+1 (866) INSUBUY 467-8289 PPO Networks Your insurance plan will participate in United Healthcare PPO under the following circumstances: • Your initial purchase of Atlas Travel product is on or after July 1, 2019, and • Your home country or citizenship is not in European Union. Your insurance plan will participate in First Health PPO under the following circumstances: • Your initial purchase is prior to July 1, 2019, or • Your home country or citizenship is in European Union. www.insubuy.com
Transcript
+1 (866) INSUBUY467-8289
PPO Networks
Your insurance plan will participate in United Healthcare PPO under the following circumstances:
• Your initial purchase of Atlas Travel product is on or after July 1, 2019, and
• Your home country or citizenship is not in European Union.
Your insurance plan will participate in First Health PPO under the following circumstances:
• Your initial purchase is prior to July 1, 2019, or• Your home country or citizenship is in European Union.
w w w. i n s u b u y . c o m
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POSSESSION OF THE CARD DOES NOT GUARANTEE COVERAGE
Member: Ville Verde
UnitedHealthcare Member ID: 123456789
Eff Dt: 06/01/2019
Health Plan (80840): 911-86532-00
Group Name: Tokio Marine
UnitedHealthcare Group Number:
917184
Payer ID: 87726
Plan Name: UnitedHealthcare Options PPO
Member Insurance
Medical Claim Address: Tokio Marine HCC MIS Group Claims Department Box No. 2005 Farmington Hills, MI 48333-2005 United States
Medical Claim Address: UnitedHealthCare Global PO Box 740372 Atlanta, GA 30374 For members: 1-317-262-2132 For Providers: 844-251-0747
Claims Submission
Inside United States Outside United States & Forms
Obtain a Claimant’s Statement & Authorization Form by visiting hccmis.com or by calling 800-605-2282 or 317-262-2132
Complete the Claimant’s Statement & Authorization Form; attach original, itemized bills; and forward to Tokio Marine HCC Medical Insurance Services. Be sure to fully complete your Claimant’s Statement & Authorization Form and sign it.
If you have already paid certain expenses, attach copies of payment receipts. In many cases, payment will be made directly to the hospital/physician that treated you.
Mail your Claimant’s Statement & Authorization Form and itemized bills including diagnosis to Outside USA address below or visit https://zone.hccmis.com/clientzone/ tocomplete and submit online.
Effective Date: May 21, 2019 Certificate Number: A90000000
POSSESSION OF THE CARD DOES NOT GUARANTEE COVERAGE
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Filing a Claim Obtain a Claimant’s Statement & authorization form by visiting hccmis.com or by calling
800-605-2282 or 317-262-2132 Complete the Claimant’s Statement & Authorization Form; attach original, itemized bills; and forward to
HCC Medical Insurance Services. Be sure to fully complete your Claimant’s Statement & Authorization Form and sign it.
If you have already paid certain expenses, attach copies of payment receipts. In many cases, payment willbe made directly to the hospital/physician that treated you.
Remember, you are responsible for the deductible, coinsurance and any ineligible charges.
