Get your personalized quote

It’s easy, click here →

Underwritten by
United States Fire Insurance Company
Choice Advantage STM Plan 3 5K/20/15K/1M
$168.12/month

Overview

Cost breakdown

Monthly Premium

$128.14

Teladoc

$19.99

AFEUSA Association

$19.99

PEP Benefit
(one time payment)

$15.00

Initial total cost

$183.12

Benefits & coverage

Plan Type

PPO

Deductible

Individual: $5,000.00

Coinsurance

20% after deductible

Policy maximum benefit

$1,000,000.00

Policy term

6 months

HIPAA creditable coverage

Yes

Max out of pocket

$15,000.00

Application fee

$0.00

Out-of-network coverage

Yes

Office visit for primary doctor

$40 Copayment per Covered Person per visit or consultation Coinsurance is 100% of Eligible Expenses and is not subject to the Plan Deductible.

Outpatient Surgery Additional Deductible

$500 per Covered Person per Surgery for Surgery performed in an Outpatient Surgical Facility after which Plan Deductible and Coinsurance will apply. There is a maximum of 3 Outpatient Surgery Deductibles per Covered Person per Coverage Period. Surgeries in excess of the maximum number of Outpatient Surgery Deductibles will remain subject to the Plan Deductible and Coinsurance.

Emergency Room Additional Deductible

$500 per Covered Person per visit for use of emergency room in the event of Sickness or Injury after which the Plan Deductible and Coinsurance will apply. The Emergency Room Deductible is waived if the Covered Person is directly admitted as an Inpatient for further treatment after which the Plan Deductible and Coinsurance will apply

Advanced Diagnostic Studies Additional Deductible

$500 per Covered Person per occurrence for Advanced Diagnostic Studies in an Outpatient setting, such as PET, MRI, CAT scans, after which the Plan Deductible and Coinsurance will apply.

Advanced Diagnostic Studies Copayment

N/A

Out of Pocket Maximum Amount

Individual: $10,000.00

Does Out of Pocket Maximum Amount include deductible?

No

Waiting Period for Illnesses

5 days

Primary Care Physician (PCP) Required

No

Specialist Referrals Required

No

Periodic Health Exam

$50 Copayment per Covered Person for one annual Routine Physical Exam. Coinsurance is 100% of Eligible Expenses and is not subject to the Plan Deductible.

Periodic OB-GYN Exam

Yes

Well Baby Care

Yes

OB-GYN Exam Conditions

$50 Copayment per Covered Person for one annual Routine Physical Exam. Coinsurance is 100% of Eligible Expenses and is not subject to the Plan Deductible.

Emergency Room

Subject to Additional Deductible shown above, then subject to Deductible and Coinsurance for each emergency room visit, including professional and facility services. (This includes the emergency room physician charge, 24 hours surveillance and all miscellaneous medical charges)

Outpatient Surgery

Outpatient Surgery: Subject to Additional Deductible shown above, then subject to Deductible and Coinsurance.
Outpatient Miscellaneous Hospital Expenses: Payable for miscellaneous Outpatient Hospital expenses, excluding Outpatient Surgery.

Hospitalization

Average Standard Room Rate: Not to exceed Average Standard room rate.
Intensive Care or Critical Care Unit: Payable for each day of confinement in an Intensive Care or Critical Care Unit.
Inpatient Doctor Visits: Subject to Deductible and Coinsurance

Surgeon

Subject to Deductible and Coinsurance

Assistant Surgeon and Surgical Assistant

Subject to Deductible and Coinsurance

Administration of Anesthetics

Subject to Deductible and Coinsurance

Routine Child Health Care

Immunizations are not subject to the Plan Deductible.

Extended Care Facility

Not to exceed $150 per day. There is a maximum limit of 30 days per Covered Person per Coverage Period.

Home Health Care

Not to exceed $50 per visit. There is a limit of 1 visit per day not to exceed a maximum 30 Home Health Care visits per Covered Person per Coverage Period.

Hospice Care

Not to exceed $2,500 per Covered Person per Coverage Period.

Ambulance (Injury or Sickness)

Not to exceed $250 per transport.

Physical, Occupational and Speech Therapy

Not to exceed $50 per day and 20 visits combined per Covered Person per Coverage Period.

