Individual Medical Policyholder Service and Insurance Benefits

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Accident Medical Expense Rider (AME)

Doctor Office Copayment (DOC) Option

Maternity Rider

Prescription Drug Card Rider

Preferred Provider Organization (PPO)

Terminations and Reinstatements

Premium Billing

Policy Definitions and Change Information

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**Accident Medical Expense Rider (AME)**
Question	Answer
What is the Accident Medical Expense (AME) rider?	The Accident Medical Expense rider provides benefits for injury due to a covered accident. AME benefits are administered per injury/accident, instead of a per calendar year. After AME benefits are paid, your annual deductible, coinsurance and emergency room copayment (if appropriate) will apply.
What benefit amounts are available on the AME?	The AME rider benefit amounts differ depending on the state your policy was issued in and the form number of your policy. See your policy for details.
How do I add the AME rider to my policy?	Please submit a written request signed by the primary insured and agent. See your policy for details
How do I remove the AME rider from my policy?	Please submit a written request signed by the primary insured and agent. See your policy for details.

**Doctor Office Copayment (DOC) Option** TOP
Question	Answer
What is the Doctor Office Copayment (DOC) option?	The Doctor Office Copayment Option is an optional benefit that provides 100% coverage for all covered reasonable and customary charges for an office visit to any physician after a copayment is paid. Copayments do not apply toward satisfying the deductible or out-of-pocket maximums.
How do I add the DOC option to my policy?	Please submit a written request signed by the agent or primary insured. See your policy for details.
How do I remove the DOC option from my policy?	Please submit a written request signed by the agent or primary insured. See your policy for details.

**Maternity Rider** TOP
Question	Answer
What is a Maternity rider?	A Maternity rider is an amendment to a medical policy that provides coverage for normal childbirth.
How do I add the Maternity rider to my policy?	The availability and procedure to add the Maternity rider varies depending on the state your policy was issued in and the form number of your policy. See your policy for details.
How do I remove the Maternity rider from my policy?	Please submit a written request signed by the primary insured or agent. See your policy for details.

**Prescription Drug Card Rider** TOP
Question	Answer
How do I use my Prescription ID Card?	Each time you fill a prescription, present your card at a participating pharmacy. Once you satisfy your annual deductible, you pay the copayment specified on your drug card. After applying any discounts, deductibles or copayments, the pharmacy will submit your claim electronically.
How do I add the Prescription Drug Card to my policy?	The ability to add the prescription drug card differs depending on the state in which your policy was issued and the form number of your policy. See your policy for details.
How do I remove the Prescription Drug Card from my policy?	The ability to remove the prescription drug card differs depending on the state in which your policy was issued and the form number of your policy. See your policy for details.

**Preferred Provider Organization (PPO)** TOP
Question	Answer
What is the Preferred Provider Organization (PPO) Option?	This option uses a PPO Network, which is comprised of a large number of participating hospitals and physicians. The providers in this network have agreed to reduce the amount they charge for services provided to insurance company policyholders. Network availability may vary depending on the area in which you live.
How do I add the PPO option to my policy?	This procedure may vary depending on the kind of policy you have, the state in which your policy was issued, and the area in which you live. See your policy for details.
How do I remove the PPO option from my policy?	This procedure may vary depending on the kind of policy you have, the state in which your policy was issued, and the area in which you live. See your policy for details.
Who is my PPO vendor? What is the name of my PPO Network?	This information is printed on your ID card, along with a telephone number for you to contact the Preferred Provider vendor for your policy.
Which physicians and hospitals are members of my PPO Network? How can I find out if my physician is a member of my PPO Network?	At the time you received your policy, you may have received a directory of physicians and hospitals in your network. If you would like an updated list, please contact your PPO vendor at the telephone number on your ID card.
Can I change my PPO Network?	This procedure may vary depending on the kind of policy you have, the state in which your policy was issued, and the area in which you live. See your policy for details.
How can I get an updated PPO Network directory?	Please contact your PPO vendor. Always verify whether your provider is a member of the PPO network in order to maximize your benefits.
How do I contact my PPO vendor?	Call the number on your ID card.

**Terminations and Reinstatements** TOP
Question	Answer
How do I terminate my policy?	Requests to terminate a policy may be received by phone call or in writing from the primary insured or agent. If the primary insured is a child, the request may be made by the guardian or payor of the policy. See your policy for more details.
I am due a premium refund. How will I receive it?	If a refund is due, a termination confirmation letter and a refund check will be issued to the insured (or premium payor, if other than the insured). See your policy for more details.
How do I reinstate my policy?	A Supplemental Application should be sent to request reinstatement of a policy. To receive an application, please contact your insurance agent. See your policy for more details. If the policy is reinstated, you will be billed for applicable premium due at that time. If a policy has lapsed over six months, a new policy application must be submitted.

