deducted on the 15th of the month.

What services are not covered?

Following is a partial list of services or charges not covered by Secure STM:**

• Any services that are not medically necessary, as defined in the policy
• Eye exams, eyeglasses, hearing aids
• Dental or orthodontic services
• Prescription or legend drugs and medications
• Treatment of foot conditions
• Conditions resulting from an act of war
• Maternity and newborn treatment prior to discharge, any infertility treatments or sterilization treatments
• Spinal manipulation or adjustment
• Services performed by family members or for which a charge would otherwise not be incurred
• Medical care received outside of the United States, Canada or its possessions
• Services payable by Medicare or Worker’s Compensation coverage
• Cosmetic surgery, treatment for acne, hair loss or varicose veins
• Transplant services to the transplant donor
• Routine physical exams and tests, preventive care and immunizations
• Experimental or investigational services
• Learning disorders, attention deficit disorder, hyperactivity or autism
• Mental or nervous disorders, depression or suicide attempt
• Alcohol or drug dependency and disorders
• Obesity treatments
• Sleep disorders
• Participation in school or organized competitive sports or any high risk sport

**The limitations and exclusions may vary by state. Please see the Policy/Certificate of Insurance for detailed information about these and other plan limitations and exclusions.

Is there a pre-existing condition limitation?

Secure STM will not provide benefits for any loss caused by or resulting from a pre-existing condition. A pre-existing condition is any medical condition or sickness for which medical advice, care, diagnosis, treatment, consultation or medication was recommended or received from a doctor within five years immediately preceding the covered persons effective date of coverage; or symptoms existed within the 5-years immediately prior to the covered persons effective date of coverage which would cause a reasonable person to seek diagnosis, care or treatment. The pre-existing condition limitation may vary by state.

*A NC Insurance Agency with offices in Boone, Elkin, Lenoir, Sparta, North Wilkesboro and West Jefferson, LifeStore Insurance is your independent insurance agency specializing in affordable North Carolina Insurance policies.