Claim Forms: Fueling the Engine
of Your Insurance Benefits

Filing claims is a crucial step in accessing the covered benefits of any enrolled supplemental insurance coverage. These membership plans are designed to provide additional support beyond standard insurance, but to utilize them effectively, submitting a claim form is essential.

The Essential Role of Claim Forms

A claim form is a critical document that acts as a formal request to your insurance provider for the benefits you are entitled to. Properly completing and submitting this form is the first step in receiving your supplemental insurance benefits. Think of it as the key to unlocking the financial support your policy promises.

Benefits of Filing a Claim Form

Access to Entitled Benefits

Filing a claim form is the primary method to access the benefits you are entitled to under your supplemental insurance policy. Without submitting this form, your insurance provider may not be aware of your need for reimbursement or coverage.

Record Keeping

A claim form serves as an official record of your request for benefits. It helps both you and your insurer keep track of claims made and ensures that your request is processed in a timely manner.

Efficient Processing

Properly completed claim forms and additional required documents can expedite the processing of your claim. This means a quicker access to the funds or services your need.

Clarity and Communication

A well-documented claim form provides clarity about the expenses incurred and the coverage needed. This reduces misunderstandings and facilitates better communication between you and your insurer.

Your Insurance Claim FAQs Explained

Healthy America Insurance Agency, Inc and H A Partners, Inc., serve as Third-Party Administrators (TPAs) for the United Business Association (UBA). While we manage billing, we do not administer claims. Claims are filed with the Claims Administrators of the insurance carrier partners who have issued a group policy to the United Business Association or the Claims Administrator for any individual insurance plans available through the UBA enrollment platform. Below are some frequently asked questions regarding claims that we often encounter.

Navigating the Steps of Supplemental Insurance Claims

Filing a supplemental insurance claim can be a straightforward process if you follow the steps carefully. This guide will walk you through each necessary action to ensure your claim is submitted correctly and efficiently.

Step 1: Seek Service for a Covered Benefit

Before filing a claim, ensure you receive service that is covered by your supplemental insurance benefit. Check your Certificate of Insurance to verify that the service is eligible. Always present your primary insurance card at time of service. Your supplemental insurance is secondary to your primary insurance, designed to help offset some of your out-of-pocket expenses like deductibles, out-of-network or coinsurance maximums and should not be used as your primary insurance.

Step 2: Pay the Provider

In most cases, you will need to pay the healthcare provider at the time of service. However, if your provider allows for an alternative payment arrangement or accepts a guarantee, the claims administrator may pay the provider directly.

Step 3: Obtain an Itemized Bill

Ask you provider for a copy of an itemized bill at the time of service. This document is crucial as it details the services provided and their costs, which you will need for your claim submission.

Make sure to get this before you leave the provider's office. This will prevent you from having to go back and ask for it later.

Step 4: Gather Necessary Documentation

To file a claim, you will need the following documents:

• Claim Form: Visit our website, go to the Member Portal, or call us at 866-438-4274 to obtain the correct claim form for your specific type of insurance claim and for the correct insurance carrier.
• Itemized Bill: Obtain this from your healthcare provider. It must be itemized to show all services rendered, codes and medical costs.
• Explanation of Benefits (EOB): This document should be provided by your primary insurance carrier and explains what has been covered by them.

Step 5: Submit the Claim Form

The first document you must submit is the claim form. Ensure it is filled out accurately and completely. You can send any supplemental bills and documentation as it becomes available or if further treatment is needed for the claim. You should file this form as soon as your have sought treatment for a covered expense. (There are some timing issues about filing claims so make sure that you review your Certificate of Insurance for the maximum allowable time you can file the claim after you seek treatment for a covered expense.)

To find the correct claim form, go to:

• Your Member Portal: the correct forms for the types of insurance and insurance carriers you are enrolled are neatly laid out for you to access on the Member Portal.
• Call Us at 866-438-4724: We will be happy to assist you and email or mail you the correct form to complete.
• Jump to our Claim Form Section Below: You can download the claim form if you know what plan you have and what type of insurance you are filing the claim for.

Step 6: Reimbursement and Payment Process

• If you Paid at the Time of Service: Depending on supplemental insurance coverage and terms, you will be reimbursed^* up to the allowable benefit amount based on the terms and conditions of your supplemental insurance Certificate.
  ^*Indemnity plans are not reimbursement plans.
• Accident Claims: These typically coordinate with other insurance coverage. Which means that primary insurance and all other insurance coverage pays first and then the supplemental group accident insurance pays what the member is out-of-pocket up to the maximum allowable benefit amount after the group accident insurance deductible. State variations can apply so make sure to review your Certificate of Insurance.
• Critical Illness Claims: These are paid as a one-time lump sum. The benefit amount could vary depending on whether the first diagnosis occurs within the first year of coverage or afterward. The covered critical illness must meet the full definition outlined in the Certificate of Insurance.
• Hospital Indemnity Claims: Paid as a lump sum based on the covered amount for the benefit, according to the terms of the insurance as outlined in the Certificate of Insurance.
• Term Life Claims: Paid as lump sum to the designated beneficiary listed. If no beneficiary, the payment will be made to the estate. Coverage must meet the terms of insurance outlined in the Certificate of Insurance.