**Premium Billing** TOP
Question	Answer
What payment options are available?	There are two payment options available: Direct Bill and Check-O-Matic. A Direct Bill is a billing statement sent to the policy payor. Direct billing options include: quarterly, semi-annually and annually. Check-O-Matic* is a convenient billing method by which premiums are automatically drawn from the premium payor's checking account.*Annual billing may not be available depending on the form number of the policy and the state of issue.
What day are Check-O-Matic premium payments withdrawn from a checking account?	The payor may choose the 1st through the 28th for a withdrawal (or draft) date.

**Policy Definitions and Change Information** TOP
Question	Answer
How do I change my address and phone number?	You can call or send in a written request with your policy number. See your policy for more details.
How do I change my name?	Contact customer service. See your policy for more details.
How do I add my spouse to my policy?	A supplemental application should be sent to request the addition of a spouse to a policy. To receive an application, please contact your insurance agent. You can also call or send in a written request. See your policy for details. If the addition is approved, you may be billed for applicable premium due.
How do I remove my spouse from my policy?	The primary insured or agent can request removal of a dependent by telephone or written notice. A spouse can also request to have him/herself removed from a policy. You can call or mail a written request. See your policy for details.
How do I add my dependent children to my policy?	You can call or mail a written request with your policy number. Newborns or newly acquired children can usually be added over the phone within 60 days after birth. Otherwise, a supplemental application may be required. See your policy for details. If the addition is approved, you may be billed for applicable premium due.
How long can my dependent children remain on my policy?	Disabled children may remain on a policy indefinitely. The age at which other dependent children must be removed varies depending on the kind of policy you have, the state in which your policy was issued, and the area in which you live. See your policy for details.
How do I remove dependent children from my policy?	The primary insured or agent can request removal of a dependent by telephone or written notice. See your policy for details.
Am I covered when I go out of the United States?	Unless specifically excluded by your contract, you are covered for the benefits listed in your policy. All policy provisions apply, including medical necessity and reasonable and customary limits.
What is a Special Exception Rider (SER)?	A Special Exception Rider excludes coverage for a specific medical condition for an individual family member. These riders are generally put on policies due to pre-existing conditions, and exclude benefits for any diagnostic services or treatment for that condition for the named family member.
There's a Special Exception Rider (SER) on my policy. How do I have it removed?	A supplemental application should be completed to request removal of an SER. See your policy for details. Some Special Exception Riders are permanent, and cannot be removed from a policy. If your rider is permanent, it will be noted at the top of your rider.
What is a Special Class Premium (SCP)?	A Special Class Premium is an additional premium amount you pay for your policy due to a medical condition you might have (for instance, high blood pressure).
There's a Special Class Premium on my policy. How do I have it removed?	A supplemental application should be completed to request removal of an SCP. To receive an application, please contact your insurance agent. See your policy for details.
What is a non-smoker discount?	A non-smoker discount is a reduction in the premium amount for our policyholders who lead a healthier lifestyle by not using tobacco products.
How do I apply for a non-smoker discount?	A supplemental application should be completed to request the non-smoker discount. Contact us for details.
Can I retain my policy beyond age 65?	Most medical insurance policies terminate when you reach age 65. However, this may vary depending on the kind of policy you have, the state in which your policy was issued, and the area in which you live. See your policy for details.
What is a deductible?	A deductible is the amount of covered expense you must incur and pay each calendar year before we will pay for covered medical expenses. This is for each individual, each calendar year. Expenses that are not covered by your policy will not be applied to your deductible.
When does my calendar- year deductible start over?	The calendar year begins January 1st and ends December 31st each year.
What is coinsurance?	Coinsurance (also known as Rate of Payment) is the percentage of covered expense you are responsible for after you have met your deductible. For example, if your coinsurance is 20% up to $5000, you pay 20% of the expenses and the insurance company pays 80% up to $5,000. Once you reach %5,000 the insurance company pays 100% of your covered charges, up to the policy maximum.
What is family out-of-pocket expense?	Family out-of-pocket expense is your deductible and coinsurance added together, for your whole family. In other words, it is the maximum you will have to pay per person, per calendar year, no matter how many members of your family need insurance benefits.
What is an HSA?	A Health Savings Account is an option that is available on some of the policies that the insurance company sells. For specific information on HSAs, click on HSAs from the home page of this site. TOP

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