If you have purchased a Short Term Medical Insurance Plan underwritten by United States Fire Insurance Company and need to file a claim form, you can download the claim form below:
The Claims Administrator for the Short Term Medical Insurance underwritten by United States Fire Insurance is:
Health Special Risk (HSR)
4100 Medical Parkway | Carrollton, TX 75007 | Phone: 800.328-1114 | Fax: 972-512-5820 |
Note: You may not have to file a claim form. If the provider contacts the Eligibility & Benefits number on your STM Plan ID Card then they will instruct the provider how to proceed with the claim.
Also, if you are going to have any of the following:
- All Hospitalizations
- Other Inpatient Care
- Surgical Procedures
You must have the Pre-Certification Requirement met - see your Short Term Medical Policy and/or your Member Guide for instructions on the Pre-Certification Requirement and any state variations.
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.
If you need help, contact us at 866.438.4274 and we will be happy to try and assist you.