Coverage Information

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.

This website provides general information about the American Health Shield – Short Term Medical insurance plan.  It is not a contract.  The complete terms, provisions and conditions or coverage are described in the Policy or Certificate issued by The Chesapeake Life Insurance Company to approved applicants.  Plan benefits, limitations and exclusions vary by state.

This plan of insurance plan is not currently available to residents of:

GA, ID, KS, MD, MA, ME, ND, NH, NJ, NY, OR, RI, SD, UT, VT.

This plan of insurance, under Policy Form STP-01 and STP-IND-01, is underwritten by The Chesapeake Life Insurance Company Oklahoma City, OK.  The Policy and Certificates issued under it, will be deemed amended to conform to the minimum requirements of the laws of the state in which coverage is issued.

Covered Medical Expense Highlights

The American Health Shield – Short Term Medical provides benefits for Covered Medical Expenses related to covered Injury or Sickness, which are:  1) not in excess of Usual and Customary Charges; 2) not in excess of a maximum benefit amount; 3) made for services and supplies which are a Medical Necessity and listed as Covered Medical Expenses in the Policy or Certificate issued by The Chesapeake Life Insurance Company. 

Covered Medical Expenses and Benefits vary be state. Detailed information about these and additional Covered Medical Expenses is listed in the Policy or Certificate issued by The Chesapeake Life Insurance Company to approved applicants.

Note - Usual and Customary Charges means the lesser of: 1) the actual charge; 2) what the provider would accept for the same service or supply in the absence of insurance; or 3) the reasonable charge as determined by The Chesapeake Life Insurance Company, based on factors such as: a) the most common charge for the same or comparable service or supply in a community similar to where the service or supply is furnished; b) the amount of resources expended to deliver the treatment rendered; c) charging protocols and billing practices generally accepted by the medical community or specialty groups; or d) inflation trends by geographic region.

Limitation & Exclusion Highlights

Unless specifically listed as a Covered Expense in the Policy or Certificate (or as may be provided by an Endorsement attached to the Policy or Certificate), no benefit will be paid for loss or expense caused by, contribution to, or resulting from:

