VISIT®
International Health Insurance Contact Us at
epi@visitinsurance.comor
1-703-660-9062
Educational Partners International TEACHER
Group
Health Insurance Plan from
VISIT®
Insurance 2023-2024 Effective August 1, 2023
What IS Covered by VISIT® Plan E
Plus?
Medical Expenses - $100,000 per each
accident or illness
Plan E Plus provides coverage for Accidents & Illness and medical
emergencies. Your Plan will cover visits to a Doctor,
Specialist, Minute Clinic, Urgent Care, Emergency Room and
Hospital, as well as associated X-rays, Lab work and
Prescriptions.
VISIT® Plan E
Plus
uses the UnitedHealthcare Medical Provider Network. Be
sure to have your doctor notify UnitedHealthcare in the
event of any scheduled Hospitalization, Surgery and MRI/CAT
Scans.
An Emergency Room should only
be used in the event of a life-threatening Medical
Emergency.
Home Country
Coverage - Your plan includes coverage for
Incidental Trips to your Home Country:
Up 14 days.
Dental
- The plan will pay up to
$300 for repair to a tooth due to an accident.
Coverage is for accidents only.
Repatriation and Medical Evacuation are
included in your Plan E Plus
Click Here to
Request a copy of the
EPI TeacherHealth
Insurance User Manual
Illnesses (examples of illnesses
typically covered: cold, flu, pneumonia, infection, new
allergies, bronchitis, urinary tract infection, conjunctivitis,
pelvic pain, cyst, rash, eye swelling, nausea/vomiting, animal
bites, ear infection, sinus pain, cuts, heart attack, stroke,
high fever, sudden/severe stomach pains, etc.)
Accidents (examples of injuries
typically covered by the Plan: medical expenses related to a car
accident (max $50,000), broken bone, back injury due to a fall,
injury from recreational sports, twisted or sprained ankle or
wrist, etc.)
$100,000
per accident or illness
Plan E Plus provides coverage for Accidents &
Sickness and medical emergencies. Your Plan will cover visits
to a Doctor, Specialist, Minute Clinic, Urgent Care, Emergency
Room and Hospital as well as associated X-rays, Lab work and
Prescriptions.
Be sure to notify the
UnitedHealthcare in the event of Hospitalization, Surgery and
MRI/CAT Scans for a pre-certification.
Physical Therapy treatment requires a referral from a licensed
doctor.
An Emergency Room should only be used in the event of a life
threatening Medical Emergency.
PRE-CERTIFICATION:
50%
reduction of eligible medical expenses if
pre-certification provisions are not met
The following must always be pre-certified for medical necessity
before admission or receiving treatments and/or supplies: Any treatment requiring
inpatient hospitalization, Surgery or surgical procedure,
including outpatient surgery, CAT scans or MRI's, Care in an extended care
facility, Home nursing care, Chemotherapy, Radiation Therapy, Interfacility Ambulance Transfer.
Preventive Care (Annual Wellness Exams, school wellness exam
and vaccinations)
NOT COVERED FOR DEPENDENTS
Preventive care and vaccinations are NOT covered by
Plan E Plus. However, EPI Teachers will receive a separate
Crescent Health Solutions insurance card that will be
used for Preventive care and Vaccines. This coverage is
for EPI Teachers ONLY.
When you are visiting the doctor for these services, please
present the Crescent Health Solutions insurance card,
rather than then the VISIT® Plan E Plus
UnitedHealthcare ID Card. (When visiting the doctor for an
accident and/or illness, then you will present the VISIT®
Plan E Plus UnitedHealthcare ID card.) If you have any questions
regarding the Preventive Care coverage, please contact
Crescent Health Solutions at 1-828-670-9145 and enter extension
3 directly or by email at
epi@crescenths.com.
IMPORTANT: Routine physical
exams and vaccinations are not covered on the J2 Plan.
We recommend that you look for a local Community Clinic or go to
a local Pharmacy to have these procedures as they can offer
these services for a lower cost than going to a doctor's office.
COVID-19
COVID-19, the disease caused by the
novel coronavirus, generally WILL be covered as would
any other illness under the EPI VISIT Health Plan,
including testing and treatment up to the policy limit. For
testing to be covered by the Insurance, you must be symptomatic.
Please be sure your Doctor’s Office submits your test as a SICK
visit. If the test is submitted as a Preventive Care visit the
claim will be denied.
