Claim Procedures
Notice of Claim
Any event which may give rise to a claim under this Policy must be notified to the Company in writing as soon as practicable and in any case, within 60 days of the event. All certificates, information and evidence required by the Company shall be furnished at no expense to the Company and shall be in such form and of such nature as the Company may prescribe.
Claim Forms
The Company, upon receipt of a written notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If these forms are not furnished within 15 days from the date notice is given, the claimant may comply with the proof of loss requirements of the Certificate by submitting within the time fixed in the Policy for filing proofs of loss, written proof showing the occurrence, nature and extent of the loss for which claim is made.
Proof of Loss
Written proof of loss must be furnished to the Company within 90 days after the date of loss. However, in case of claims for loss for which the Policy provides any periodic payment contingent upon continuing loss, this proof may be furnished within 90 days after termination of each period for which the Company, is liable. Failure to furnish proof within the time required will not invalidate nor reduce any claim if it is not reasonably possible. However, except in the absence of legal capacity of the claimant, the proof may not be furnished later than one year from the date when the proof was originally required.
Time for Payment of Claim
Benefits payable under the Policy will be paid immediately upon receipt of satisfactory written proof of loss
Payment of Claim
Benefits for accidental loss of life will be payable in accordance with the beneficiary designation and the provisions of the Policy which are effective at the time of payment. If no designation is then effective, the Benefits will be payable to the estate of the Insured Person for whom claim is made. Any other accrued Benefits unpaid at the Insured Person's death may, at the option the Company be paid either to his beneficiary or to his estate. All other Benefits will be payable to the Insured Person. However, all or any part of the Benefits payable under the Policy with respect to Hospital, dental, nursing, medical or surgical services may, at the Company's option, be paid directly to the Hospital or individuals rendering the services, unless such Insured Person requests otherwise in writing no later than when proof of loss is filed.
If any Benefits are payable to the estate of a Insured Person, or to a Insured Person's beneficiary who is a minor or otherwise not competent to give a valid release, the Company may pay up to $1,000.00 to any relative, by blood or marriage, of the Insured Person or beneficiary who is deemed by the Company to be equitably entitled to payment. Any payment made by the Company in good faith pursuant to this provision will fully discharge the Company's obligation to the extent of payment.
Physical Examination and Autopsy
The Insured Person shall submit to any medical examination requested by, and at the expense of, the Company. The Insured Person shall, as soon as possible after the occurrence of any Accidental Bodily Injury, obtain and follow the advice of a qualified medical practitioner. The Company will not be liable for any consequences arising by reason of the Insured Person's failure to obtain and follow such advice or use such appliances or remedies as may be prescribed.
The Company shall in the case of death of an Insured Person be entitled to have a post-mortem examination conducted at its own expense, where it is not forbidden by law.
Legal Actions
No legal action may be brought to recover on the Policy before 60 days after written proof of loss has been given as required by the Policy. No such action may be brought after three years from the time such written proof of loss is required.
Right of Subrogation
The Company shall be fully and completely subrogated to the rights of the Insured Person against parties who may be liable to provide indemnity or make a contribution in respect of any matter which is the subject of a claim under the Policy.
The Company will have the right to take over and conduct in the name of the Insured Person the defense or settlement or recovery of any claim, or to prosecute in the name of the Insured Person for Benefit any claim and settlement or recovery of any claim.
The Insured Person shall give all assistance as the Company may require. If the Insured Person fails to provide such assistance, the Company shall not be liable under the Policy. The Insured Person further agrees to cooperate fully with the Company in seeking such indemnity or contribution including, where appropriate, the Company instituting proceedings at their own expense against such parties in the name of the Insured Person.
How to file a claim
If the Insured Person has to claim under the Policy, please read the following instructions carefully. Please quote the Certificate Number in all correspondence. A separate record of this Certificate Number should be kept in case the Certificate is lost.
Medical Expenses
Ask the provider to whom the Insured Person is responsible for payment to send this form together with his detailed, itemized bill to International Claims Services.
The claim form is to be used only when a provider does not bill the Company directly, and when you have out-of-pocket expenses to submit for reimbursement.
- Part 1 and Part 2 are completely filled out by the member.
- All claims forms must have itemized bills and receipts attached, and should include the following information:
- Name of patient.
- Printed invoice number.
- Name and entity of medical practitioner or institution.
- Description of services rendered.
- Prescriptions must accompany all pharmacy bills.
- Please fill in and sign a claim form.
All claims should be sent to:
International Claims Services (ICS)
26741 Portola Parkway, Ste. 1E #505
Foothill Ranch CA 92610,USA
Note: No payment can be made without the original indemnification (claim) form duly filled in and signed and accompanied by detailed original bills. Please confirm the name and address to which payment should be made.
Permanent Disablement or Death
In case of death, the following documents will be required:
- Police report
- Coroners report
- Death certificate
- Legal statement, regarding the legal heirs of the deceased.
Status of claims:
Members wishing to request the status of a claim or have a question about a reimbursement received, please submit the status request form via our website at www.claimssite.com or e-mail the customer service dept. at claims@claimssite.com.
Inquiries regarding the status of past claims must be received within 12 months of the date of service to be considered for review.
Important Notice to the Insured Person, Doctors and Hospitals:
A 24 Hour Emergency Telephone Service is operated for the Benefit of persons insured under the Policy so that in the event of an EMERGENCY medical problem covered by the Policy, help and advice will be given.
In the event of a Medical Emergency call:
Care Coordination Contact Information (24/7)
In USA & Canada - Toll Free: 1-866-914-5333
Worldwide Collect: 1-905-669-4920
Note: Neither the Company nor its claims administrator, shall be responsible for the availability, quality or results of any medical treatment or the failure of the Insured Person to obtain medical treatment.
In addition, any expenses incurred by the Company or its claims administrator, which arises in circumstances not covered by the Insurance Certificate, shall be recoverable in full from the Insured Person.
Special Notice to the Physicians and/or Hospital
Each Insured Person covered under the Policy is covered against Hospital and medical expenses, as described in the Conditions of Insurance, up to the amount insured as stated in the Certificate's Schedule of Coverage. Payment of medical expenses will be guaranteed, provided that the conditions of this insurance have been fulfilled and that no Exclusions are applicable. Please refer to the General Exclusions and Special Exclusions for each Benefit.
The Insured Person must fill out the indemnification (claim) form and then the Physician or a representative of the Hospital must sign it. This provision may be waived when treatment is sought at the appropriate Preferred Provider facility or physician.
The medical coverage is for services as described in Benefit A.
In order to prevent any misunderstanding about existence of coverage, it is advisable to contact
Care Coordination Contact Information (24/7)
In USA & Canada - Toll Free: 1-866-914-5333
Worldwide Collect: 1-905-669-4920
Email: gbgcare@managingwithcare.com
as soon as possible in the case that the cost of the medical care is a substantial amount. In case further investigations are deemed necessary, the claim will not be settled prior to consultation with the Company's medical advisors.
Medical expenses will only be covered if they are necessary as a result of the Insured Person sustaining a bodily Injury as a result of an Accident or Sickness during the Period of Insurance.