Essentially with your Short Term Medical Insurance underwritten by United States Fire Insurance Company, you need to pre-certify for Hospitalizations, other inpatient care, surgeries and other surgical procedures. The number to pre-certify is on the back of the card. You ONLY need to have the provider's office contact that number if you meet one of the requirements to certify, otherwise they only need to contact the verification of eligibility and benefits number for the Claims Administrator - HSR. Look below image of ID card for specific Pre-Certification Requirements.
- All hospitalizations, other inpatient care, and Surgeries or Surgical Procedures must be Pre-Certified.
- To comply with the Pre-Certification requirements, the Covered Person must:
- Contact the Company or its agent at the telephone number contained in the Insured's Policy (also located on the back of the ID card) as soon as possible before the expense is to be incurred; and
- Comply with the instructions of the Company and submit any information or documents they require; and
- Notify all Doctors, Hospitals, and other providers that this insurance contains Pre-Certification requirements and ask them to fully cooperate with the Company.
- If the Covered Person complies with Pre-Certification requirements, and the expenses are Pre-Certified, the Company will pay Eligible Expenses subject to all terms, conditions, provisions and exclusions described in the policy. If the Covered Person does not comply with the Pre-Certification requirements or if the expenses are not Pre-Certified:
- Eligible Expenses will be reduced by 50%; and
- The Deductible will be subtracted from the remaining amount; and
- The Coinsurance will be applied.
- Emergency Pre-Certification: in the event of an emergency Hospital Admission, Pre-Certification must be made within 48 hours after the admission, or as soon as is reasonably possible.
- Pre-Certification does not guarantee benefits - the fact that expenses are Pre-Certified does not guarantee either payment of benefits or the amount of benefits. Eligibility for and payment of benefits are subject to all the terms, conditions, provisions and exclusions herein.
- Concurrent review - For inpatient stays of any kind, the Company will Pre-Certify a limited number of days of confinement. Additional days of inpatient confinement may later be Pre-Certified if a Covered Person received prior approval.
*Please read your Policy for any state variations on pre-certification requirements.
Read the brochure and Policy carefully. The brochure 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 and 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. Short Term Medical 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 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.
Important: Healthy America and United Business Association (UBA) are not authorized to pay claims or be involved in the claims decision process. All claim decisions are made by the TPA claims administrator and the insurance carrier.