• IMPORTANT BENEFIT INFORMATION
• COVERED MEDICAL EXPENSES
• LIMITATIONS AND EXCLUSIONS

What is Flex-Term Medical?

A NEW kind of Temporary Major Medical Insurance Plan that is flexible and satisfies your medical insurance needs for up to 12 months at a time. You can pay for the coverage you need now, or pay it monthly for up to 12 months, so it's easy on your budget. If you continue to need major medical insurance at the end of the 12 Month Period, you can apply for another 12 Month Coverage Period. 

* You can apply for up to three consecutive 12 Month Coverage Periods.
** Texas has unlimited re-applies.

* When your coverage period is almost over, you will receive an application form to apply for another 12 month coverage period. If you re-apply within 30 days prior to the end of your coverage your insurance and your monthly installments will not be interrupted. Furthermore, any condition(s) for which benefits were paid during a certificate period will not be subject to the pre-existing conditions limitation during any subsequent certificate period, provided the enrollment form is received by HPA, Inc. on time. However, any condition(s) that were excluded because of a pre-existing condition under the prior coverage period will continue to be subject to the pre-existing conditions limitation under the following coverage period.

** Texas Residents Only - Freedom STM (CNL-6000-ST-BR03)
The Freedom STM is issued on a temporary need and terminates at the end of the period applied for. If the need for temporary health insurance continues, you may apply for a new STM* coverage period. Your application is subject to the eligibility and underwriting requirements. Furthermore the coverage is not continuous. Any condition that incurred expense during the last coverage period will be treated as a preexisting condition, and excluded under the next coverage period. Certificate members over the age 59 are not eligible to reapply for coverage.

*Only if an STM plan is available in your residence state at the time; and the plan benefits, premiums and features may be different.

Who is eligible for this coverage?
.Available to association members and their spouses (through the age of 59) and their dependent children under the age of 19 years old (or under age 25 years old and enrolled and attending as a full time student at an accredited college, university, vocational or technical school); who have a social security number, do not exceed the company’s height and weight guidelines, and can answer "NO" to all the medical questions on the enrollment form. Children age 19 and over must apply separately. Child(ren) alone can apply and are to use the 0-24 premium rate (male or female, based on their gender) for the youngest child; and the per child rate for each of the child siblings to be insured. The minimum age for a child only coverage is 2 years old. The application must be completed and signed by the parent or legal guardian.

How does this coverage work?
 The Plan has two options to choose from, option A and option B.

Option A: First you pay the annual $250, $500, $1000, or $2500 deductible, after which the plan pays 80% of the next $5,000 of eligible expenses. The plan then pays 100% of the remaining covered expenses up to a maximum of $1,000,000 per insured. 

Option B: First you pay the annual $250, $500, $1000, or $2500 deductible, after which the plan pays 50% of the next $5,000 of eligible expenses. The plan then pays 100% of the remaining covered expenses up to a maximum of $1,000,000 per insured. 

* Benefits for Mental, Nervous, Alcohol and Drug Disorders are paid at 50%.

Once my coverage is issued, 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 may I be insured under this plan?
Benefit periods are for a maximum of 365 days. However, should you continue to need major medical insurance at the end of the 12-Month Period, you can reapply for another 12-Month Coverage Period with the same annual deductible.   Furthermore, any condition(s) covered under the previous Coverage Period, will also be covered under the subsequent 12 month Coverage Period(s), provided you submit your re-enrollment form to the Company within 30 days prior to the end of your current coverage period. 

Texas Residents Only
Unlimited re-applies. The coverage is not continuous. Any condition that incurred expense during the last coverage period will be treated as a preexisting condition, and excluded under the next coverage period.

What are the coverage limits under this plan?
This plan pays a lifetime maximum of $1,000,000 for each insured.Please refer to the Exclusions and Limitations section on this page for all limitations.

What happens if I require further treatment after my plan expires?
If you or your dependent is receiving benefits for a hospital confinement on the date that the Group Policy terminates or coverage under the Group Policy terminates, benefits will continue in accordance with the terms of the Group Policy for as long as the confinement remains continuous and you or your dependent is totally disabled by reason of such injury or sickness. However in no event will coverage continue beyond the end of 90 days following the date the Group Policy or your or your dependent's coverage terminates. Benefits payable after the Coverage Period in which insurance under the Group Policy or coverage terminates are subject to a new Deductible Amount and satisfaction of the Co-insurance limit.