Organ or Tissue Transplants

Not to exceed $50,000 per Covered Person per Coverage Period.

Acquired Immune Deficiency Syndrome (AIDS) Human Immunodeficiency Virus (HIV)

Not to exceed $10,000 per Covered Person per Coverage Period.

Temporomandibular Joint Disorder (TMJ)

Not to exceed $3,500 per Covered Person per Coverage Period.

Kidney Stones

Not to exceed $1,500 per Covered Person per Coverage Period.

Appendectomy

Not to exceed $2,500 per Covered Person per Coverage Period.

Joint or Tendon Surgery

Not to exceed $2,500 per Covered Person per Coverage Period.

Knee Injury or Disorders

Not to exceed $2,500 per Covered Person per Coverage Period for both left knee and right knee.

Gallbladder Surgery

Not to exceed $2,500 per Covered Person per Coverage Period.

Mental Disorders - Inpatient

Not to exceed $100 per day. There is a maximum limit of 31 days per Covered Person per Coverage Period.

Mental Disorders - Outpatient

Not to exceed $50 per visit. There is a maximum limit of 10 visits per Covered Person per Coverage Period.

Substance Use - Inpatient

Not to exceed $100 per day. There is a maximum limit of 31 days per Covered Person per Coverage Period.

Substance Use - Outpatient

Not to exceed $50 per visit. There is a maximum limit of 10 visits per Covered Person per Coverage Period.

Physician network

One of the popular aspects of short term medical insurance plans is they do not confine you to a specific network. In other types of insurance plans, if a member seeks services outside of the network their cost-share responsibility will be higher or they will have to pay the full claim themselves. The only downside to the open network allowance is that you may get balance billed To avoid balance billing, see a network provider. Your network for this plan is the PHCS (Private Healthcare Systems), which is part of the MultiPlan Network, providing access to almost 900,000 healthcare providers under contract.

This plan's network is the Multiplan PHCS network.

 

 

Please note: PHCS Network applies to outpatient physicians only.  
Facility Charges (Inpatient and Outpatient) benefit amounts are payable at 150% of the Medicare Rate.

The MultiPlan PHCS Practitioner & Ancillary Only network is not affiliated with United States Fire Insurance Company and the insurance benefits provided are not dependent on the use of this network. For more information about this network please visit Multiplan.com.

Covered expenses

The following benefits are payable under the Certificate after a Covered Person incurs charges for Eligible Expenses in excess of any applicable Additional Deductibles and the Plan Deductible and/or Copayment, unless otherwise specified. Benefits will be paid at the Coinsurance amount shown in the Schedule of Benefits. Once the Out of Pocket Maximum amount is reached, the Coinsurance amount for the remainder of the Coverage Period is 100%. All benefits payable are subject to the Maximum Allowable Expense and the Overall Coverage Period Maximum Benefit. Your Schedule of Benefits shows Your Plan Deductible, Additional Deductibles, if any, Copayment, the Company’s Coinsurance amount, the Out of Pocket Maximum amount and the Overall Coverage Period Maximum Benefit. Reimbursement is also subject to any benefit limitations shown in the Schedule of Benefits. Eligible Expenses for the same treatment or service that are applicable to more than one benefit limitation shown in the Schedule of Benefits will be applied toward all applicable limitations.

  • Preventive / Wellness Care (This benefit is not subject to the Plan Deductible or Coinsurance Percentage)
  • Organ and Tissue transplants
  • Outpatient and Inpatient Treatment for Mental and Nervous Disorders
  • Physical Therapy maximum benefit $50 per visit per day for a maximum of 20 visits
  • Ambulance Transportation
  • Inpatient prescription drugs
  • Doctor's office consultation in excess of a $25 or $40 co-pay. This benefit is not subject to the Plan Deductible or Coinsurance Percentage
  • Outpatient Hospital or Emergency Room Care
  • Inpatient Room & Board, including Intensive Care
  • Miscellaneous Medical Services, doctors medical care and treatment performed in a hospital
  • Home Health Care benefit $50 per visit for a maximum of 1 visit per day and 30 Home Health Care visits
  • Surgeon services in the hospital or outpatient surgical facility
  • Assistant Surgeon services up to 20% of surgeons benefit
  • Hospice Care

Note: This is a brief description of the plan benefits, which may vary by state.

