Details of SMART Short Term Medical Insurance from Markel Insurance Company

by Tony Novak   January 8, 2011

Markel Smart Short Term Medical Insurance is designed to be an affordable way to protect you and your family from the high cost of unexpected illnesses and accidents. Plan Highlights Eligibility & Effective Dates How are Benefits Covered? benefits covered? Do I need Precertification? Coverage Termination Exclusions and Limitations Is there a pre-existing condition limitation? Child Only Directions Payment Options & Methods Payment Methods Coverage Effective Date Coverage Termination Date Extension of Benefits after Termination Cancellation procedures for a monthly payment option Cancellation procedures for a single payment option Renewability Money BackGuarantee Plan Highlights Freedom to choose your own doctors and hospitals $1 Million Lifetime Maximum Coverage Inpatient and Outpatient Hospital Benefits Physician Services – diagnosis and treatment Surgery in a Hospital or Ambulatory Surgical Center Intensive Care Unit Charges X-Ray and Laboratory Services Ambulance Services Spinal Manipulation/Adjustment Mammography, Pap smear and screens *Benefits vary by state. Refer to your coverage document for specific terms and conditions. Eligibility & Effective Dates You and your spouse under age 65 (and not eligible for Medicare) are eligible for this coverage; as well as you and your spouse's unmarried dependent children under age 19 (or under age 25 if a full-time student), who have a social security number and can answer "No" to the five health questions on the application. Children age 19 and over should apply separately. Child-only coverage is available for ages 2 through 18. The application must be completed and signed by the parent or legal guardian. The insurance can be effective as early as 12:01 a.m. the next day after the transmission date. However, the applicant can choose a later effective date not to exceed 60 days from transmission date. Coverage ends on expiration date listed in your coverage document. How are benefits covered? Markel Smart STM pays benefits based on the following diagram: Do I need precertification? Pre-admission certification is required prior to an Inpatient hospitalization or Surgery of an insured as follows: (a)  Ten days prior to an non-emergency hospitalization; surgical procedure; or (b)  Within 48 hours or on the first business day following an Emergency admission; or (c)  Within 48 hours of delivery for complicated childbirth. This is not a guarantee of benefits. Failure to precertify will result in a benefit reduction of $1000 or 50% of the eligible expenses, whichever is less. Call 1-800-874-2378 for precertification. Coverage Termination Coverage ends when: the premium is not paid when due; you enter full-time active duty in the Armed Forces; you become eligible for Medicare; the policy expires; the elected coverage period expires; The Insurance Company determines that fraud or misrepresentation has been made in filing a claim for benefits; or a dependent ceases to be eligible. Exclusions This Short Term Medical insurance is a temporary plan for up to 365 days and it does not cover:  Pre-existing conditions*; any services that are not medically necessary; Eye exams, eyeglasses, hearing aids and related surgeries; Dental or orthodontic services; Treatment of feet conditions; Conditions resulting from an act of war, suicide attempt or high-risk sports; Maternity and newborn treatment prior to discharge, any infertility treatments or sterilization treatments; Services performed by family members or for which a charge would otherwise not be incurred; Services payable by Medicare or Worker's Compensation coverage; Cosmetic surgery; Services for mental, nervous, alcohol or drug treatment; Routine physical exams and tests, preventive care and immunizations for children over age 16; Experimental or investigational services; Obesity treatments; Sleep disorders; Over-the counter-medications and prescription drugs; Certain surgeries during the first six months.  This is not a complete list of the exclusions. Please see the detailed list in policy certificate you will receive when you purchase Short Term Medical Insurance.  See your individual policy for the complete list of Exclusions Is there a pre-existing condition limitation? Pre-existing conditions are not covered. This includes any condition or complication that was treated or produced symptoms 1-3 years immediately prior to his/her effective date of Insurance to your Markel Smart STM effective date. This plan does not cover "pre-existing conditions". A pre-existing condition is any medical condition for which the covered person required medical treatment, advice, consultation, or expense during the 1-3 years immediately prior to his/her coverage effective date or which provides symptoms within 1-3 years immediately prior to his/her effective date of Insurance. The pre-existing condition limitation may vary by state. Child Only Directions 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. Payment Options & Methods Markel Smart STM - Short Term Medical lets you choose the payment option (single or monthly payment) and payment method (automatic bank draft, credit card, or personal check) 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 personal check or money order, you must mail your completed application form and initial payment. Payment Options 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 enter the exact total number of days you need coverage and pay for that Benefit Period (30 day minimum / 180 day maximum). 