Frequently Asked Questions
How do I apply?
In which countries can I receive treatment?
Treatment can be received in any country within your coverage area based on plan option purchased.
What happens if the treatment is not available locally?
If treatment is not available locally, your plan will cover the cost of transportation to the nearest country within your coverage area where the appropriate treatment is available. This requires pre-approval and all must be coordinated by the Plan Administrator. Should local treatment be available and you choose to seek treatment in another country within your coverage area, transportation costs will not be covered.
How should I proceed in the event of an emergency?
Seek immediate treatment. Please do not wait to contact the Plan Administrator or Service Representative before seeking emergency medical treatment. Whenever possible, please have a family member of physician contact the Plan Administrator within 48-hours of incident to discuss payment arrangement. For emergency assistance, please contact us at: +1 (305) 405-8929, U.S. Toll Free: +1 (800) 222-3002, or Int’l Toll Free: +1 (844) 596-2729.
What if I need emergency medical evacuation?
Emergency medical evacuation is available in the event of a medically necessary treatment not being readily available at the place of the incident, to the nearest appropriate medical facility or as determined necessary by our Medical Evacuation Team based on the particulars of the medical case. Emergency Medical Evacuation MUST be arranged by the Plan Administrator for coverage to be in effect. Our group of skilled medical advisors will decide the most appropriate method of transportation for the evacuation and the most appropriate medical facility to which you will be evacuated. For emergency assistance, please contact us at: +1 (305) 405-8929, U.S. Toll Free: +1 (800) 222-3002, or Int’l Toll Free: +1 (844) 596-2729.
How do I file a claim I have already paid for?
Claims may be submitted via: • E-mail (email@example.com) with a completed claim form • Member Portfolio • Fax (305) 443-9671 • U.S. Postal Mail or courier: 1901 Ponce de Leon Blvd., Coral Gables FL 33134 You will need to provide the following information: • Itemized invoice on letterhead with official seals • Invoice must include the diagnosis • Proof of payment • All claims must be submitted within 90 days from the date of service/treatment for processing.
How do I request direct settlement or payment to the facility?
You may request for the Plan Administrator to initiate a direct payment when there is an Inpatient admission and or an Outpatient surgical procedure. You will need to take into consideration the deductible that has been chosen in the event the deductible has not been satisfied. You may contact the Plan Administrator at the numbers indicated on the ID card.
What if I have a question about my claims?
Our Customer Service Representatives are here to assist, guide and support you every step of the way. Please feel free to contact our office at +1 (800) 222-3002 within the U.S. at + 1 (305) 405-8929, outside the U.S. or via email at firstname.lastname@example.org with any questions you may have regarding claims submission or status of your claim.
What if I have questions regarding my premium?
If you have any questions regarding your premium or payments, please contact us at + 1 (305) 370-3203 and one of our agents would be happy to assist you with any questions you may have. You may also e-mail your queries to: email@example.com.
What happens if I become pregnant or have a child?
Should you become pregnant and are currently subscribed to maternity benefits, you will need to complete and submit a Maternity Questionnaire prior to any claims being considered for reimbursement. Pre-certification is required at least one month prior to delivery. Failure to pre-certify may result in a penalty in accordance with the terms of your policy. In order to ensure that the newborn expenses are covered from date of birth, you must communicate in writing the intent to add the newborn to your policy within 60 days from the date of birth. Notifications or requests received after 60 days from the date of birth may require underwriting and the child may not be added as of date of birth.
Can I buy prescription medication with a Premier Health insurance plan?
All prescriptions are on a pay and claim basis. When overseas, medications can be purchased from your local pharmacy. Then, simply file a reimbursement claim by using our Claim Form outlining the total medical cost. Please include the following: • Claim form • Physicians copy of the script • Prescription receipt • Proof of payment
I need to make a change to my plan. What do I need to do?
Depending on the type of change you are looking to make to your policy, the change can be made either during the policy year or upon renewal. Changes that can take place during the policy year are adding or removing dependents based on the following qualified statuses: • Marriage, death of spouse, divorce, legal separation and annulment. • A change in the number of dependents; including birth, death or adoption To add or remove dependents you must notify the company within 30 days of the qualified status. A policy change form with evidence of insurability must be submitted along with proper documentation such as the birth certificate, marriage certificate, adoption papers, and/or legal documentation. Changes to coverage can only be made at the time of renewal. During this time, you may change from a lower deductible to a higher deductible within the same plan option or a similar plan without being subject to underwriting. For example: you may change from US cover $500 deductible to US cover $1000 deductible. Changes to lower deductibles within the same plan option or to a different plan are not allowed. To make changes to your coverage, you must notify the company within 31 prior to the renewal date. A policy change form with evidence of insurability must be submitted. If you need to make any other changes to the plan, please contact us at +1 (305) 370-3203 or email us, firstname.lastname@example.org.