STM THE TIME IS NOW. sm Short Term Medical Insurance & Gap Insurance working together. The Time for Healthcare Coverage is Now. * Group Term Life Insurance Term Group & Critical Illness Benefit Rider Super Gap Plus Plan Includes: STM SUPER PLUS PLAN INCLUDES STM PLAN + SUPER GAP PLUS Individual Short Term Medical Insurance Individual Short Term Group Accident Medical Expense Benefit Group Group Accident Insurance which includes: Group Non-Insurance Benefit Boost Services Include: Group Hospital Fixed Indemnity which includes: Group Group Accidental Death & Dismemberment Benefit Group Retail Prescription Discount Card & Pet RX Discount Card Discount Card Retail Prescription X-Rays & imaging & Daily Outpatient Laboratory Test Benefit X-Rays & imaging Daily Outpatient Laboratory Test & Daily Physician Office Visit Benefit, Daily Outpatient Radiology, Visit Benefit, Daily Outpatient Radiology, & Daily Physician Office Free Vitamins, MeMD (Telehealth 24/7), & MailMyPrescriptions.com MeMD (Telehealth Vitamins, Free Aetna Dental Access Discounts, Identity Theft Protection - LifeLock Aetna Dental Access Discounts, Identity Theft Protection Emergency Room Visit Benefit & Daily Hospital Confinement Room Visit Emergency SHORT TERM GROUP ACCIDENT CRITICAL ILLNESS DAILY HOSPITAL EMERGENCY PHYSICIAN OFFICE VISIT, GROUP TERM NON-INSURANCE MEDICAL INSURANCE INSURANCE INSURANCE BENEFIT CONFINEMENT ROOM VISIT LABS, IMAGING & X-RAY LIFE INSURANCE* SERVICES BENEFIT BENEFIT & WELLNESS BENEFIT Short Term Medical Insurance of STM Plan is underwritten by United States Fire Insurance Company. Group Accident Insurance and Group Hospital Fixed Indemnity Insurance of the Super Gap Plus Plan are underwritten by United States Fire Insurance Company. *Group Term Life Insurance of Super Gap Plus Plan is underwritten by Investors Heritage Life Insurance Company and not available in all states. Non-Insurance Benefit Boost Services are provided by Healthy America and United Business Association. ah-2557 *Note: Since STM Super Plus Plan includes an individual Short Term Medical insurance plan and does not require you to join the association or to purchase Super Gap Plus Plan to apply for coverage, if you do not want to join the association or do not want the Super Gap Plus plan, you can purchase the STM Plan in lieu of the STM Super Plus Plan on a stand-alone basis. The Super Gap Plus Plan sold outside of the STM Super Plus Plan also might be available in additional states. The STM Super Plus Plan is a STM SM The Time for Healthcare Coverage is Now. combination of both the STM Plan individual short term medical insurance with the Super Gap Plus Plan into one convenient plan. G sm INSIDE STM SUPER PLUS PLAN Individual Short Term Medical Insurance PGS 04-21…STM PLAN PGS 06-07…$5,000 Deductible Plan PGS 14-18…Limitations & Exclusions PG 08………Benefit Descriptions PGS 19-21…Additional Information: PG 09………Pre-Certification Requirements (Billing, Effective Dates, Claim Forms) PGS 10-12…Medical Benefits COVERAGE SHORT TERM MEDICAL INSURANCE BILLING, FULFILLMENT, ENDORSED BY: COVERAGE UNDERWRITTEN BY: & CUSTOMER SERVICE United States Fire Insurance Company PROVIDED BY: Healthy UBA america Group Association Supplemental Gap Plan PGS 22-63…SUPER GAP PLUS PLAN PGS 24-27…Group Accident Insurance PGS 34-35…Group Hospital Fixed Indemnity Insurance PGS 28-29…Group Hospital Fixed Indemnity Insurance Daily Emergency Room Visit for Daily Hospital Confinement Benefit Accident & Sickness Benefit PG 30………Group Hospital Fixed Indemnity Insurance PGS 36-41…Group Hospital Fixed Indemnity Insurance Daily Physician Office Visit Benefit Critical Illness Insurance Benefit PG 31………Group Hospital Fixed Indemnity Insurance PGS 42-43…Group Term Life Insurance Daily Outpatient Diagnostic Radiology, PGS 44-49…Limitations & Exclusions X-Ray & Imaging Benefits PGS 50-51…State Availability for STM Super Plus PG 32………Group Hospital Fixed Indemnity Insurance PGS 52-67…Non-Insurance Benefit Boost Services Daily Outpatient Laboratory Test Benefit PGS 68-71…About United Business Association & Other Membership Details ASSOCIATION BENEFITS GROUP ACCIDENT INSURANCE BILLING, FULFILLMENT, PROVIDED BY: & GROUP HOSPITAL FIXED & CUSTOMER SERVICE INDEMNITY INSURANCE PROVIDED BY: COVERAGE UNDERWRITTEN BY: United States Fire Insurance Company Healthy UBA america GROUP TERM LIFE INSURANCE COVERAGE UNDERWRITTEN BY: FOR TIMES WITHOUT TRADITIONAL HEALTH INSURANCE BETWEEN OPEN ENROLLMENTS STUDENT NOT ON PARENT PLAN BETWEEN JOBS COBRA TOO EXPENSIVE THE COVERAGE IS A SHORT TERM MEDICAL INSURANCE POLICY THAT IS NOT INTENDED TO QUALIFY AS THE MINIMUM ESSENTIAL COVERAGE REQUIRED BY THE AFFORDABLE CARE ACT (ACA). UNLESS YOU PURCHASE A PLAN THAT PROVIDES MINIMUM ESSENTIAL COVERAGE IN ACCORDANCE WITH THE ACA, YOU