Common
issues treated through Teladoc includes: allergies,
bronchitis, cold and flu symptoms, respiratory
infections, skin problems, sinus problems, and much
more.
Call
1-800-TELADOC (835-2362) or visit
www.teladoc.com to
access the TELADOC services –
Service is FREE! With TELADOC you can be
connected with a licensed physician in minutes, not
hours or days like you would at the ER, Urgent Care, or
with your Doctor. And, you can get care from
wherever you are home, work or traveling.
Prescription Drugs Reimbursed at
80%
In addition to your VISIT® Plan
E Plus Health Insurance ID card, you will receive two
Discount Drug Cards (Universal
Rx
and
WELLCARD) for your Prescriptions. When going to the
pharmacy, please present both Discount Drug Cards. If
the prescription is eligible for either discount, it will be
applied at the time of your purchase. If there is a remaining
cost due after the discount, please pay the remaining balance to
the pharmacy and keep the receipt. To be reimbursed for the
remaining balance of the prescription, please submit a PATIENT
Claim Form with your receipt and a copy of your prescription.
The deductible and co-insurance apply.
Click here
to download a copy of the Discount card to be used at your local
pharmacy
to access
Discounts through Lilly (Diabetic Medicine Assistance)
Deductible
The deductible is the portion of your medical bill that is your
responsibility.
$250 Annual Deductible (New August 1, 2023)
Your policy has a $250 ANNUAL DEDUCTIBLE. This
means you are responsible for the first $100 of medical expenses
each year. The deductible is paid to the doctor's office or the
Medical Facility that has provided you treatment.
Emergency Room:
$500 (New August 1, 2023)
(For Illness only, if not admitted Injuries not subject to ER
Deductible)
Copayment
Walk In Clinic:
$15 Urgent Care: $25
Coinsurance Your share of the costs of a covered health care service,
calculated as a percent of the allowed amount for the service.
In-Network
- 90/10% The
percentage of costs of a covered health care
service you pay after you have paid your Deductible and Copays.
NEW -
In-Network – 90/10
(Maximum
Out-of-Pocket $500 NOT including the Deductible and Copays)In-Network
you are responsible for paying 10%
of the first $5,000 in medical expenses. The Insurance company
will pay 90%. After $5,000 in medical expenses, the Insurance
company will pay 100% of covered medical expenses.
Out-of-Network – 80/20% (Maximum
Out-of-Pocket $1,000 NOT including the Deductible and Copays)Out-of-Network
you are responsible for paying 20% of the first $5,000 in
medical expenses. After $5,000 in medical expenses, the
Insurance company will pay 100% of covered medical expenses.
Local Ambulance Injury &
Illness must result in Inpatient Hospital admission
100% up to maximum limit
Chiropractor Care
Physical Therapy
Medical Order required from a Doctor
100% In-Network
Emergency
Medical Evacuation
up to $1,000,000
Repatriation
of mortal remains
(Must be approved in advance by the company)
Up to the maximum limit for return of mortal remains or ashes to
country of residence, or $5,000 maximum limit for cremation or
local burial at the place of death. Not subject to deductible
Pre-existing condition coverage
No coverage for any medical
condition, sickness, Injury, Illness, disease that existed at
the time of application or any time during the 36 months
prior to the effective date of coverage under this policy.
Click here to review the upgrade options. Contact
VISIT®
for more information.
AD&D -
Accidental Death & Dismemberment
$25,000 per
Insured/Spouse $5,000 per Dependent Child
Maternity coverage (including prenatal and miscarriage)
No coverage Click here to review the upgrade options. Contact
VISIT®
for more information.
Home Country coverage
14 Days Your plan includes coverage for Incidental Trips to
your Home Country:
Up to $50,000.
Dental (Accident Coverage only)
To a
maximum of $300 (available only if purchased for 1 month or
more)
Dental
Discounts are available on some dental procedures through
the WellCard. For more information, visit the WellCard website at
www.wellcardhealth.com/Public/DentalCare.aspx
Use Group# SC001600 to register
Emergency Eye Exam
Loss or Damage to prescription corrective lenses due to
an accident
$150 Maximum Limit $50 Deductible
Discounts are also available on eye exams and corrective
lenses through the WellCard. For more information, visit the
WellCard website at
www.wellcardhealth.com
Use Group#
SC001600 to register
Personal
Liability
$100,000
Trip
Interruption
up to $5,000
Return of
minor child
up to $100,000
Lost baggage
up to $250
Assistance
Services
Included -
1-800-628-4664 / 1-317-655-4500
Press 0 between 7am-6pm (EST) OR Press 9 between 6pm-7am (EST)
Preventive Care
- Preventive care and vaccinations are NOT covered by Plan
E Plus. However, EPI teachers will receive a separate
Crescent Health
Solutions
insurance card that will be used for Preventive care and
Vaccines. This coverage is for EPI Teachers ONLY.