Limitations & exclusions

Loss caused by, contributed to or resulting from the following is excluded or otherwise limited as specified:

  1. Pre-existing conditions:
    1. Charges resulting directly or indirectly from a condition for which a Covered Person received medical treatment, diagnosis, care or advice, including diagnostic tests or medications, within the 24 month period immediately preceding such person’s Certificate Effective Date of coverage under the Policy.
    2. Pre-Existing Conditions includes conditions that produced any symptoms which would have caused a reasonable prudent person to seek diagnosis, care or treatment within the 24 month period immediately prior to the Covered Person’s Certificate Effective Date of coverage under the Policy.
  2. Waiting Period:
    1. Covered Persons will only be entitled to receive benefits for Sicknesses that begin, by occurrence of symptoms and/or receipt of treatment, more than 5 days following the Covered Person’s Certificate Effective Date of coverage under the Policy.
    2. Covered Persons will only be entitled to receive benefits for Cancer that begins, by occurrence of symptoms or receipt of treatment more than 30 days following the Covered Person’s Certificate Effective Date of coverage under the Policy.
  3. Charges during the first 6 months after the Certificate Effective Date of coverage for a Covered Person for the following:
    1. Total or partial hysterectomy, unless it is Medically Necessary due to a diagnosis of carcinoma;
    2. Tonsillectomy;
    3. Adenoidectomy;
    4. Repair of deviated nasal septum or any type of surgery involving the sinus;
    5. Myringotomy;
    6. Tympanotomy;
    7. Herniorraphy
  4. The benefits payable for the following conditions or procedures are limited to the specified amounts shown in the Schedule of Benefits:
    1. Kidney Stones
    2. Appendectomy
    3. Joint or tendon Surgery
    4. Knee Injury or disorder
    5. Acquired Immune Deficiency Syndrome (AIDS)/Human Immuno-deficiency Virus (HIV)
    6. Gallbladder Surgery
  5. Charges which are not incurred by a Covered Person during his/her Coverage Period.
  6. Charges which exceed any limits or limitations specified in this Certificate, including the Schedule of Benefits.
  7. Charges for services of supplies in excess of the Maximum Allowable Expense
  8. Charges for services or supplies which are not administered by or under the supervision of a Doctor.
  9. Mental, emotional or nervous disorders or counseling of any type, unless specifically covered as an Eligible Expense.
  10. Marital counseling or social counseling.
  11. Treatment for Substance Abuse, unless specifically covered as an Eligible Expense.
  12. Outpatient Prescription Drugs, unless specifically covered as an Eligible Expense. This does not include those administered by a Doctor in an Inpatient or Outpatient setting covered as an Eligible Expense.
  13. Medications, vitamins, and mineral or food supplements including pre-natal vitamins, or any over-the-counter medicines, whether or not ordered by a Doctor.
  14. Any drug, treatment or procedure that either promotes or prevents conception including but not limited to: artificial insemination, treatment for infertility or impotency, sterilization or reversal of sterilization.
  15. Any drug, treatment or procedure that corrects impotency or non-organic sexual dysfunction.
  16. Modifications of the physical body in order to improve the psychological, mental or emotional well-being of the Covered Person, such as sex-change surgery.
  17. Cosmetic Treatment, except for reconstructive surgery where expressly covered as an Eligible Expense
  18. Weight modification or surgical treatment of obesity.
  19. Eye surgery, including LASIK, when the primary purpose is to correct nearsightedness, farsightedness or astigmatism.
  20. Dental Expenses, except as necessary to restore or replace sound and natural teeth lost or damaged as a result of an Injury. The Injury must be severe enough that the contact with the Doctor occurs within seventy-two (72) hours of the Accident, unless extenuating circumstances exist due to the severity of the Injury that prevent you from contacting the Doctor.
  21. Expenses incurred in the treatment by any method for jaw joint problems including temporomandibular joint dysfunction (TMJ), TMJ pain syndromes, craniomandibular disorders, myofacial pain dysfunction or other conditions of the joint linking the jaw bone and skull and the complex of muscles, nerves and other tissues related to the joint, unless specifically covered as an Eligible Expense.
  22. Routine pre-natal care, Pregnancy, child birth, and post-natal care. (This exclusion does not apply to “Complications of Pregnancy” as defined.)
  23. Sclerotherapy for veins of the extremities.
  24. Abortions, except in connection with covered Complications of Pregnancy or if the life of the expectant mother would be at risk.
  25. Joint replacement or other treatment of joints, spine, bones or connective tissue including tendons, ligaments and cartilage. This exclusion does not apply if these treatments are related to a covered Injury.
  26. Surgeries, treatments, services or supplies which are deemed to be Experimental Treatment.
  27. Chronic fatigue or pain disorders.
  28. Kidney or end stage renal disease.
  29. Treatment or diagnosis of allergies, except for emergency treatment of allergic reactions.
  30. Treatment for cataracts.
  31. Treatment of sleep disorders.
  32. Treatment required as a result of complications or consequences of a treatment or condition not covered under this Certificate.