For general questions regarding eligibility / benefits / claims please call 800-605-2282 or 317-262-2132 *Access worldwide toll-free numbers online at http : //hccmis.com/tollfree
Mail your Claimant’s Statement & Authorization Form and itemized bills including diagnosis to: Electronic Payer ID: HCCMI Tokio Marine HCC MIS Group Claims Department Box No. 2005 Farmington Hills, MI 48333-2005 United States
First Health Group Corp. a wholly owned subsidiary of Aetna
Medical Insurance Services Group
SAMPLE ONLY
INSUBUY.COM
Effective Date:
Home Country:
Certificate Passport Citizenship
Overall Policy Maximum
Maximum per Injury/Illness Overall Maximum Limit
Deductible
Medical Expenses (including hospitalization) Overall Maximum Limit
Emergency Medical Evacuation & Repatriation $1,000,000 One Million US Dollars
Emergency Reunion $100,000 One Hundred Thousand US Dollars
Repatriation of Remains Overall Maximum Limit
Trip Interruption $10,000 Ten Thousand US Dollars
Personal Liability
Emergency Dental due to Accident Overall Maximum Limit
Emergency Dental ‐ Acute Onset of Pain $300 Three Hundred US Dollars
Paid in full by
Sincerely,
Mark Carney
Tokio Marine HCC ‐ Medical Insurance Services Group
Plan Administrator for Lloyd’s, Fitzwilliam House, 10 St. Mary Axe, London, England EC3A 8BF
* Plan pays in US Dollars only. Amounts in Euros are provided for convenience and are based on conversion rate as of
We are pleased to confirm short term medical coverage under the Atlas Series, insured by Lloyd’s Syndicate 4141 and
administered by Tokio Marine HCC – MIS Group, a member of the Tokio Marine HCC group of companies. Tokio Marine HCC
– MIS Group has authority to enter into contracts of insurance on behalf of the Lloyd’s underwriting members of Lloyd’s
Syndicate 4141, which is managed by HCC Underwriting Agency Ltd. Lloyd’s is authorized as an insurer in Spain by the
Spanish insurance regulatory authority (Dirección General de Seguros y Fondos de Pensiones) under reference L0017. This
plan will make direct payment to providers when the plan administrator is contacted and submitted charges are approved.
This coverage is valid worldwide, including the Destination Country(ies) listed below, except for the member’s Home
Country and countries restricted by U.S. economic sanctions and embargo programs. Atlas Travel satisfies Schengen Visa
health insurance requirements.
CONFIRMATION OF COVERAGE
Atlas Travel
This coverage is extendable up to the maximum certificate duration. Please see policy documents for further details, or feel free to
contact us with any questions or concerns.
Termination Date
(€8,899*)
(€88,990*)(€889,900*)
$1,000 (€890*)
$50,000 (€44,495*)
$25,000 (€22,248*)
(€267*)
Fifty Thousand US Dollars
United States
05/21/2019
A92000000 China
China
07/16/2019
PayPal
Destination Country(ies):
Name
Connie Liu
June 16, 2019
One Thousand US Dollars
06/29/2019
Twenty Five Thousand US Dollars
SAMPLE ONLY
INSUBUY.COM
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��������� �������Savings average from 5%-15% off the cash price for brand drugs and average 15%-40% off the price of generic drugs. In the event a pharmacy’s price is lower than our discounted price, you will always receive the lowest price available.
�� � ����� ��� ��������Your VantageAmerica Solutions Discount Pharmacy Card is widely accepted at over 54,000 participating pharmacies across the United States, including most national and regional chains, pharmacy associations, and many local community pharmacies. If your community pharmacy is not enrolled, ask them to contact member services at 1-800-974-3454. We always welcome new participation.
�������� ��� ����This program applies to your entire family. Everyone deserves to save. All family members and friends are eligible for this program. Please present your card every ���� �� ��� �� � � ����������� �� ������� �����savings. There are absolutely no restrictions.
Save Money with your FREEPrescription Discount Card
Easy to Use!Just present the attached card at a participating pharmacy ��� ��� ���� �� �� ���� � ������� ��� �� � �prescription. You will also realize immediate savings of 25%-80% on MRI and CT scans and 5%-30% on Diabetic Supplies. Additionally, you can save 10%-35% on Dental Care, and 15% on Hearing Equipment. Simply call the numbers on your card or visit the websites provided. Or, if you have questions or need assistance of any kind, call the Member Service Center at 1-800-975-3322 between the hours of 8:00 am and 5:00 pm (CST). One of our representatives will be happy to help you get the most from your complimentary VantageAmerica Solutions Discount Pharmacy Card.
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Disclosures:a. The discount medical card program is NOT health
insurance.b. The plan provides discounts at certain health care
providers for medical services.c. The plan does not make payments directly to the
providers of medical services.d. The range of discounts for medical or ancillary services
provided under the plan will vary depending on the typeof provider and medical or ancillary services received.
e. The plan member is obligated to pay for all healthcare services but will receive a discount from thosehealth care providers who have contracted withVantageAmerica Solutions, Inc., a discount medical planorganization.