When you are visiting the doctor for these services, please
present the Crescent Health Solutions insurance card, rather than
then the VISIT® Plan E Plus UnitedHealthcare ID Card.
(When visiting the doctor for an accident and/or illness, then
you will present the VISIT® Plan E Plus
UnitedHealthcare ID card.) If you have any questions regarding
the Preventive Care coverage, please contact Crescent
Health Solutions at 828-670-9145 and enter extension 104
directly.
Pre-existing conditions - Any medical condition,
sickness, injury, illness, disease that existed at the time of
application or any time during the 36 months prior to the
effective date of coverage under this policy is NOT covered.
Mental Health
- Any mental and nervous disorders or rest cures are NOT
covered. This includes treatment for anxiety, depression,
and stress related conditions. Treatments by a
Psychologist, Psychiatrist, Counselor or Medical Physician that
has diagnosed a mental/nervous condition are not covered. Please contact VISIT® at 703-660-9062 for more
information on how to
UPGRADE your plan to include Mental Health coverage.
Maternity -
Maternity including Pregnancy or
Illness resulting from Pregnancy, childbirth, or miscarriage is
NOT covered by Plan E Plus. The SHA Plan provides coverage
for maternity, however, you MUST be on the plan prior to
conception. Click here to review the upgrade options.
Please contact VISIT®
at 703-660-9062 for more information. Dental -Regular dental
care, treatment for cavities, root canals, and any other dental
condition is not covered. Damage to a tooth due to an
accident is covered to a maximum of $500.
Discounts are also available on eye exams and corrective
lenses through the WellCard. For more information, visit the
WellCard website at
www.wellcardhealth.com
Use Group# SC001600 to register Vision - Glasses and Eye Exams are not
covered. Infections and medical conditions like Pink Eye
may be covered. Please contact the Claims Office with any
specific medical condition questions.
Discounts are also available on eye exams and corrective
lenses through the WellCard. For more information, visit the
WellCard website at
www.wellcardhealth.com
Use Group#
SC001600
When calling your medical provider or
presenting your ID card say: “My healthcare coverage
uses the UnitedHealthcare Network
and I found your name on the directory."
DO NOT SAY: “I have VISIT Insurance
or I have IMG Insurance" or “I use IMG’ Network or
VISIT” or “I have the E Plus insurance.” Providers WILL
NOT recognize this language, and your coverage may not
be accepted.
TELADOC
- Call
1-800-TELADOC (835-2362) or visit
www.teladoc.com to
access the TELADOC services –
Service is FREE!
TELADOC
Service is FREE!
With TELADOC you can be connected with a licensed physician in
minutes, not hours or days like you would at the ER, Urgent
Care, or with your Doctor. And, you can get care from
wherever you are home, work or traveling. Common issues
treated through Teladoc includes allergies, bronchitis, cold and
flu symptoms, respiratory infections, skin problems, sinus
problems, and much more. Click here to Get Started
TELADOC should be used for
NON-EMERGENCY health issues ONLY! To set-up your
account, please go to www.teladoc.com
or download the APP.
When setting up your account, please use the IMG Insured ID
Number listed on the attached ID card and Zip Code 46208.
COVID-19,
the disease caused by the novel coronavirus,
generally WILL be covered as would any other
illness under the EPI Health Insurance policy,
including testing and treatment up to the policy
limit. If you have Dependents, please be sure
their policy is paid-to-date to avoid any lapse
in coverage!
• COVID-19 TESTING -
COVID-19 PCR Test is only covered if you are
symptomatic. The test will not
be covered for travel or non-illness related
testing. Your doctor must submit the COVID-19
test as a “sick
visit” and provide your medical records when submitting
your claim. You should also submit a Patient
Claim Form through your MyIMG Account explaining
your symptoms. To expediate your claim, please
ask for your medical records at the time of your
visit.