  33. Treatment incurred as a result of exposure to non-medical nuclear radiation and/or radioactive material(s).
  34. Treatment for acne, moles, skin tags, diseases of sebaceous glands, seborrhea, sebaceous cyst, unspecified disease of sebaceous glands, hypertrophic and atrophic conditions of skin, nevus.
  35. Treatment for or related to any Congenital Condition, except as it relates to a newborn child or newborn adopted child added as a Covered Person pursuant to the terms of this Certificate.
  36. Treatment, medication or hormones to stimulate growth, or treatment of learning disorders, disabilities, developmental delays or deficiencies, including therapy.
  37. Spinal manipulation or adjustment.
  38. Biofeedback, acupuncture, recreational, sleep or MIST Therapy®, holistic care of any nature, massage and kinesiotherapy, unless specifically covered as an Eligible Expense.
  39. Hypnotherapy when used to treat conditions that are not recognized as Mental Disorders by the American Psychiatric Association, and non-medical self-care or self-help programs.
  40. Eyeglasses, contact lenses, hearing aids, hearing implants, eye refraction, visual therapy, orthoptics, visual eye training and any examination or fitting related to these devices, and all vision and hearing tests and examinations.
  41. Care, treatment or supplies for the feet, and orthopedic prescription devices to be attached to or placed in shoes.
  42. Treatment of weak, strained, flat, unstable or unbalanced feet, metatarsalgia or bunions; treatment of corns, calluses or toenails; and orthopedic shoes.
  43. Care and treatment for hair loss including wigs, hair transplants or any drug that promises hair growth, whether or not prescribed by a Doctor.
  44. Exercise programs, whether or not prescribed or recommended by a Doctor.
  45. Telephone or Internet consultations and/or treatment or failure to keep a scheduled appointment.
  46. Charges for travel or accommodations, except as expressly provided for local ambulance.
  47. All charges incurred while confined primarily to receive Custodial or Convalescence Care.
  48. Services received or supplies purchased outside the United States, its territories or possessions, or Canada unless specifically covered as an Eligible Expense.
  49. Any services or supplies in connection with cigarette smoking cessation.
  50. Any services performed or supplies provided by a member of a Covered Person’s Immediate Family.
  51. Services received for any condition caused by a Covered Person’s commission of or attempt to commit an assault, battery, or felony, whether charged or not, or to which a contributing cause was the Covered Person being engaged in an illegal occupation.
  52. Services or supplies which are not included as Eligible Expenses as described herein.
  53. Participating in hazardous occupations or other activity including participating, instructing, demonstrating, guiding or accompanying others in the following: operation of a flight in an aircraft other than a regularly scheduled flight by a commercial airline, professional or semi-professional sports, extreme sports, parachute jumping, hot-air ballooning, hang-gliding, base jumping, mountain climbing, bungee jumping, scuba diving, sail gliding, parasailing, para kiting, rock or mountain climbing, cave exploration, parkour, racing including stunt show or speed test of any motorized or non-motorized vehicle, rodeo activities, or similar hazardous activities. Also excluded is Injury received while practicing, exercising, undergoing conditional or physical preparation for such activity.
  54. Injuries or Sicknesses resulting from participation in interscholastic, intercollegiate or organized competitive sports. This does not include dependent children participating in local community sports activities.
  55. Injury resulting from being under the influence of or due wholly or partly to the effects of alcohol or drugs, other than drugs taken in accordance with treatment prescribed by a Doctor.
  56. Intentionally self-inflicted Injury or Sickness (whether the Covered Person is sane or insane).
  57. Charges resulting from a declared or undeclared war, or from voluntary participation in a riot or insurrection.
  58. Charges incurred by a Covered Person while on active duty in the armed forces. Upon written notice to Us of entry into such active duty, the unused premium will be returned to the Covered Person on a pro-rated basis.
  59. Costs for Routine Physical Exams or other services not needed for medical treatment, unless specifically covered as an Eligible Expense.
  60. Charges You or Your Covered Dependent are not required to pay, or which would not have been billed, if no insurance existed.
  61. Charges to the extent that they are paid or payable under other valid or collectible group insurance or medical prepayment plan.
  62. Charges that are eligible for payment by Medicare or any other government program except Medicaid. Costs for care in government institutions unless You or Your Covered Dependent are obligated to pay for such care.
  63. Charges related to Injury or Sickness arising out of or in the course of any occupation for compensation, wage or profit, if the Covered Person is insured, or is required to be insured, by occupational disease or workers’ compensation insurance pursuant to applicable state or federal law, whether or not application for such benefits have been made.
  64. Medical expenses which are payable under any automobile insurance policy without regard to fault (does not apply in any state where prohibited).

