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Please include the following information with your request:
• Census including Employees': Age, Gender, Dependent Coverage Status and Home Zip Code
• Current SPD or Plan Designs
• Minimum of 12 months of paid claims data by month
• Large Claim information including: Claim Amount, Age, Gender, Prognosis and Diagnosis
• Current pooling point (if currently fully-insured)
• Current Stop Loss fees and attachment points (if currently self-funded)
• Contract type along with requested Individual Stop Loss and Aggregate Stop Loss levels.
Click on the “Access My Reports” link above. From there, you will be directed to a new site. At this site, enter in your login information. If you are not registered, please contact your Report Analyst. Once you have signed in, click on the appropriate quick links from the home page.
Where can I find if a claim was received for a specific employee?
Click the “View a Member’s Claims or Coverage” link above. From there, you will be directed to a new site. At this site, enter in your login information. If you are not registered, please contact our Customer Care team.
Once you have signed in, simply click on the “Claims” link. You can find a claim by the member’s ID number or by the claim number.
Where can I find if a certain diagnosis or procedure code is covered?
We do not quote benefits based on diagnosis or procedure codes; please call our Customer Care team at 1-866-738-3924 with a detailed description of the service being provided and the code, and they will provide you an accurate benefit quote.