A: When you buy insurance from a US insurance company, you would receive the medical insurance card that will have your name, policy number, group number if applicable, insurance company's usually toll-free telephone number and the address where the claims can be submitted. When you get sick, visit the doctor with that card, and most of the times, the receptionist will take that card, call the insurance company and verify the coverage. The doctor's office has all the details to bill the insurance company directly, and you would pay the deductible if you have not fulfilled the amount yet. In fact, most of the plans are PPO plans and have providers all across the United States that participate in the PPO network. Also, most of the times, hospitals will directly bill the insurance company. But sometimes individual doctor's office may not comfortable with billing the insurance company directly, they may demand the payment from you upon receipt of treatment. In that case, you would get the itemized bill from the doctor which you can submit for claim to the insurance company.

A: There are primarily 3 types of plans.
Scheduled benefit plan: Insurance company has set limit for each type of treatment/visit, as clearly mentioned in the brochure and the policy. The insurance company will pay maximum according to the schedule and anything beyond that is your responsibility.
e.g., Inbound USA and Inbound Immigrant from Seven Corners. Visitors Care from IMG.

Per policy period coverage plan: After you pay the deductible for covered expenses, insurance company in most cases pays 80% for the first $5,000 of covered expenses and you will pay remaining 20%. After $5,000, insurance company will pay 100% up to the policy maximum limit for all covered expenses. Policy maximum limit is for the lifetime of the policy. e.g., your deductible is $250, maximum coverage is $50,000 and if your covered expense is $14,000, you would first pay $250 deductible, then you will pay 20% of first $5,000 which is $1,000. Thus you would end up paying $1,250 and rest $12,750 would be paid by the insurance company, for that covered illness/accident. But if your covered expense is $1,400 instead, you pay $250 deductible, then 20% of $1150, which is $230. In this case, you would end up paying $480 and insurance company would pay the remaining, $920.
e.g. Protection America & Patriot America from IMG. Atlas America from Multinational Underwriters. Diplomat America from Global Underwriters. Liaison International from Seven Corners.

Per incident coverage plan: After you pay the deductible once, the insurance company pays 80% for the first $5,000 of covered expenses per incident and you will pay remaining 20% per incident. After $5,000, the insurance company will pay 100% up to the policy maximum limit for all covered expenses. Policy maximum limit is per incident. e.g., your deductible is $250, maximum coverage is $50,000, and if your covered expense is $14,000, you would first pay $250 deductible, then you will pay 20% of first $5,000 which is $1,000. Thus you would end up paying $1,250 and rest $12,750 would be paid by the insurance company for that covered illness/accident. If you get sick or injured again and if your covered expense is $15,000, you will not have to pay the deductible again in the same policy period. Insurance company will pay 80% for first $5,000 expense, you will pay 20% ($1,000). Thus you would end up paying $1,000 and rest of $14,000 would be paid by the insurance company, for that covered illness/accident.
e.g., Visit USA from Travel Insurance Services.

A: Fixed coverage plans pay a fixed amount for every procedure and you have to pay the difference, no matter how high it is.

Deductible is the amount you have to pay first before the insurance company pays anything at all. The deductible is applied only towards the eligible expenses.

Following are 2 examples that will help you clarify the most frequently asked situation about doctor's office visits. Lets assume that a doctor's office visit is covered at $55/visit and X-rays are covered up to $400 and you have taken $50 deductible.

• Let's assume you visit the doctor's office several times and every time you visit the doctor, he charges you $80 for the visit. Also assume that you are not using any other medical services. As the insurance company pays only $55/visit, you always have to pay the difference of $25 from your pocket in this case. Again, insurance company is only concerned about the first $55/visit.
  
  When you visit the doctor for the first time, the insurance company is supposed to pay you $55, you have $50 towards unsatisfied deductible. Therefore, that $55 goes towards the $50 deductible. That means, the insurance company will pay $5.
  
  When you visit the doctor for the second time, the insurance company is supposed to pay you $55 and you don't have any unsatisfied deductible. Therefore, insurance company pays $55.
  
  For all subsequent visits, up to all covered number of visits, it will continue to pay $55/visit.
  
  
• Let's assume that you visit the doctor's office several times and get one X-ray taken.
  
  When you visit the doctor for the first time, the insurance company is supposed to pay you $55, you have $50 towards unsatisfied deductible. Therefore, that $55 goes towards the $50 deductible. That means, insurance company will pay $5.
  
  The doctor orders X-rays when you visit for the first time and it costs you $150 for the X-ray. The insurance company will pay all $150 as you have completely satisfied your deductible.
  
  For all subsequent visits, up to all covered number of visits, it will continue to pay $55/visit.
  
  

A: Most insurance companies whose products we offer have a provider network. And the link to provider network is provided next to that product's details. And if you visit any provider such as a doctor/hospital in that network, they have a Network Negotiated Charge(NNC) between them. Hence, the providers will charge only the amount they have agreed to with the insurance company.

However, you are free to visit any provider you wish. If you visit any provider outside the network, there may be a reduction in benefits.

A: Fill the claim form that you received from the insurance company at the time you received the insurance card. Or you can also download the claim form from our Current Clients section. Follow the instructions in the claim form. Please include all itemized bills from hospital/doctor/provider along with the claim form. If you have any questions regarding claims, contact the claims department of the insurance company and the contact phone numbers are usually listed on the insurance card.

A: Taking an appointment for any ailment is a time consuming process, hence many hospitals provide an emergency room facility. There are also many urgent care centers around. These are the quick medical care services provided by almost all medical centers.

Emergency services are those services required as a result of unforeseen injuries or acute illness, for which a delay in treatment would result in a permanent physical impairment, or loss of life. Such as heart attacks, strokes, poisoning, sudden inability to breathe etc.

On the other hand, urgent care includes less serious medical conditions which require immediate attention. Such as fever, fractured bone, any cuts which require immediate attention, etc.

** Note: Always make sure from your insurance company as to what situations are treated as urgent and emergency. If possible, it is better to contact your primary care physician in an urgent situation and arrange for your urgent care.

A: Stop dreaming in daylight.

A: No. You need to inform the insurance company (called pre-notification or pre-certification) only for major things like hospitalization, surgery, MRI etc.