We've compiled our most frequently asked questions below. If you are not able to find the information that you are looking for, please contact us at geb@clico.com.
How do I submit a claim for medical, dental or vision expenses?
How do I submit a death claim?
What is assignment of benefits?
How do I access overseas medical treatment?
Why are you requesting receipts when I submitted everything already?
What is a deductible?
What is co-insurance?
Why aren't drugs dispensed by the doctor covered?
What are prescription drugs?
What are Reasonable and Customary Charges?
How do I submit a claim for medical, dental or vision expenses?
You need to complete a Health Insurance Claim Form for the applicable expense. Claim forms are available from your Plan Administrator or Human Resources department. These forms can be downloaded
here.
Your completed health claim form must be submitted to our Head Office with the original bills, receipts or other proof of payment within ninety (90) days of the date the services were rendered. Reimbursement of healthcare expenses shall be made in respect of the amount actually charged to and paid by the Insured or claimant subject to the benefit maximums stipulated by your health plan.
Detailed instructions for completing your Health Insurance Claim Form are available here.
How do I submit a death claim?
You need to complete the Claim for Death Benefit Form available here.
Notice of death claims must be given within ninety (90) days after the occurrence of such death, or as soon thereafter as it is reasonably possible.
Detailed instructions for completing your Claim for Death Benefit Form are available here.
What is assignment of benefits?
When an Insured member requests an assignment of benefits, the member is in fact asking that payments be made directly to a physician, hospital, or other provider of service. In order to complete this request, the Insured member must submit a Pre-certification request. Pre-certification forms are completed where non-emergency hospitalization, surgical or diagnostic imaging services are medically necessary.
Pre-certification forms are available from your Plan Administrator or Human Resources department; or they can be downloaded here.
Once the Pre-certification form has been reviewed and approved by the company's Medical Advisor , you will be provided with an estimate of the plan liability based on policy benefits assignable to the applicable Providers. The amount in excess of the plan liability is the responsibility of the Insured and is payable before the claim is submitted.
Please note that Pre-certification does not create an admission of liability on the part of Colonial Life.
Detailed instructions for completing your Pre-certification form are available here.
How do I access overseas medical treatment?
A member wishing to receive medical treatment abroad would first have to be referred by his/her attending physician (who should be a Specialist in the relevant field) and one other physician appointed by Colonial Life, to determine that such treatment is medically necessary and unavailable locally.
If overseas treatment is not pre-certified or the treatment and services are available locally, then the Insured is responsible for payment to the overseas providers and may submit the claim upon his/her return. The claims will be converted to local currency and processed as if the services had been performed locally. Additionally, the cost of airfare is not covered for unapproved overseas treatment.
There are two options available to obtain treatment abroad:
- Global Excel offers 24-hour service to members including locating the nearest treatment facilities in the event of an emergency or non-emergency situation. For non-emergency hospitalization, arrangements (which have been duly authorized) may be made via Global Excel for direct payment to the provider up to the Plan's limits. Charges in excess of the Plan's limits will be the responsibility of the patient.
- Health Administration Services (HAS) is a locally based medical case management services provider specializing in Central and South America.
Colonial Life would advise on the potential liability of the plan's benefits and engage the services of its business partners, Global Excel or HAS, to seek discounts on the patient's behalf.
Please note that all outpatient services and/or treatment are the Insured's responsibility and are non-assignable. However, you are entitled to claim for these expenses under the plan benefits.
Why are you requesting receipts when I submitted everything already?
Receipts normally state the amount paid, the name of the payee, the date of payment and should also state 'Received the sum of $... from "name/patient"'. Invoices are often submitted as a substitute for receipts so please ensure you receive and submit receipts for all expenses incurred on the accompanying claim form.
What is a deductible?
A deductible is the fixed dollar amount of eligible covered expenses that you must pay before benefits are payable under your plan.
What is co-insurance?
Co-insurance is a specified percentage of eligible covered expenses that an Insured pays after the deductible has been met. The plan benefits usually pay the remaining percentage of these expenses up to a specified limit as defined in your plan schedule.
Why aren't drugs dispensed by the doctor covered?
Doctors are not licensed to dispense drugs to their patients. Only drugs sold by a registered pharmacist or pharmacy will be considered.
What are prescription drugs?
Prescription drugs are drugs which are medically necessary and appropriate for the treatment of the patient's illness and obtainable only by a written prescription from a licensed medical doctor. It does not include over-the-counter items, even if prescribed by a doctor.
What are Reasonable and Customary Charges (R&Cs)?
Reasonable and Customary charges represent the average or amount most commonly charged by physicians or suppliers of medical services, medicines and supplies within a specific geographic area. (This term is also known as Usual, Customary and Reasonable Charges or UCRs.)
See Reasonable and Customary Charges for Dental Services and Diagnostic Imaging Techniques