We encourage
you to use a FREE Testing site, if available, to
avoid additional out of pocket expenses.
Types of COVID-19 Tests: o COVID-19 PCR
Test – The COVID-19 PCR
Test is covered as long as you are symptomatic
at the time of the test. The polymerase
chain reaction (PCR) test for COVID-19 is a
molecular test that analyzes your upper respiratory specimen, looking for genetic
material (ribonucleic acid or RNA) of
SARS-CoV-2, the virus that causes COVID-19. PCR
tests are generally given at a Doctor’s office,
Urgent Care or Hospital. o COVID-19 RAPID Test and Home Test
- A viral test tells you if you have a current
infection. Two types of viral tests can be used:
nucleic acid amplification tests (NAATs) and
antigen (RAPID) tests. (The
Rapid Test is NOT COVERED by your plan) o
COVID-19 Antibody Test - An
antibody test (also known as a serology test)
tells you if you had a past infection. Antibody
tests should not be used to diagnose a current
infection. (Antibody
Test is NOT COVERED by your plan).
• COVID-19 VACCINE – The
COVID-19 Vaccine is currently being offered for
FREE at most facilities. An administrative fee
may apply. The COVID-19 vaccine is NOT covered
on your health plan.
• COVID-19 TREATMENT - If you
test positive for COVID-19, your medical expense
will be covered by the UnitedHealthcare Plan up
to the policy maximum of $100,000. If you are experiencing symptoms related to
COVID-19, it is important that you first contact
your doctor or urgent care facility by phone to
review the proper protocol to receive a test and
treatment for COVID-19. Be sure to follow the
current CDC Guidelines. When going to the
doctor, please be sure to take your
UnitedHealthcare Insurance card. If you need a
copy of your card, please email us at
epi@visitinsurance.com.
Prescriptions are covered at 80%, after your $100
Deductible for covered illnesses and injuries.
In addition to your
Health Insurance ID card, you will receive two
Discount Drug Cards (Universal Rx and
Wellcard)
for your Prescriptions.Click Hereto download a
copy of the card to be used at your local
pharmacy.
Where can I Use It? You may use your
Discount Prescription card at most major
Pharmacies,
click here for more information. When going to the pharmacy, please present
both Discount Drug Cards. If the prescription
is eligible for a discount, it will be applied
at the time of your purchase. If there is a
remaining cost due after the discount, please
pay the remaining balance to the pharmacy and
keep the receipt. To be reimbursed for the
remaining balance of the prescription, please
submit a PATIENT Claim Form with your receipt
and a copy of your prescription. The
deductible and co-insurance apply.
Prescriptions can
be filled at ANY Pharmacy.
In addition to your VISIT® Health
Insurance ID card, you have two Discount Drug Cards for your
Prescriptions. Please present both Discount Drug Cards at
the Pharmacy. If the prescription is eligible for a
discount, it will be applied when you purchase your
prescription.
(The Universal Rx Discount information is
now located on your VISIT® Plan Health Insurance ID card or
you can download a copy of the card by going to
https://imgpoc.com.
Please pay any remaining pharmacy costs
due after the discount and keep the receipt and a copy of
the prescription.
Steps for submitting your CLAIM for
REIMBURSEMENT
Complete and submit a PATIENT Claim
Form (include your Doctor visit and prescriptions on the
same PATIENT CLAIM FORM)
Include a copy of the Receipt.
Include a copy of the Prescription
(this can be the Prescription Information that is typically
stapled to the prescription bag)
The Claim can be submitted online
through your MyIMG
Account
Reimbursements are only for covered
medical expenses, not for pre-existing conditions.
Additional discounts may be available through the
pharmaceutical company that manufactures your prescription.)
Additional Prescription Resources:
Click here
to download a copy of the Universal Rx Discount card to be used at your local
pharmacy
Assist must be
contacted for the following reasons:
As soon as non-emergency hospitalization is
recommended.
Within 48 hours of the first working day
following an emergency admission.
When your physician recommends any surgery
including outpatient.
For emergency evacuation, repatriation, and
assistance services.
For
non-life threatening illnesses, please make an
appointment with a doctor or use a local non-emergency
clinic like Minute Clinic or Urgent Care - Walk-in
Clinics. A list of local providers are
located below.
If an emergency:
• Go directly to the hospital, or call 911 for emergency
response
• Call the 24-hour assistance service center at
1-800-628-4664
to alert
the center of your situation.
