Health Insurance Deductible Reimbursement

Overview

Most insurance plans have a deductible associated with them.  84% of people file a claim every year.  All of those people have to pay that deductible out of pocket.  This benefit changes that.  You get reimbursement for up to $500 on a deductible per claim making it so most people would experience ZERO out of pocket fees. 

• Coverage up to your deductible amount or $500, whichever is less.
• Covers you and your family if hospitalized as a result of an accident that occurs in the home.

Description

This Health Insurance Deductible Reimbursement benefit will reimburse the covered Member for a claim against the Member's Primary health insurance policy equal to the deductible limit shown on Member's current health insurance policy or (depending on the benefit amount) up to $250.00 or $500.00, whichever is less. The Health Insurance Deductible Reimbursement benefit will only be provided when a claim is filed with Member's current insurance carrier and a payment is made to Member for a claim against the Member's insurance policy which exceeds Member's deductible. Only one (1) benefit will be paid per claim occurrence. This benefit is in excess of any other applicable indemnity plan, including when the deductible is waived for any reason.

Definitions: "You" or "Your" means the enrolled Member. "Primary Health Insurance" means the health insurance policy of the Member which is recognized and covered. This policy must be a state filed and approved form. Benefit Term: The actual claim against the Primary Health Insurance which is the basis for a request for reimbursement of a deductible under this Certificate of Coverage, must have occurred while Member was an active and paid Member.

Exclusions:

1. Any loss that does not exceed the current Health Insurance deductible or does not cause a payment to be made by the current Health Insurance carrier to member because the claim against the Primary Insurance deductible.
2. Any claim not covered or specifically excluded in member's Primary Insurance policy.
3. Any loss or damage caused by fraud, abuse, intentional acts, war or hostilities of any kind or arising from illegal activity.

How To File a Claim

How to file a claim:

Call the Claims Administrator at 1-800-711-4280 within forty-five (45) days of the original date of claim. The Claims Administrator will send You a Claim Form. Please include:

1. a copy of Your Health Insurance policy, in force at time of claim, and showing Your Deductible amount;
2. any claim settlement documents from your carrier.
3. any other documents requested by Administrator to substantiate the conditions of this benefit outlined herein.