MAY BE SUBJECT TO A FEDERAL TAX PENALTY. ALSO, THE TERMINATION OR LOSS OF THIS POLICY DOES NOT ENTITLE YOU TO A SPECIAL ENROLLMENT PERIOD TO PURCHASE A HEALTH BENEFIT PLAN THAT QUALIFIES AS MINIMUM ESSENTIAL COVERAGE OUTSIDE OF AN OPEN ENROLLMENT PERIOD. NOTE: THE POLICY IS NOT RENEWABLE. NO CONTINUOUS COVERAGE. The policy of insurance provides coverage for short term duration only. It is not renewable. Although this short term plan may be written for new and completed separate Coverage Periods (as long as you meet the eligibility criteria described in the application), coverage does not continue from one policy to another. This means that a new application must be submitted, a new effective date is given, a new preexisting condition exclusion period begins and a new deductible and out- of-pocket expense must be met. Any medical condition which may have occurred and/or existed under a prior policy will be treated as a preexisting condition under the new policy. United States Fire Insurance Company Short Term Medical Insurance provides coverage for unexpected medical bills and other health care expenses. Short Term Medical Insurance can be a great fit for those in-between coverage. Short Term Medical plans offer medical coverage, are medically underwritten, and do not cover preexisting INSIDE conditions. They do not provide Minimum Essential STM PLAN Coverage as mandated by the Affordable Care Act. PGS 6-7 $5,000 Deductible Plan PG 8 Benefit Descriptions PG 9 Pre-Certification Requirements PGS 10-12 Medical Benefits PGS 14-18 Limitations & Exclusions PG 19-21 Additional Information (Billing, Effective Dates, Claims & Administrator contact info) Read this guide carefully. This is a brief description of Short Term Medical Insurance and is not an insurance contract, nor part of the insurance policy and is subject to the terms, conditions, limitations, and exclusions of the policy. Coverage may vary or may not be available in all states. You’ll find complete coverage details in the policy. Short Term Medical Insurance is underwritten by United States Fire Insurance Company. The Short Term Medical Policy does not meet Minimum Essential Coverage as mandated by the Affordable Care Act. Short Term, limited duration plans are not subject to certain provisions of federal health care reform, including the provisions related to Essential Health Benefits, lifetime limits, preventive care, guaranteed renewability, and preexisting conditions. The preexisting condition exclusion for Short Term Medical Plans will apply for all insureds, including those under the age of 19. Know your plan. Short Term Medical plans offer medical coverage, are medically underwritten (so you can be declined) and do not provide Minimum Essential Coverage. What does this mean for the applicant? They may have to pay a tax penalty, depending on their income level and the cost of plans available. Examples of the claims Short Term Medical Plans do not cover are for most preventive care, mental health and treatment related to medical conditions they had prior to the plan’s effective date. Because these plans are not guaranteed renewable, the applicant may not be eligible for another short term plan after the plan’s termination date; and the preexisting condition exclusion will apply to any conditions that arose during any prior short term plans. SHORT TERM To be considered for reimbursement, expenses must qualify as “eligible MEDICAL expenses” under the policy, and are also subject to all other policy provisions, such as reasonable and customary or eligible expense limits, or whether or INSURANCE not they were Medically Necessary. $5,000 $5,000 Deductible Plan DEDUCTIBLE Deductible is per Covered Person per Coverage Period. Maximum of 3 Deductibles per family per Policy Period. Once 3 family members have met their respective Deductible in a Coverage Period, no further Deductible will be required for the remainder of the Policy Period. The Deductible, Coinsurance Percentage, Coinsurance Limit, Co-Pays and Policy Period Maximum apply to each Covered Person and for ALL benefits, unless otherwise stated for a specific benefit listed on pages 10-12. Coinsurance Percentage 20% (% of covered expenses you pay after deductible to Coinsurance Limit) Coinsurance Limit (is after deductible, per person and copays are not included) $10,000 Policy Period Maximum (per person for ALL Benefits) $1,000,000 Coverage Period Availability (12 month option is not available in all states. Also 12 month 6 or 12 months durations only cover 364 days and not 365 days. WAITING If coverage was purchased within 3 days of the Covered Person’s Effective PERIOD Date, then in respect to Sickness, Covered Person will only be entitled to receive benefits for Sicknesses that begin, by occurrence