 

This is a brief description of coverage, and is subject to the terms, conditions, limitations and exclusions of the policy. Please see the policy and certificate for complete details. Coverage may vary or may not be available in all states. Plans are underwritten by United States Fire Insurance Company, Eatontown, NJ.

Frequently asked questions

Short-Term Medical pays benefits 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.

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 depending on their state. 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 3 Coverage Periods x 364 days depending on their state. 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, $7,500

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:

Choice of 70%, 80%, or 100%

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, $5,000, or $10,000

Once members reach their Out of Pocket Maximum Amount selected, we pay 100% of up to the Coverage Period Maximum Benefit.

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

Pre-Existing Waiver Rider:

If a condition for which a Covered Person received medical treatment, diagnosis, care or advice, including diagnostic tests or medications, develops during your initial policy term, the Waiver of Pre-Existing Conditions Rider will allow resulting charges to be paid in the consecutive policy term. The waiting periods on all subsequent terms will be waived if the member purchased the Waiver of Pre-Existing Conditions Rider during their initial purchase. Terms of coverage and limitations may vary by state.

In a state with a maximum policy duration of 6 months, you may have the option to select depending on state:

  • 6 months
  • up to 36 months with Pre-Existing Waiver Rider
  • up to 36 months without Pre-Existing Waiver Rider
  • Prepay up to 180 days

In a state with a maximum policy duration of 364 days, you may have the option to select depending on state:

  • 364 Days
  • up to 3 Coverage Periods x 364 days with Pre-Existing Waiver Rider
  • up to 3 Coverage Periods x 364 days without Pre-Existing Waiver Rider
  • Prepay up to 180 days

When a member applies for consecutive policy terms in one enrollment, they will be issued their initial term of coverage, and subsequent terms will be pended. During the member’s initial enrollment, the member will complete an application and their initial policy and certificate will be issued. Ten days prior to their subsequent policy going into effect, the member will receive an email with their new monthly rate (if applicable), and they will have the opportunity to opt out at this time. If the member does not opt out, upon successful payment, the member will be issued new policy documents, such as, application, policy, certificate, and schedule of benefits. The waiting periods on all subsequent terms will be waived if the member purchased the Waiver of Pre-Existing Conditions Rider during their initial purchase. The limitations on consecutive policy terms varies by state, please see your certificate or master policy for complete details.