A Medical Emergency is an injury or illness that is acute and poses an
immediate risk to a person's life or long term health.
Some examples of medical emergencies
are:
Chest pain accompanied
by sweating, nausea, vomiting, shortness of breath,
radiating pain that moves to the arm or neck, dizziness, or
feeling that your heart is beating irregularly or too fast
Choking
Severe bleeding that
doesn't stop after 15 minutes of direct pressure
Fainting
Broken or displaced
bones
Swallowing poison
Burns
Suddenly not being
able to walk, speak, or move a portion of your body
For minor illnesses,
the following treatments are available at your local
Minute Clinic located inside CVS Pharmacy:
Diagnose, treat and
write prescriptions for common family illnesses such
as strep throat, bladder infections, pink eye, and
infections of the ears, nose and throat
Provide common
vaccinations for flu, pneumonia, pertussis and
hepatitis, among others
Treat minor wounds,
abrasions, joint sprains, and skin conditions such
as poison ivy, ringworm, lice and acne
Provide a wide range of
wellness services including TB testing, sports and
camp physicals, and lifestyle programs such as
smoking cessation and a medically based weight loss
program
Offer routine lab tests,
instant results and education for those with
diabetes, high cholesterol or high blood pressure
Provide care to adults
and children 18 months and older for most services
Precertification is a requirement under your
certificate for certain medical services.
Pre-certification is a general determination of medical
necessity only, not an assurance of coverage,
verification of benefits or a guarantee of payment.
The following must always be pre-certified for medical
necessity before admission or receiving the treatments
and/or supplies:
Any treatment requiring
inpatient hospitalization
Surgery or surgical procedure,
including outpatient surgery
CAT scans or MRI's
Care in an extended care
facility
Home nursing care
Chemotherapy
Radiation Therapy
Interfacility Ambulance Transfer
During the pre-certification process, medical professionals
review the planned medical services against standard medical
criteria to ensure that the services are within accepted medical
standards and are medically necessary.
Precertification may be initiated by you, your representative or
your medical provider. This can be done through MyIMG,
through
the Client Resources page of www.IMGLOBAL.com or
by calling IMG at 1-800-628-4664 (within the U.S.) or
1-317-655-4500.
Most U.S. hospitals and physicians are familiar with the
precertification process and will make the phone call for you,
though they are not required to do this. You are responsible
for ensuring the precertification process is done five days
before you are hospitalized or within 48 hours after an
emergency admission to the hospital.
Service at your fingertips anytime, anywhere - that’s what
MyIMG
provides.
MyIMG
is our proprietary online service that allows you to access
information and manage your IMG accounts, 24 hours a day, seven
days a week, from anywhere in the world. Our service centers in
the U.S. and Europe are always available to help or handle
emergencies 24 hours a day, but through MyIMG
you have immediate access to a wealth of information about your
account and can manage routine areas to help you save time when
you may need it most. Some features include:
You will need to put in your Health
Insurance ID Number and Date of Birth to set-up an account.
If you do not have your Health Insurance ID Number, please
contact our office at 703-660-9062.
Be sure your Doctor files your claim through
UnitedHealthcare using the information found on
your VISIT® Plan E Plus ID Card.
This will allow your doctor to file your claim
electronically which will help expedite the
claims process. Your ID card includes a Member
ID Number and a Group Number your Doctor must use to
file the claim properly. Improperly filed
claims may be delayed or denied.
UnitedHealthcare Member ID: xxxxx
(This number is found on your ID Card and is
unique for each person)
Your Doctor may contact
UnitedHealthcare at 1-800-628-4664with any questions on how to submit a claim.
Doctor's Claim Forms must be submitted directly to
UnitedHealthcare UHI Global
PO BOX 30526
Salt Lake City, UT 84130
PATIENT Claim Form
You must also complete a
PATIENT
Claim Form. This is a separate
form than the Claim information provided by your
Doctor.
Click here for a PATIENT Claim Form for
you or your dependents.
You
must submit the completed PATIENT Claim Forms to
VISIT® within 90 days of your visit to the doctor or
hospital. SUBMIT YOUR PATIENT Claim
Form Online:
MyIMG By email:
epi@visitinsurance.com
Fax: 703-991-9164
How can I be
reimbursed for medical payments I paid?
Any medical expense you have paid may be submitted
to the claims office for reimbursement. Please
complete and submit a PATIENT Claim Form and include
all receipts for expenses you have paid.
