FAQs

Q. Is the coverage that is offered Major Medical?
A. No. This coverage is designed to supplement any other coverage that you may have. This coverage is not considered a secondary plan and there is no coordination of benefits with any other insurance carrier that you may have.

Q. How do I file a claim?
A. A completed claim form will need to be submitted to our Claims Department for processing. Please complete the claim form in its entirety. Detailed instructions are included along with the claim form. A claim form and instructions may be obtained by calling our Customer Service Center, downloading the form from our website or in your certificate package that you received.

Q. How long do I have to file a claim?
A. There is a one-year timely filing provision in your certificate.

Q. I submitted a claim form. Did you receive it?
A. Once a claim form has been received, it normally takes 2 - 3 working days to pre-process the claim before it is sent to the Claims Examiner for processing. During this pre-processing stage the claim form is not accessible for review until the pre-processing is complete and entered into the claim system.

Q. Once the pre-processing of my claim is complete, how long will it take to process my claim?
A. Total processing of the claim, including pre-processing is 10 - 15 business days.

Q. After the claim is processed, will I receive my check?
A. If all the provisions of the certificate are met, then your claim will be considered for benefits.

Q. What if all the provisions of the certificate are not met? How long will it take to process my claim?
A. Claims submitted for benefits that are subject to a pre-existing condition exclusion, waiting period or within the contestability period of the policy may require additional medical information that can extend processing time. Also, in the event that a claim form is not completed in its entirety, additional information may be requested. However, you will be notified within 10 - 15 days of any additional information needed to continue the processing of your claim.

Q. Will my benefit check be payable to me?
A. If not otherwise required by law, benefits will be paid directly to you, the insured, unless you authorize a hospital, physician or other health care provider to receive your benefits. This is called "assigning benefits." You can assign your benefits by signing the appropriate section on the claim form or by signing an assignment of benefits at the provider's office in the event that the provider files the claim for you.

Q. Are my benefits taxable?
A. If you pay your premiums under a flexible benefits plan with pretax dollars, or if your employer pays part or all of your premiums, some of the benefits you receive may be taxable. You may receive a W-2 form from your employer that will include the benefit amount you received that may be taxable. If you have questions about taxability of benefits, discuss them with your employer or contact your tax advisor.

Q. Can I fax my claim in?
A. No. The original claim form is required to process your claim.

Q. If I send my claim form in overnight or by Federal Express will this help to expedite my claim?
A. Claims delivered in this manner will expedited the delivery of mail time but will not expedite the processing of the claim. Claims are processed in received date order, not by method of delivery.

Q. What information do I need to file a claim?
A. Please follow the detailed instructions on the claim form. To expedite your claim, it is important that you send us as much information as possible. Delays can be experienced when incomplete information is submitted. Depending on the claim submitted, the following information will be needed along with the completed claim form.

• Disability Claims -There are 3 sections of the initial claim form. Part A, which is your section of the claim form, Part B, which is the employer's section of the claim form and Part C, which is the attending physician's section of the claim form. A signed and dated HIPPA authorization will need to be completed.
• Hospitalization Claims - Itemized bill showing admission and discharge dates, inpatient room charges (semi or private room charges), diagnosis and a signed and dated HIPPA authorization.
• Accident Claims - complete description of your accident. If the accident was motor vehicle accident, a copy of the police or accident report is required. If your injury occurred on the job, a first report of injury filed with your employer will need to be attached to the completed claim form. If you were first treated in the emergency room, a copy of the discharge papers from the hospital will be required to verify the first date of treatment.
• Health Screening or Wellness Claims - itemized bill that includes date of service, type of test performed, charges, and provider's name, address and phone number.
• Critical Illness Claims - Medical documentation required for specific critical illness (see claim form), birth certificate, names of all doctors and hospital in attendance and a signed and dated HIPPA authorization.
• Cancer Claims - pathology report used in the diagnosis of a malignant cancer, birth certificate, any itemized medical bills with the diagnosis and procedure codes and a signed and dated HIPPA authorization.
• Beneficiary's Statement for Death Claim -a certified copy of the birth and death certificate. If the cause of death is due to and injury or accident, a copy of the police report is required.

Q. Who completes the Beneficiary's Statement?
A. The Beneficiary's statement must be completed by the person(s) to whom the insurance may be payable.

Q. If my disability claim is ongoing, will the initial claim form that I submit support my ongoing disability.
A. No. A supplemental claim form will be required with updated medical information and employer's verification, as requested by your Claims Examiner.

