Plan Highlights

• Important Short Term Health Insurance Information

• What is Short Term Health Insurance?

• Short Term Health Insurance Eligibility Requirements

• Child Only Coverage

• Coverage Effective Date

• Coverage Termination Date

• Extension of Benefits After Termination

• Renewability

• Payment Options & Methods

• Money Back Guarantee

Important Information

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 changing or purchasing health/medical insurance coverage

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.

What is Short Term Health Insurance?

According to a 09/30/2002 U.S. Department of Commerce press release, 41.2 million Americans are uninsured.  Don’t risk being a statistic –  medical treatment costs for a sickness or injury could be financially devastating!

American Health Shield – Short Term Health Insurance is a quality, affordable plan of Health insurance designed specifically for healthy people who are temporarily without health insurance.  Coverage can become effective as early as tomorrow, be purchased for periods as short as 30 days or up to 180 days, and paid for in one single payment or easy monthly installments.

Ideal protection for persons:

• Between jobs, laid off, on strike
• Attending school or recently graduated
• Employed part-time or temporarily
• Waiting for permanent health insurance to begin
• Temporarily without health insurance for most any reason

American Health Shield – Short Term Medical is not an HMO or PPO plan.  In the event of a sickness or injury, an insured person may receive treatment from any licensed healthcare provider or facility anywhere in the U.S.

Eligibility Requirements

Who is eligible to apply for the American Health Shield – Short Term Health Insurance:

• You and your spouse, up to age 64 and 11 months, and your unmarried dependent children between age 15 days and age 19 (23, if a full-time student) that live with you.

To be considered for coverage, persons listed on the application form must:

• live in a state where this plan of insurance is available. P.O. Boxes will NOT be accepted as a permanent residence address.  If you apply using a P.O. Box for mailing purpose, you must contact the Short Term Medical department toll-free at 1-800-753-1000 (Mon-Fri 8:30 a.m. to 5:00 p.m. EST) with your actual address.;
• not be covered by major medical, group health, hospital, governmental, or other medical insurance coverage that will not terminate prior to the Effective Date of this plan;
• not be pregnant or the expectant father of an unborn child;
• not have been declined for insurance due to health reasons or have received consultation or treatment (within the past 5 years) for any condition identified on the application form;
• be a US citizen and not traveling outside the U.S.;
• not participate in hazardous activities or sports.

IMPORTANT: Any false statement, material misstatement or omission of information on the application form will be considered a misrepresentation and may be the basis of claim denial or later rescission of coverage issued on the basis of the information given. Such claim denial or rescission and termination of coverage will apply to the Named Insured and his/her covered Dependents without liability to The Standard Security Life Insurance Company.

Child only coverage is available with the American Health Shield.  If applying for Child Only Coverage, please read the following instructions.  A policy will NOT be issued if these instructions are not followed.

1. Apply using the information of your Child as the primary applicant.
2. If you are applying for more than one child, list the additional children as dependants.
3. The application must be signed by the parent or guardian and you must state your relationship to the child with your signature.
4. If applying by mail or fax, complete the application online or download the application. Mail a copy of the application along with your payment information to: C.B.P.I. P.O. BOX 20594 TAMPA, FL 33622-0594 or Fax to: (727) 799-9093.
5. If applying by online by credit card, you must still mail or fax a copy of the application to the above address. 

Payment Options & Methods

American Health Shield - Short Term Health Insurance let’s you choose the payment option (single or monthly payment) and payment method (personal check, money order, or credit card) 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 check or money order, you must mail your completed application form and initial payment to The Standard Security Life Insurance Company.

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 select and pay for the Benefit Period that best suits your needs: 30 days, 60 days, 90 days, 120 days, 150 days, or 180 days.

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 Benefit Period expires, simply stop making monthly payments and your coverage will terminate at the end of the 30 day period you last made payment for.

Check or Money Order:  You will receive payment coupons with your Policy or Certificate.  The 1^st payment coupon will reflect a credit equal to your initial payment.  Subsequent monthly payments, must be received by The Standard Security Life Insurance Company on or before the payment due dates shown on payment coupons.

Credit Card:  Your initial payment and subsequent monthly payments will be automatically debited (on or immediately following the payment due dates) from the MasterCard or VISA you identified on the Payment By Credit Card Authorization form.  If your wish to discontinue coverage before your Benefit Period expires, simply mail or fax your written request for termination to The Standard Security Life Insurance Company and we will discontinue future credit card debits.  Note - 5 days advance written notice is required to ensure future credit card debits are discontinued.

Coverage Effective Date

If you submit the application form and initial payment via:

Internet or facsimile, the earliest date that coverage can begin (if approved by The Standard Security Life Insurance Company) is 12:01 a.m. on the day after The Standard Security Life Insurance Company receives the completed application form and valid payment by credit card information.  A later effective date may be requested, but no more than 30 days following the application date.  Note - payment must be made by MasterCard or VISA.  If submitting your completed application by fax, the fax number is: (727) 799-9093.

U.S. Mail, the earliest date that coverage can begin (if approved by The Standard Security Life Insurance Company) is 12:01 a.m. on the day after the postmark date stamped by the U.S.P.S. on the envelope in which The Standard Security Life Insurance Company 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 by The Standard Security Life Insurance Company.  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 The Standard Security Life Insurance Company 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 The Standard Security Life Insurance Company’s acceptance of the submitted application form and your initial payment for the American Health Shield – Short Term Medical.

Coverage Termination Date

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. 

Renewability

The American Health Shield - Short Term Health Insurance 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 by The Standard Security Life Insurance Company, 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 The Standard Security Life Insurance Company issue successive Benefit Periods totaling more than 360 days.  

Money Back Guarantee

Immediately following The Standard Security Life Insurance Company’s 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 American Health Shield – Short Term Health insurance plan.  If you are not satisfied that this coverage will meet your insurance needs, simply return the Policy or Certificate (with your written request for cancellation) within 10 days after you receive it.  Coverage will be canceled as of the effective date and you will receive a full refund of your initial payment and the administrative fee – no questions asked!