How do I Pay for My
Prescriptions? In addition to your VISIT®
Plan E Plus Health Insurance ID card, you will
receive two Discount Drug Cards (Universal
Rx and WELLCARD) for your Prescriptions. Be sure
to Register your WellCard online at
www.wellcardhealth.com. When going
to the pharmacy, please present both Discount
Drug Cards. If the prescription is eligible
for either discount, it will be applied at the time
of your purchase. If there is a remaining cost
due after the discount, please pay the remaining
balance to the pharmacy and keep the receipt.
To be reimbursed for the remaining balance of the
prescription, please submit a
PATIENT
Claim Form with your receipt and a copy of your
prescription. The deductible and
co-insurance apply.
If you have lost your ID CARD, please email
us at epi@visitinsurance.com to
request a replacement or you can download a copy
from your
MyIMG
Account.
If you are
filing for a reimbursement, you will need to file a
Claim Form, please submit the original, itemized bills
and payment receipts to us along with a Claim Form
below. Claims must be filed within
90 days of your medical procedure.
CLAIM FORMS
VISIT®
E Plus Plans - Medical Claim Form -
English
VISIT®
E Plus Plans - Medical Claim Form -
Spanish
How do I check on the status
of my Claim? For
claims questions, please first check your MyIMG
Account.
After checking your online account, if you still
have questions,
we ask that you
provide the following information by email to us at
epi@visitinsurance.com:
Name of the
Person the Claim is for – if it is for a
dependent, please provide THEIR full name
Date you or your
dependent went to the doctor?
Name of the doctor
you or your dependent went to?
Amount of the
claim?
Any specific
questions or details you have about the claim?
If you have a copy
of a bill you do not understand, please include
a copy of the bill in your email?
One of our
Claims Advocate will review your Inquiry and work on
resolving your questions and or concerns. Our Claims
Advocate will need a few days to review the
information and research the claim. Due to the high
call volume, the preferred and most efficient form
of communication is
EMAIL Therefore it’s important that you check
your email often because we may need additional
information to resolve your concerns quickly and
accurately.
*Please
note, the Claims Office will make the final
determination on your claim (NOT VISIT Insurance).
VISIT Insurance can assist you in making sure you
have filed all the proper forms (Doctor and Patient
Claim Forms, Medical Records, Accident Form and
Subrogation Form as required) in order to have your
clam properly processed as well as assist you in
understanding any documents you may have received.
If your Claim is showing as PENDING, please
be sure to check the status of the claim on your
MyIMG
Account to see what information is needed to
finalize your claim.
There
is no record of my claim
Contact your doctor's office and ask
them to submit the claim to IMG. If they say
they have already submitted the claim, be sure to
verify the address they sent the claim to and the
date it was sent. Email this information to
insurance@imglobal.com and ask the Claims Office
to research their records to see if the claim is in
their system. If the Claims Office is unable
to locate the claim, please contact your doctor's
office and ask them to resubmit the claim.
Claims can be mailed to:
International
Medical Group, Inc.
Claims Department PO BOX 88500
Farmington Hill, MI 48333
Patient to submit a completed IMG Claim Form You must
complete a PATIENT
IMG Claim Form to process your claim. This
form can be completed online through your
MyIMG Account or you can download the
IMG Claim Form and mail it or fax it to the
claims office.
Charges
pending receipt of medical records requested from
provider
To process your claim, your
doctor must provide the medical records to IMG for
your treatment. Please contact your doctor's
office and ask them to submit your medical records
to the IMG. Medical records can be mailed to:
International Medical Group,
Inc. Claims Department PO BOX 88500
Farmington Hill, MI 48333
Your file has been closed due to a lack of
response
This means that additional
information has been requested but the Claims Office
has not received the information.
The file can be
reopened once the information is received.
In order to
process these charges, please submit on a HCFA/UB
Form Indicating Standardized procedure (CPT) and
Diagnosis (ICD) codes. These forms are standard forms
that doctors use to file a claim with an insurance
company. Your doctor should have these forms
available. If they are not sure what to file
or have questions, please have the them call IMG at
1-800-628-4664.
How long do I have to file a claim?