Does this plan use a pre-certification/pre-admission service?
Yes. This plan requires a Pre-Admission Certificate by "Medical Cost Management" within 48 hours prior to in-patient hospitalization or surgery of an insured. If you fail to pre-certify, benefits may reduced 50%. 

What is the "pre-existing conditions" definition for this plan?
A pre-existing condition is any medical condition for which the covered person required medical treatment, consultation, or expense during the 3 years immediately prior to his/her coverage effective date or which provides symptoms within 3 years immediately prior to his/her effective date of Insurance. This definition may vary by state.

Are there expenses not covered under this plan?
Yes, this plan is designed to protect you in the event of an illness or injury and is not meant to cover routine exams and preventive care. Short Term Medical is for temporary coverage only and therefore does not include some of the benefits a permanent health plan offers. Please refer to the Exclusions and Limitations section of this web site.

How do I apply for this coverage?
First, make sure you do not live in a state the Plan is not available in. Next look up therates that apply to you based on your gender and zip code. Then, complete the application, sign it, and send it to the administrator along with your initial premium payment to the address below.

Mail Application and premium payment to:
Insurance Services of America 
1757 E. Baseline Road, Suite 126
Gilbert, AZ  85233

Can I fax my application?
Yes, faxed applications will be excepted, only to hold an effective date. Due tosignature requirements, HPA, Inc. must receive original application within 10 days of fax.

Can I get a refund of my premium if I am not satisfied?
Yes. If upon review of your Certificate of Insurance you are not COMPLETELY SATISFIED with your coverage, and you have not filed any claims, you may return the Certificate of Insurance within 30 days and receive a full refund of all premiums paid -- no questions asked.

How is this coverage billed?
After submitting your enrollment form with first month’s premium, you will then be billed monthly. You indicate on your enrollment form how you wish to pay for your coverage. You may elect to be billed for the monthly premiums (plus the administration fee), OR you can select one of the other two payment methods: (1) Automatic Pre-authorized Bank Withdrawal; or (2) Credit Card - MasterCard, Visa and Discover are accepted. 

When does my coverage begin?
Your coverage will be effective on the later of;12:01 a.m. the day after yourrequested policy date or 12:01 a.m. the day after the postmark date affixed by the U.S. Post Office.Coverage will take effect provided your completed application and full premium payment are received, and your answers on the enrollment form are complete and meet the requirement for coverage.

Highlights:

• Provides comprehensive Major Medical insurance protection 
• Allows 12 months of coverage, with the option of two additional 12-month periods 

• Is suited for individuals and families, or even child-only coverage 

• Covers you in case of emergency 

• Covers you worldwide, in case you need care while traveling 

• Pays benefits up to $1,000,000 lifetime, per insured person 

• Allows a choice of $250, $500, $1,000 or $2,500 deductibles 

• Gives you the freedom to choose any doctor and hospital 

• Offers an optional prescription drug discount program (not affiliated with Insurance Company)

• Makes it easy on your budget with several monthly payment options: check, money order, credit card, automatic bank withdrawal and direct bill 

The Flex-Term Medical Plan is perfect if you are:

1. Self-employed 

2. A part-time or temporary worker 

3. Between health insurance plans 

4. Unemployed or recently laid off 

5. Looking for a lower-cost alternative to COBRA or more comprehensive health insurance 

6. A college student or recent graduate who is just starting out 

7. Unable to afford other coverage 

This is only a general summary of the features of the Flex-Term Medical Plan. Complete details may be found in the Master Policy. Benefits and policy provisions may vary by state. 

Covered Medical Expenses:

• Hospital Charges — medical care and treatment. 

• Ambulatory Surgical Center charges. 

• Physicians Services for diagnosis, treatment and surgery. 

• Intensive Care — up to 3 times average semi- private room rate. 

• Convalescent Nursing Home — up to $30 per day for 30 days. 

• Private Duty Nursing — up to $75 per 8 hour shift. Maximum 90 shifts per coverage period. 

• X-ray exams, laboratory tests and analyses. 

• X-ray and radioactive isotope therapy. 

• Anesthesia, oxygen, casts, splints, crutches, braces, surgical dressings, artificial limbs or eyes, rental of necessary medical supplies.. 

• Blood or blood derivatives and their administration. 

• Ambulance Services — $250 per transportation. 

