The Group Accident Insurance includes Group Accident Medical Expense Insurance underwritten by United States Fire Insurance Company.
Group Accident Medical Expense Insurance works like this:
- You may pay the provider at the time of service for the claim related to the Accident. Your provider may request you assign any benefit payment to their office. In any case, claims should be filed with your primary insurance carrier first. All assignments of benefits will be honored unless proof of payment is provided.
- You file the claim using the CLAIM FORM and send it along with all the required documents to the claims administrator. You can find your ID# for every product and the product names on your ID card.
- The claim is reviewed and determined if it is a covered expense.
- Administrator will review all other applicable insurance you may have regarding an eligible accident claim. Benefits will be then considered up to the maximum benefit as indicated in your Certificate of Insurance.
Essentially, this is an excess product - If an injury to the Covered Person results in his/her incurring Eligible Expenses for any of the services in the Schedule of Benefits, we will pay the Eligible Expenses incurred, subject to any applicable Deductible Amount, Benefit Period, that are in excess of Expenses payable by any other Health Care Plan, regardless of any Coordination of Benefits provision contained in such Health Care Plan. The Covered Person must be under the care of a Physician when the Eligible Expenses are incurred. The Expense must be incurred solely for the treatment of a covered injury while the person is insured under the Certificate of Insurance or during the Benefit Period stated on the Schedule of Benefits. The first Expense must be incurred within the time frame shown on the Schedule of Benefits. The total of all medical benefits payable under the Group Accident Insurance Certificate of Insurance is shown in the Schedule of Benefits and is subject to the specific maximums shown on the schedule of benefits and could vary by state. Please see the Certificates of Insurance for Group Accident Insurance for your state to view all limitations, exclusions, terms and conditions.
(It is what you are actually out-of-pocket up to the annual maximum benefit - if insurance paid for some of it, that amount would be deducted from what you would receive since you are NOT out-of-pocket that amount.)
If you need help in understanding how the Group Accident Medical Expense Insurance works, you can call us at 866.438.4274 or via Chat and we can help you understand it as clearly as we can.
Read the Certificate(s) of Insurance of your product carefully. This 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 Accident 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: 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.