Your
IMG PATIENT Claim Form
must be submitted to the IMG Claims Office within 90
days of your visit to the doctor, urgent care,
emergency room and/or hospital. You and your
doctor, hospital and other healthcare and medical
service providers and suppliers shall have one
hundred eighty (180) days from the date a claim is
incurred to submit a complete Proof of Claim,
medical records and any additional information
needed to process your claim.
Click Hereto request a copy of the
EPI TEACHER User Manual
for Answers to Frequently
Asked CLAIMS
Questions
For Members
For Providers
VISIT®
at
1-800-247-5575
or
1-703-660-9062 Monday - Friday 9am to 6pm, available by
email after hours. Email:
epi@visitinsurance.com
For emergency and other assistance services
Assist 24/7:
1-800-628-4664 (toll free) or
0-317-655-4505 (collect)
To a Report a Claim,
Verify Eligibility or Check on the Status of
a Claim Contact: International Medical Group, Inc.
Claims Department PO BOX 88500
Farmington Hill, MI 48333
What is a Deductible?
For a covered medical expense, the deductible is the portion of
your medical bill that is your responsibility. The
deductible will first be subtracted from the total medical
bill and you will need to pay this portion directly to the
doctor or hospital.
Your deductible is $100
per year.
What is Co-insurance?
After You pay the Deductible, the plan pays 80%
of the next $5,000 of eligible expenses, then 100% to the
selected Medical maximum.
How do I Pay
for My Prescriptions? Prescriptions are
a reimbursable expense. You will need to pay for your
prescription and then complete a claim form to be reimbursed.
If you need to apply for a reimbursement,
download a Claim Form.
VISIT®
E Plus Plans - Medical Claim Form -
English
What is a pre-existing condition?
A Pre-existing condition means any medical condition, sickness,
Injury, Illness, disease, Mental Illness or Mental Nervous
Disorder, regardless of the cause including any congenital,
chronic, subsequent, or recurring complications or consequences
related thereto or resulting therefrom that with reasonable
medical certainty existed at the time of application or any time
during the 36 months prior to the effective date of coverage
under this policy , whether or not previously manifested ,
symptomatic, known, diagnosed , treated or disclosed. This
specifically includes but is not limited to any medical
condition, sickness, Injury , Illness, disease, Mental Illness
or Mental Nervous Disorder , for which medical advice ,
diagnosis , care or treatment was recommended or received or for
which a reasonably prudent person would have sought treatment
during the 36 month period immediately preceding the effective
date of coverage under this policy.
What is Precertification? Emergency Pre-certification: In the event
of an Emergency Hospital admission, Pre-certification must be
made within 48 hours after the admission, or as soon as is
reasonably possible.
Pre-certification Does
Not Guarantee Benefits – The fact that expenses are
Pre-certified does not guarantee either payment of benefits or
the amount of benefits. Eligibility for and payment of benefits
are subject to all the terms, conditions, provisions and
exclusions herein.
Concurrent Review – For Inpatient stays of any
kind, the Plan Administrator will Pre-certify a limited number
of days of confinement. Additional days of Inpatient confinement
may later be Pre-certified if a Member receives prior approval.
What is a Reasonable & Customary charge?
Reasonable and Customary charge is the amount normally charged
by medical service providers for similar services and supplies
in your area of living. Doctor's not in the Multiplan
Network are not required to charge the Reasonable and Customary
charge. Please note:
Going to a doctor or hospital outside the
UnitedHealthcare Network may
result in higher payments for your medical procedure and a
higher out-of-pocket expense for you and your family.
What is Medical Evacuation?
Medical Evacuation means transferring the insured person to the
nearest hospital or medical facility in case of an emergency
injury or sickness or back to his/her home country. It can be
done by any necessary means of transportation.
What is Repatriation?
In case of death, the Repatriation benefit covers the
transportation of your remains back to your family and your home
country.
Are Injuries from Sports Covered?
Recreational sports are covered through the regular medical
coverage.Injuries
from intercollegiate, interscholastic, intramural or club
sports are not covered.
Is there Dental Coverage?
There is limited coverage injury to natural
teeth on your policy.
Do I need a referral to go to a Specialist?
A doctor’s referral typically is not required.
VISIT®
International Health Insurance
Programs
P.O. Box 210
Mount Vernon, VA 22121 Phone: 1-703-660-9062 /
1-800-247-5575 Fax: 1-703-991-9164 Email:epi@visitinsurance.com
Hours: Monday - Friday 9:00 am to 6:00 pm
VISIT®
International Health Insurance
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