• Organ Transplants — up to $50,000.* 

• Spinal Manipulation/Adjustment — up to $1,000.* 

• Foreign Travel — Lifetime Maximum $25,000. (Benefit is payable after a $250 Deductible) 

• Mental and Nervous Disorders as a Bed Patient- Lifetime Maximum $5,000.*

• Mental and Nervous Disorders as Outpatient at a maximum of $30 per day up to 30 visits- Lifetime Maximum of $5,000*

• Alcohol and/or Drug Disorders — Lifetime Maximum of $1,000.* 

• Acquired Immune Deficiency Syndrome (AIDS) — Lifetime Maximum of $10,000.* 

• Home Health Care — up to 40 visits maximum. 

• Mammography/Pap Smear screens and exams 

•  Benefits for Mental, Nervous and Drug Disorders are paid at 50%. There is a combined maximum of $5,000 for in and outpatient Mental Illness. The benefit amount shown is the "Maximum Lifetime Benefit Per Insured Person". 

Pre-Admission Certification:
This Plan requires a Pre-Admission Certificate by "Medical Cost Management" prior to in-patient hospitalization or surgery of a Member or Insured Dependent within 48 hours. If you fail to pre-certify, benefits will be reduced 50%. To pre-certify call Medical Cost Management at: 1-800-367-9938.

Coverage Termination:
Coverage will end if the premium is not paid when due, you enter full-time active duty in the Armed Forces, you cease to be a Member of the Association, the Group Master Policy terminates, the expiration of the 12 Month Coverage Period, if The Insurance Company determines fraud or misrepresentation has been made in filing a claim for benefits, or on the date you or your dependent(s) cease to be eligible.

Coordination of Benefits:
Benefits may be reduced if you have other health care coverage, so that the total paid does not exceed the allowable expenses.

Extension of Coverage after Termination:
If a Member, or Insured Dependent, is receiving benefits for a hospital confinement on the date that the Group Policy terminates, benefits will continue in accordance with the terms of the Group Policy for as long as the confinement remains continuous and the Member or Insured Dependent is Totally Disabled by reason of such injury or sickness. However, in no event will coverage continue beyond the end of 90 days following the date the Group Policy or his coverage terminates. Benefits payable after the Coverage Period in which insurance under the Group Policy or coverage terminates are subject to a new Deductible Amount and satisfaction of Co-insurance Limit.

Exclusions & Limitations:  

Exclusions and Limitations: Pre-existing conditions are not covered.
A pre-existing condition is any condition that required medical treatment, consultation, or expense during the 3 years* immediately before the insured person's Effective Date of Insurance; or which produces symptoms within 3 years* immediately prior to the insured person's Effective Data of Insurance. These symptoms must be significant enough to establish manifestation or onset by one of the following test: (1) they would allow a physician to make diagnosis of the disorder; or (2) they would cause an ordinarily reasonable person to seek diagnosis or treatment. * May vary by state.