“Usual and Customary Fee” (or “Fees”) means the usual, fair and reasonable fee for medical treatment provided to a Covered Person (or any other form of medical care, procedure, drug or supply). In determining a Usual and Customary Fee, the Company at its discretion, consults:

  • One (1) or more standard industry sources to calculate services of comparable severity and nature in the same geographical area, the cost of the goods and services reasonably required to produce and deliver such treatment and/or the charge most commonly paid for such treatment. The standard industry sources utilize cost-based formula methodology and/or pricing data (updated semi-annually) to produce replicable and consistent cost and/or pricing parameters.
  • The cost to the health care provider of performing or providing the medical treatment, including reasonable allowance for overhead and profit.
  • Fee schedules used by third parties such as Medicare or Medicaid, including Medicare allowable charge data for Medicare Part B.
  • Hospital cost data as submitted to Medicare, including Medicare allowable charge data for Medicare Part A.
  • Prevailing negotiated fee schedules for same or similar services performed in the same geographical area.

If not 100% satisfied with coverage and members have not already used any of the insurance benefits, they may return the Certificate to us within 10 days of receipt (30 in Indiana). Coverage will be cancelled as of the effective date and the plan cost will be returned. No questions asked!

  1. Pre-Existing Condition
    1. Charges resulting directly or indirectly from a condition for which a Covered Person received medical treatment, diagnosis, care or advice, including diagnostic tests or medications, within the 24* month period immediately preceding such person’s Certificate Effective Date of coverage under the Policy.
    2. Pre-Existing Conditions includes conditions that produced any symptoms which would have caused a reasonable prudent person to seek diagnosis, care or treatment within the 24* month period immediately prior to the Covered Person’s Certificate Effective Date of coverage under the Policy.

This exclusion does not apply to any Eligible Expense payable for Pre-Existing Conditions until the Allowance Benefit maximum shown in the Schedule of Benefits has been reached.

*varies by state

Choice Advantage 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 (adult rates apply to anyone 18 or older).

"Out Of Pocket Maximum" means an amount of Eligible Expenses that are the responsibility of each Covered Person to meet before the Company will begin paying the expenses at 100%. It does not include Deductibles, Copayments, the penalty coinsurance for failure to pre-certify required services or charges in excess of the Maximum Allowable Expense. Once the Out of Pocket Maximum is met, the Certificate will begin paying 100% of Eligible Expenses for the remainder of the Coverage Period, not to exceed the Overall Coverage Period Maximum Benefit and any applicable benefit limits.

Coverage under this Certificate will cease at 12:01 a.m. for a Covered Person, based on the time zone in the place where the Insured resides, on the earliest of the following:

  1. The date premiums are not paid in accordance with the terms of this Certificate, subject to the Grace Period;
  2. On the next premium due date after the Company receives a written request from the Insured to terminate coverage, or any later date stated in the request;
  3. The date an Insured performs an act or practice that constitutes fraud, or is found to have made a misrepresentation of material fact, relating in any way to the Certificate, including claims for benefits under the Certificate;
  4. The date of the Insured’s death or the termination date of the Insured’s coverage, if the Insured’s spouse is not covered under the Policy;
  5. The Certificate Termination Date stated on Your Schedule of Benefits.
  6. The date that You enter full-time active duty in the armed forces of any country or international organization other than for reserve duty of 30 days or less;
  7. The date other major medical insurance coverage becomes effective for a Covered Person;
  8. The date You become eligible for Medicare;
  9. The date that insurance under the Policy is discontinued; or
  10. The first day of any policy month We elect to terminate the Policy by giving the Group Policyholder at least 30 days advance written notice.

TERMINATION UPON INSURED'S DEATH

The Insured will cease to be a Covered Person on the date of their death. If the Insured's Spouse is a Covered Person when the Insured dies, the Spouse will become the Insured.

TERMINATION OF SPOUSE'S COVERAGE

The Insured’s Spouse will cease to be a Covered Person at the earlier of:

  1. The date of their death;
  2. The date the Spouse and Insured become legally divorced or legally separated;
  3. The date the Spouse becomes eligible for Medicare; or
  4. The date that the spouse enters full-time active duty in the armed forces of any country or international organization other than for reserve duty of 30 days or less.

TERMINATION OF A CHILD'S COVERAGE

A child’s coverage will terminate on the earlier of:

  1. The date the child ceases to meet the requirements of a Dependent; or
  2. The date that the child enters full-time active duty in the armed forces of any country or international organization other than for reserve duty of 30 days or less.

RTBs

© 2021-2024 HealthInsurance.com, LLC

Privacy Policy  |  Terms and Conditions