Contact for Assistance

If you need help with any step in filing your claim or require additional assistance, please call us at 866-438-4274. Our team is ready to assist you with the process.

By following these steps, you can ensure your supplemental insurance claim is filed correctly and efficiently, allowing you to receive the benefits you are entitled to.

Special Considerations for Dental and Vision Plans

While the steps outlined above provide a comprehensive guide for most types of supplemental insurance claims, it's important to note that some types of coverage, specifically dental and vision insurance, often operate differently. Here's what you need to know about these exceptions:

No Claim Form Required

For many dental and vision insurance plans, especially when using in-network providers, you typically do not need to file a claim form yourself. Instead, the provider will handle the claims process directly with the insurance company, streamlining the experience for you. Show the provider your ID card at time of service. For vision insurance, make sure you instruct the provider that you have VSP.

In-Network Providers

The provider coordinates with your insurance carrier, ensuring that the covered benefits are applied correctly to your visit at time of service. Members pay the provider at time of service for all expenses outside the allowable amounts based on the policy and Certificate of Insurance. Review your Certificate of Insurance to determine your eligible benefits, terms, conditions, limitations and exclusions of your plan.

Out-of-Network Providers

If you choose to visit an out-of-network provider, you may need to file a claim form yourself. This involves obtaining an itemized bill from the provider and submitting it along with any required documentation to your insurance company with the claim form.

Need Assistance

If you have questions about your dental or vision insurance coverage or the claims process, don't hesitate to reach out. Contact us at 866-438-4274 for personalized assistance. Our team is ready to help you navigate your insurance benefits and ensure you receive the coverage you deserve.

Claim Forms and Membership Plans

Below is a guide to help you understand which claim forms correspond to the various membership plans. Please note that not all of these membership plans are currently marketed or available in every state. This list includes all membership plans with active membership, regardless of their marketing status.

Understanding Insurance Company & Claim Administrators

When dealing with supplemental insurance membership plans and claims, it's important to familiarize yourself with the full names of the underwriting insurance companies and claims administrators. This ensures clarity and helps in navigating the claims process efficiently.

*Underwriting Insurance Companies

Below are the names of the underwriting insurance companies associated with your membership plans:

• SiriusPoint: SiriusPoint America Insurance Company
• GTL: Guaranteed Trust Life Insurance Company
• US Fire: United States Fire Insurance Company
• Windsor: Windsor Life Insurance Company
• Federal Ins Co. / Chubb: Federal Insurance Company, a member insurer of the Chubb group of companies
• Renaissance: Renaissance Life and Health Insurance Company of America
• FCL: First Continental Life and Accident Insurance Company
• VSP: Vision Service Plan

These companies are responsible for underwriting the supplemental group insurance you have enrolled in (based on the membership plans enrolled), providing you with financial protection and benefits outlined in your policy.

Claims Administrators

Claims administrators play a crucial role in the processing of claims. Here are the acronyms and full names of some of the claims administrators involved:

• HSR: Health Special Risk, Inc.
• CBP: Co-Ordinated Benefits Plans

These administrators manage the claims process for some of the underwriting insurance carriers, ensuring that each claim is reviewed and processed according to the terms and conditions outlined in your policy.

Important Considerations

• Role of HealthyAmerica, H A Partners, and UBA: It is important to note that HealthyAmerica, H A Partners, Inc., the United Business Association (UBA), and the Healthy America Association (HAA) are not authorized to pay claims or make decisions regarding claim outcomes. All claim decisions are made by the claims Third-Party Administrator (TPA) and the insurance carrier.
• Need Assistance? If you require help or have questions about the claims process, feel free to contact us at 866-438-4274. While we cannot make decisions on claims, we are here to provide support and guidance to help you navigate any challenges you may encounter.

Understanding the entities involved in your supplemental insurance claims' processes will help you manage your policies more effectively and ensure that you receive the benefits you are entitled.

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Need Claim Assistance?

If you have questions about your coverage or the claims process, whether for standard supplemental insurance claims or specific inquiries about dental and vision insurance, don't hesitate to reach out. Contact us at 866-438-4274 for personalized assistance. Our team is ready to help you to navigate your insurance benefits and ensure you receive the coverage you deserve.

Important Note

All descriptions about claims and insurance coverage above are a broad overview and not state specific. Some coverage availability may vary by state. Always review the state specific Certificate of Insurance available on your Member Portal for each plan enrolled to determine coverage benefits, availability, terms, conditions, limitations, and exclusions. If there are any discrepancies between the descriptions above and the Certificate, the Certificate will govern.

Also, HealthyAmerica, H A Partners, Inc., and the United Business Association (UBA) are not authorized to pay claims or be involved in the claim decision process. All claim decisions are made by the Third-Party Claim's Administrator and the insurance carrier.