1. A Pre-existing Condition, defined as: 1) the existing of symptoms within the five (5) years immediately prior to the Insured’s Effective Date or, 2) any condition which originates, is diagnosed, treated, or recommended for treatment or for which medication was prescribed or recommended within the five (5) years immediately prior to the Insured’s Effective Date; 2. Addiction such as: (a) alcoholism, drug addition, nicotine addiction, caffeine addiction and non-chemical addictions such as gambling, sexual, spending, shopping, working and religious; and codependency; 3. Acne; acupuncture; allergy, including allergy testing, except for an acute allergic reaction resulting in a medical emergency; alopecia; 4. Autistic disease of childhood, hyperkinetic syndromes, milieu therapy, learning disabilities, behavioral problems, parent-child problems, attention deficit disorder, conceptual handicap, developmental delay or disorder or mental retardation, 5. Biofeedback; 6. Chronic Pain Disorders; 7. Complications of any treatment or surgery for an excluded service or procedure; 8. Congenital conditions, except as specifically provided for Newborn Infants; Circumcision; 9. Cosmetic procedures, except cosmetic surgery required to correct an Injury for which benefits are otherwise payable under this policy or for newborn children; hirsutism; warts, nonmalignant moles and lesions; 10. Custodial care provided in: rest homes, health resorts, homes for the aged, halfway houses, or places mainly for domiciliary or custodial care; extended care in treatment or substance abuse facilities for domiciliary or custodial care; 11. Dental treatment, except for accidental Injury to Sound, Natural Teeth; 12. Elective Surgery or Elective Treatment, elective abortion; 13. Expenses incurred outside of the United States, its possessions, territories or Canada; 14. Foot care including flat foot conditions, supportive devices for the foot, the treatment of subluxations of the foot, care of corns, bunions (except capsular or bone surgery), calluses, toenails, fallen arches, weak feet, chronic foot strain and symptomatic complaints of the feet; 15. Health spa or similar facilities, strengthening programs; 16. Hearing examinations or hearing aids; or other treatment for hearing defects and problems. "Hearing defects" means any physical defect of the ear which does or can impair normal hearing, apart from the disease process; 17. Hypnosis; 18. Immunizations, preventive medicines or vaccines, except where required for treatment of a covered Injury; 19. Injury caused by, contributed to, or resulting from the addiction to or use of alcohol, intoxicants, hallucinogenics, illegal drugs, or any drugs or medicines that are not taken in the recommended dosage or for the purpose prescribed by the Insured Person's Physician; 20. Injury or Sickness for which benefits are paid or payable under any Workers' Compensation or Occupational Disease Law or Act, or similar legislation; 21. Injury or Sickness to the extent that benefits are paid by Medicare or any other government law or program (except Medicaid); or medical coverage under any automobile insurance; 22. Injury sustained while (a) participating in any intercollegiate, international, or professional sport, contest, or competition; (b) traveling to or from such sport, contest, or competition as a participant; or (c) while participating in any practice or conditioning program for such sport, contest, or competition; 23. Lipectomy; 24. Mental and Nervous Disorders; 26. Normal pregnancy; maternity services or supplies; 27. Organ transplants; 28. Participation in a riot or civil disorder, participating in the commission of a felony; 29. Prescription Drug, services or supplies as follows: a) Therapeutic devices or appliances, including hypodermic needles, syringes, support garments and other non-medical substances, regardless of intended use; b) Birth control and/or Contraceptives, oral or other, whether medication or device, regardless of intended use; c) Immunization agents, biological sera, blood or blood products administered on an outpatient basis; d) Drugs labeled, “Caution - limited by federal law to investigational use” or experimental drugs; e) Products used for cosmetic purposes; f) Drugs used to treat or cure baldness, and anabolic steroids used for body building; g) Anorectics - drugs used for the purpose of weight control; h) Fertility agents or sexual enhancement drugs, such as Parlodel, Pergonal, Clomid, Profasi, Metrodin, Serophene, or Viagra; i) Growth hormones; or j) Refills in excess of the number specified or dispensed after one (1) year of date of the prescription. 30. Private duty nursing; charges for standby Physicians; 31. Rehabilitation Services for charges for benefits for rehabilitation services other than those provided in the Benefits Section; 32. Reproductive/Infertility services including but not limited to: family planning; fertility tests; infertility (male or female), including any services or supplies rendered for the purpose or with the intent of inducing conception; premarital examinations; impotence, organic or otherwise; tubal ligation; vasectomy; sexual reassignment surgery; reversal of sterilization procedures; 33. Research or examinations relating to research studies, or any treatment for which the patient or the patient’s representative must sign an informed consent document identifying the treatment in which the patient is to participate as a research study or clinical research study; 34. Routine Newborn Infant Care, well-baby nursery and related Physician charges in excess of 48 hours for vaginal delivery or 96 hours for cesarean delivery; 35. Routine physical examinations and routine testing; preventive testing or treatment; screening exams or testing in the absence of Injury or Sickness, except as specifically provided in the Policy; 36. Sclerotherapy for veins of the extremities; 37. Services rendered or supplies purchased from your immediate family; 38. Skeletal irregularities of one or both jaws, including orthognathia and mandibular retrognathia; temporomandibular joint dysfunction; deviated nasal septum, including submucous resection and/or other surgical correction thereof; nasal and sinus surgery; 39. Hazardous activities including skydiving, parachuting, hang gliding, glider flying, parasailing, sail planing, bungee jumping, scuba diving, and participating in a rodeo; 40. Sleep disorders; 41. Suicide or attempted suicide while sane or insane (including drug overdose); or intentionally self-inflicted Injury; 42. Supplies, except as specifically provided in the Policy. 43. Surgical breast reduction, breast augmentation, breast implants or breast prosthetic devices, or gynecomastia; other than as specifically provided in the Policy; 44. Taxes; provider administrative expenses; travel, transportation or living expenses; 45. Recreational use of any vehicle not operated on public roadways, including but not limited to motorcycles, all terrain vehicles (3 and 4 wheel), snowmobiles, ski cycles, and jet skis; 46. Treatment in a Government hospital, unless there is a legal obligation for the Insured Person to pay for such treatment; 47. Treatment or removal or repair of tonsils or adenoids, except for a Medical Emergency; 48. Vision services and supplies related to eye refractions or eye examinations, eyeglasses or contact lenses or prescriptions or fitting of eyeglasses, and radial keratotomy, keratomileusis or excimer laser photo refractive keratectomy or similar type procedures or service except when due to a disease process; 49. War or any act of war, declared or undeclared; or while in the armed forces of any country (a pro-rata premium will be refunded upon request for such period not covered); and 50. Weight management services and supplies related to weight reduction programs, weight management programs, related nutritional supplies, treatment for obesity, surgery for removal of excess skin or fat and treatment of eating disorders such as bulimia and anorexia. Exception: benefits will be provided for the treatment of dehydration and electrolyte imbalance associated with eating disorders.

Plan limitations and exclusions vary by state. Detailed information about plan limitations and exclusions are listed in the Policy or Certificate issued by The Chesapeake Life Insurance Company to approved applicants.