Other expenses not covered under this plan include:
Eye examinations. Eye glasses. Hearing Aids and Surgery – Charges in connection with eye examinations, eyeglasses, contact lenses, routine hearing exams to access need for or change in hearing aids, hearing aids or their fittings, lasik, RK or other corrective vision surgery, hearing loss surgery; unless the charges are necessarily incurred to treat, within 24 months of its occurrence, an accidental bodily Injury sustained while the person was insured for this benefit and the treatment giving rise to the charges begins within 90 days after the date of the accident causing injury. Dental Work – Charges incurred: (1) orthodontic or dental work, diagnosis or treatment (unless necessarily incurred to treat an accidental injury to sound, natural teeth sustained while the person was insured, and the charges begin within 90 days after the accident causing the injury); (2) prognathism, retrognathism , microtrognadibular reposition of the maxilla (upper jaw) or mandible (lower jaw) or both maxilla and mandible; and (3) temporomandibular joint dystunction (TMJ). Alcohol or Drug Disorders – Only charges that are incurred while the person is confined as a Hospital Registered Bed-Patient to treat the Alcoholic or Drug Disorders. Surgery – Eligible Expenses for the first six months of coverage do not include a total or partial hysterectomy, unless it is Medically Necessary due to a diagnosis of carcinoma (subject to all other policy provisions, including but not limited to the pre-existing condition exclusion); tonsillectomy; adenoidectomy; repair of deviated nasal septum or any type of surgery involving the sinus; myringotomy; tympanotomy; or herniorrhaphy. Benefits are not payable and charges will not acrue toward any deductible, for expenses resulting from: War, riot or any act incident to war or riot; while committing or attempting to commit an assault or felony; intentionally self-inflicted injuries, suicide or attempted suicide (while sane or insane), military service, Insured Newborn dependent child not yet discharged from the Hospital, unless incurred as the result of premature birth, congenital Injury or Sickness, or Sickness or Injury sustained during or after birth. Any work-related accidental bodily Injury or Sickness for which the Member or Insured Dependent is covered under a Worker's Compensation Act or similar law. Pregnancy or any complication of therefrom or elective termination of Pregnancy (except a Complication of Pregnancy as defined in the Group Policy). Any services furnished by the Member, a Dependent or his Immediate Family. Services or supplies rendered to a transplant donor of any organ or bodily element or the acquisition cost of any organ or bodily element. Any treatment for the purpose of causing a Pregnancy, such as drugs, medicines; artificial insemination; in vitro fertilization; and embryo transplants or any condition or complication caused by or resulting from such treatment. Sterilization or reversals of sterilization. Participation in skydiving, scuba diving, hang or ultra light gliding, riding an all terrain vehicle such as a dirt bike, snowmobile, or go-carts, racing with motorcycles, boats, or any form of aircraft or any participation in sports for pay or profit, and rodeo contests. Charges not defined or are not specifically identified under the Group Policy as Eligible Expenses. Committing or attempting to commit an assault or felony. Voluntary inhalation or ingestion of any gas, poison or poisonous substance. Cosmetic, reconstructive or plastic surgery unless: As a result of an Injury that occurred while the person was insured; or (a) To correct the disorder of a normal bodily function if the disorder had its inception while the person was insured under the Group Policy; or (b) Expenses are incurred for reconstructive breast surgery on a non-diseased breast to establish symmetry with the diseased breast following a mastectomy. Custodial maintenance, routine physical or premarital examinations, check ups, diagnostic or other tests, immunizations, screenings and research studies, preventative or routine care, except as specifically covered under the Group Policy. Testing, diagnosis or treatment of learning disabilities, attention deficit disorder, hyperactivity, autism or related conditions. Experimental services, supplies or treatments. Travel, even though prescribed by a Physician. Obesity, including any treatment, advice, consultation, medication, program or surgery. Weak, strained or flat feet; instability or imbalance of the foot; metatarsalgia, bunions, corns, colluses or toenails; except for charges: (I) by a Hospital during Confinement; (ii) for the care and treatment of a metabolic or peripheral vascular disease; (iii) for prompt repair or Injury from an accident that occurred while the insured person was insured under the Group Policy. Gender change or modification, sterilization or elective reversalsurgical procedures; breast reduction or breast enlargement for any reason; or the treatment or testing for sexual dysfunction. Common household items, i.e. exercise cycles; air or water purifiers; air conditioners; allergenic mattresses; and blood pressure kits. Outpatient prescription drugs, medicine, vitamins, mineral or food supplements, contraceptives, prenatal vitamins or any over the counter medicines. Any expense for an Injury or Sickness occurring while under the influence of alcohol, illegal drugs, hallucinogenic or narcotics unless prescribed by a Physician and used as recommended. Complications resulting from treatment of conditions not covered under the Group Policy. Expenses for testing or treating a sleeping disorder.

What is a Reasonable and Customary Charge?
A charge which is: (1) made by a Physician or supplier of services, medicines or supplies; and (2) the customary charges made by others rendering or furnishing such services, medicines, or supplies within an area in which the charge is incurred for Sickness or Injuries comparable in severity and nature to the Sickness or Injury being treated. The term "area" as it would apply to any particular service, medicine or supply means a county or such greater area as is necessary to obtain a representative cross section of the level of charges.

This is only a general summary of the features of the Flex-Term Medical Plan. Complete details may be found in the Master Policy. Benefits and policy provisions may vary by state. 

ABOUT THE INSURANCE COMPANY:
Clarendon National Insurance Company is rated A (Excellent) for financial condition by the A.M. Best Company, independent analysts of the insurance industry.  A.M. Best Ratings range from A++ to D. 

ABOUT THE ADMINISTRATOR:
Health Plan Administrators, Inc is a fully licensed, full service Third Party Administrator transacting business worldwide. HPA is a third generation company dating back to 1939. Industry leading services include: professional customer service, prompt claims payment, state of the art billing and reporting.

This site provides only a brief description of the benefits, exclusions and other provisions of the Master Policy CNL-6000-ST-MP. This site is not a contract of insurance. To the extent any information in this site is inconsistent with the Master Policy, the terms of the Master Policy will control. Because the Master Policy is issued and delivered in the District of Columbia, laws of other states may not apply in all instances. Benefits may vary in different states.