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.  Payment Methods Personal Check:  You will receive payment coupons with your Policy or Certificate.  The 1st payment coupon will reflect a credit equal to your initial payment.  Subsequent monthly payments, must be received by SASid on or before the payment due dates shown on payment coupons. Automatic Bank Draft or Credit Card: Your initial payment and subsequent monthly payments will be automatically debited (on or immediately following the payment due dates) from your bank account or your MasterCard / VISA that is identified on the Electronic Payment Authorization form. If you wish to discontinue coverage before your Benefit Period expires, simply mail or fax your written request for termination to Markel and we will discontinue future automated electronic debits. Note - 5 days advance written and signed notice from the Primary Insured is required to ensure future credit card debits are discontinued. Mail or fax notice to: Markel Smart STM PO Box 1086 Janesville, WI 53547-1086 FAX 608-755-7955 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 Markel) is 12:01 a.m. on the day after Markel receives the completed application form and valid electronic payment information.  A later effective date may be requested, but no more than 30 days following the application date.  Note - payment must be made by automatic bank draft or MasterCard / VISA. U.S. Mail, the earliest date that coverage can begin (if approved by Markel) is 12:01 a.m. on the day after the postmark date stamped by the U.S.P.S. on the envelope in which Markel 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 Markel.  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 Markel 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 Markel’s acceptance of the submitted application form and your initial payment for the Markel Smart STM – 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 is totally disabled and receiving benefits for a hospital confinement on the date his or her coverage terminates, Covered Medical Expenses for that condition will continue to be paid as long as the condition continues. Timely payment of premium is required to continue coverage. The extension of coverage will end on the earlier of: (1)  The date the Hospital Confinement for the Total Disability ends; (2)  The end of the 90 day period following his termination date; (3)  The date premium payment is not paid when due; or (4)  The date the Overall Maximum Benefit Payable has been paid.  Benefits payable during this extension of coverage are subject to a new Deductible Amount and satisfaction of the Coinsurance limit. (5)  The earliest date permissible by law. Cancellation procedures for a monthly payment option: A written statement must be faxed to our office and it needs to include: Name Date of Birth Social Security Number Policy Number Termination Date Signature This must be faxed to 608-755-7955.  Once the fax is received the policy will be canceled.  To avoid being charged for another month we must receive the fax 5 days prior to the billing date.  Your billing date is the date of your application.  A letter confirming the cancellation will be mailed.  A refund will be issued if the policy is within the 10-day free look.  However, the fees are non-refundable.  If the policy is beyond the 10-day free look, no refund is due. Cancellation procedures for a single payment option: A written statement must be faxed to our office and it needs to include: Name Date of Birth Social Security Number Policy Number Termination Date Signature This must be faxed to 608-755-7955. A refund will be issued if the policy is within the 10-day free look. However, the fees are non-refundable. If the policy is beyond the 10-day free look, no refund is due. Renewability Markel Smart STM - Short Term Medical - 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 Markel, 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 Markel issue successive Benefit Periods totaling more than 365 days. Money Back Guarantee Immediately following Markel’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 Markel Smart STM – Short Term Medical insurance plan.  If you are not satisfied that this coverage will meet your insurance needs, simply return the Policy or Certificate with your written and signed request for cancellation within 10 days after you receive it.  Coverage will be canceled as of the effective date and you will receive a refund of your initial premium payment – no questions asked!

*State legislation may vary; consult your agent for specific requirements.