Agile Help CenterAmerican Financial Security Life Insurance Company
Frequently Asked Questions
Why Short-Term Medical (STM)?
Short-Term Medical pays benefits like a major medical insurance plan, but for a predetermined length of time. You can select from a wide range of deductible and coinsurance options to tailor a plan to fit their lifestyle needs and budget.
How do members figure out what coverage they need and enroll?
Consider the benefit period and choose payment method:
- Single Payment
This option is ideal if it is known exactly how many days the coverage is needed. The minimum number of days that members may apply for coverage is 30 days; the maximum is 180 days. Payment via all major credit cards or bank draft is accepted.
- Monthly Payment
This plan gives members the flexibility to continue coverage for as long as it is needed and allows them to discontinue the plan once their temporary need ends. Members can select coverage periods of up to 36 months. Payment via all major credit cards or bank draft is accepted.
Consider lifestyle needs and budget and choose one from each of the following:
- Deductible:$1,000, $2,500, $5,000
The selected deductible must be paid by each Covered Person before Coinsurance benefits are payable. After 3 individuals meet their deductible, the deductible is deemed satisfied for any remaining covered individuals.
- Coinsurance Percentage: 80/20
The Coinsurance Percentage represents the percent of covered eligible expenses that we pay and that members pay after the deductible has been satisfied up to the Out Of Pocket Maximum.
- Out of Pocket Maximum: $2,000 or $4,000
Once members reach their Out of Pocket Maximum Amount selected, we pay 100% of up to the Coverage Period Maximum Benefit.
What medical expenses are covered?
The following benefits are for the Insured and each Covered Dependent subject to the plan Deductible, Coinsurance Percentage, Out Of Pocket Maximum, Additional Deductibles, and Coverage Period Maximum Benefit. Benefits are limited to Maximum Allowable Expense for each Covered Eligible Expense, in addition to any specific limits stated in the policy.
- Preventive / Wellness Care
- Doctor's office consultation/Urgent Care visits
- Organ and Tissue transplants
- Inpatient prescription drugs
- Physical, Occupational and Speech Therapy
- Ambulance Transportation
- Outpatient Hospital or Emergency Room Care
- Inpatient Room & Board, including Intensive Care
- Outpatient Miscellaneous Medical Services, doctors medical care and treatment performed in a hospital
- Home Health Care
- Extended Care Facility
- Outpatient Surgical Facility
- Surgeon services in the hospital or outpatient surgical facility
How does Usual, Reasonable and Customary Fees affect my benefits?
Usual, Reasonable and Customary Amount - means the lesser of:
- The actual charge; or
- What the provider would accept for the same service or supply in the absence of insurance; or
- The amount based on one or more factors such as:
- The amount of resources expended to deliver the service or supply; or
- The amount charged for the same or comparable service or supply in a community similar to where the service or supply is furnished; or
- The costs incurred by providers in a community similar to where the service or supply is furnished and the amount by which the service or supply is commonly marked up by providers; or
- Charging protocols and billing practices generally accepted by the medical community or specialty groups, including charging protocols and billing practices related to Medicare; or
- Inflation trends by geographic region; or
- The negotiated rate; or
- For facility based charges, 150% of the Centers for Medicare and Medicaid Services Prospective Payment System amount unadjusted for geographic locality.
All benefits are limited to Usual, Reasonable and Customary Fees.
Usual, Reasonable and Customary Fee definition may vary by state.
What if members change their minds after the purchase of STM coverage?
If not 100% satisfied with coverage and members have not already used any of the insurance benefits, they may return the certification to us within 10 days of receipt. Coverage will be cancelled as of the effective date and the plan cost will be returned. No questions asked!
What is the Pre-Existing Conditions Limitation?
Pre-Existing Condition - means a condition:
- For which medical advice, diagnosis, care, or treatment (includes receiving services and supplies, Consultations, diagnostic tests or prescription medicines) was recommended or received from a Physician within the 36* months immediately preceding the Covered Person's Effective Date; or
- That had manifested itself in such a manner that would have caused an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services and supplies, Consultations, diagnostic tests or prescription medicines) within the 36* months immediately preceding such person's Effective Date.
*varies by state
Who is eligible to apply for this insurance?
AdvantHealth STM is available to members and their spouses, who are between 18 and 64 years old and their dependent unmarried children under 26 years old; and can answer "No" to all of the questions in the application for insurance. Child-only coverage is available for ages 2-17.
When does the coverage terminate?
A Member's coverage under the Policy will terminate on the earliest of the following dates:
- The last day for which Your premium has been paid;
- The date You become a full-time member of the Armed Forces of any country if the period of active duty is to exceed 31 days;
- The date the Policy terminates;
- The date You reach age 65 or become effective under Medicare;
- The date You cease to be a Member of the Policyholder;
- The end of the Coverage Period;
- The date You die;
- The date You reach the Coverage Period Maximum Benefit Amount;
- Your Effective Date in the event of any fraud or intentional misrepresentation of material fact on Your part in obtaining coverage under the Policy; or
- The next premium due date in the event of any fraud or intentional misrepresentation of material fact on Your part or the part of Your representative in filing a claim.
At the death of the Member, all rights and privileges as a Member under the Policy will transfer to the surviving Dependent Spouse. The Dependent Spouse will then be considered the Member instead of a Dependent. In the event the Dependent Spouse remarries, coverage under the Policy for the Dependent Spouse and Dependent Child(ren), if any, will end on the first day of the month following the date of that marriage. If there is no surviving Dependent Spouse, or at the death of a surviving Dependent Spouse, all rights and privileges as a Member under the Policy will transfer to each Dependent child, if any, and he or she will be considered the Member instead of a Dependent.
Insurance on a Dependent will terminate on the date such Dependent ceases to qualify as a Dependent. Except as Provided in the Continuation of Coverage provision, Your Dependent insurance will automatically terminate on the Earliest of the following dates:
- The date Your insurance terminates;
- The last day for which Your Dependent premium has been paid;
- In the case of Your Dependent child, the date he or she no longer qualifies as a Dependent by attaining the limiting age (see definition of “Dependent”).
- In the case of Your Dependent child, the first day following the Dependent's marriage;
- The date Your Dependent enters active duty with the armed services of any country if the period of active duty is to exceed 31 days;
- In the case of a Dependent Spouse, the first day following the date of the final decree of dissolution of marriage; or
- The date a Covered Person reaches the Coverage Period Maximum Benefit Amount.