Q. What is a HIPPA authorization and why is it needed?
A. This is an authorization form that is completed by the insured for the purpose of evaluating your eligibility for insurance and eligibility for benefits under your existing certificate. This authorization form completed by you authorizes your medical providers to disclose any medical documentation needed to complete the processing of your claim. Congress passed the Health Insurance Portability and Accountability Act (HIPAA) in 1996. The part of HIPAA that deals with privacy provisions is called the Privacy Rule. It lays out requirements for protecting individuals' medical records and other personal health information, referred to as protected health information (PHI). Generally, the Privacy Rule requires health care providers, health plans and health care clearinghouses to:

• Limit the use and disclosure of protected health information.
• Obtain a written authorization for some uses and disclosures of protected health information.
• Notify individuals about their privacy rights and respond when individuals invoke their rights.
• Require their business associates, including sales representatives, to agree to safeguard the privacy of protected health information.
• Adopt and implement privacy policies and procedures.
• Train their workforce on privacy policies and procedures.
• Secure protected health information so it's not available to those who don't need it.

Q. How do I make changes to my personal information such as name changes or address changes.
A. You can download a Service Request form from the website or call our Customer Service department for a Service Request form to be mailed out to you. Any changes must be accompanied to a dated signature.

Q. Can I keep my certificate on an individual basis if I should terminated my employment?
A. You would have to refer to the verbiage of your certificate. If your certificate carries a portability clause then you would need to make a written statement within 31 days of your termination date. There may be other stipulations regarding the portability privilege under your plan that you would need to refer to. In the event that your plan is portable and your previous employer terminates the plan, your plan would also terminate.

Q. If I continue my coverage on an individual basis, can I increase my coverage at anytime?
A. No. The option to increase will no longer be available on an individual basis.

Q. If I am eligible to keep my coverage on an individual basis, what payment options do I have?
A. There are 4 payment options which are monthly electronic draft from your banking account, paying your premiums quarterly, semi-annually or annually. Paying your premiums other than monthly cannot be set up electronically. A premium due notice will be generate when the premium is due.

Q. Who do I call regarding questions about my coverage?
A. You can call our Customer Service Center between the hours of 8:00 a.m. to 5:00 p.m. Eastern Standard Time or you can email our Customer Service Center at CSC@caicworksite.com

Q. How do I pay my premium while on leave of absence?
A. You can call our Customer Service Department and you will be advised of the proper procedure. Typically under the Family Medical Leave Act, which is 3 months or less, you would need to send the amount that would have been deducted from your paycheck for the pay periods you will miss.

Q. What if I want to cancel my coverage?
A. Call our Customer Service Center and you will be advised on the cancellation procedures.

Q. Does my Life Insurance coverage accumulate cash value?
A. Yes. However, it normally takes about 3 - 5 years before the cash value begins to accumulate.

Q. How is the cash value accumulated?
A. Cash values are accumulated by crediting premium payments and interest to a fund from which deductions are made for expenses and cost of insurance. The rates at which the interest is credited are declared by the company or may be specified in the certificate. The initial surrender charge is determined at the beginning of each certificate year. The fund value (not to be confused with the surrender value) is accrued based on the premium deposited. Once the fund value exceeds the surrender charge is when the cash value begins to grow.

Q. Once my certificate has accrued cash value, can I take a loan against the cash value and how long does the process take?
A. You can take a loan against the accrued cash value. The request for a loan must be in writing from the owner of the certificate. There is an interest rate that will be charged for loans as described in the certificate schedule page. Processing of a loan request is a minimum of 45 days and a maximum of 6 months.

Q. How do I repay my loan?
A. The loan may be repaid partially, at a minimum of at least $10.00 or all at the same time to include the interest that has accrued. However, repayment may be made only while the certificate is in force and prior to the death of the insured.

Q. What will happen to my life insurance certificate if the loan and the interest that has accrued exceed the cash value?
A. The certificate will lapse. However, at least 31 days prior notice must be mailed by us to the owner's last know address.

Q. How do I change my beneficiary on my life insurance plan?
A. A Service Request form can be downloaded from the website or you can call our Customer Service Department for this form. When changing a beneficiary, someone must witness the form other than the beneficiary or the owner of the certificate.

Q. Will I receive an annual statement on my life insurance?
A. You will receive an annual statement on the anniversary date of your Universal Life plan. Annual statements are not generated on Whole Life plans.

Q. What information will I find in the annual statement?
A. This statement shows the current certificate values, premiums paid and deductions made since the last report and any outstanding certificate loans.

Q. Can I continue my Universal Life insurance on an individual basis?
A. Yes. With the Universal Life plan, if the Group Master Policy terminates, the insured will continue to have coverage as long as the premiums are paid.

Q. What if I stop paying my premiums but do not cash surrender my Universal Life plan?
A. If payment of premiums discontinues and the certificate is not surrendered, monthly deductions will continue as long as there is sufficient accumulated value. The certificate will remain inforce until the earlier of the following dates: 1.) The maturity date (if there is sufficient accumulated value to make monthly deduction to that date), or 2.) The end of the grace period. 3.) The date of the insured's death.