The Emergency Room Visit Benefit is part of the Group Hospital Fixed Indemnity Insurance underwritten by United States Fire Insurance Company.
You had to go to the emergency room and you showed them your ID card - what happens next?
Your UBA Gap Product is not major medical insurance or a comprehensive health plan. The Emergency Room visit benefit is an Indemnity which means that you will do the following when a claim occurs:
- Pay the provider at the time of service. You may pay the provider at the time of service for the claim. your provider may request you assign any benefit payment to their office. All assignment of benefits will be honored unless proof of payment is provided.
- File the Claim using the proper CLAIM FORM. Send it to the location on the form along with any items requested by the claims administrator.
- Once the claim is reviewed and if it is determined to be a covered expense according to the Certificate of Insurance, then the claims administrator will pay the appropriate party (either you or the provider- if they provided an assignment of benefit payment.)
Read the Certificate(s) of Insurance of your product carefully. The brochure is a brief description of various group association insurance products and is not an insurance contract, nor part of the Certificate of Insurance and is subject to the terms, conditions, limitations, and exclusions of the Certificate(s) of Insurance and/or Certificate Riders. Coverage may vary or may not be available in all states. You'll find complete coverage details in the Certificate(s) of Insurance and/or Certificate Riders. Group Hospital Fixed Indemnity Insurance is underwritten by United States Fire Insurance Company, Eatontown, NJ.The insurance described in this Help Guide article provides limited benefits. Limited benefit plans are insurance products with reduced benefits intended to help supplement comprehensive health insurance plans. The insurance coverage is not an alternative to comprehensive coverage. It does not provide major medical or comprehensive medical coverage and is not designed to replace major medical insurance. Further, the insurance coverage is not minimum essential benefits as set forth under the Patient Protection and Affordable Care Act.
Important: HealthyAmerica 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.
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