Claims Submission Process
You made a wise decision by choosing Caribbean Insurers (Health) Limited (“CIHL”) for your health insurance needs. As a valued customer, you have a dependable, quality health plan from a leading health insurance Carrier which provides peace of mind.
And when it comes to service, you have high expectations – CIHL strives to exceed them with extensive provider networks, prompt and fair claims payment and excellent customer service.
Important facts you should know about filing for a claim
- Claims processing is usually completed within 30 working days from the date of filing
- It is a condition of this Certificate that Underwriters are advised full details of all potential or actual claims that may give rise to a Covered Medical Expense under your policy, even if such Covered Medical Expense falls wholly or partly within the applicable Deductible. Any such claim must be advised to CIHL identity card as soon as is reasonably possible, but in no event later than 90 days from the date services are first rendered. Failure to comply with this condition in relation to any claim will lead to denial of that claim
- If your Certificate/Policy is terminated for whatever reason, claims commenced before the date of termination must be advised to CIHL within 30 days of the date of termination. Claims advised over 30 days will be denied
- All claim payments are made locally
To file a claim it is a requirement of your policy that CIHL (or your Policy’s Underwriter) must be provided with:
- The name of the claimant and his/her ID card number;
- The date of the commencement of the claim;
- Diagnosis and/or details of the illness or injury;
- Originals of all operative/medical bills and expenses;
- Originals of all medical reports from attending Physicians;
- Details of any other relevant expenses
Failure to comply with the above claims reporting requirements will result in the claim being denied.
Date a Covered Medical Expense is incurred
Unless otherwise stated in your Policy, the date that a Covered Medical Expense is incurred is the date that the covered treatment, service or supply is rendered to the Insured Person provided that such date is on or after the Effective Date of Cover and prior to the expiry of this Certificate/Policy.
Examination
The Underwriters shall have the right at the Underwriters’ own expense and opportunity through their medical representatives to request a physical examination to the Insured Person when and so often as they may reasonably require for the duration of a claim hereunder, and also the right and opportunity to make an autopsy in the case of death where it is not forbidden by law.
Review of a denied claim
If a claim is denied, in whole or in part, Underwriters will advise the Insured Person and will specify the reason or describe any additional information required to complete the claim. All appeals should be submitted in writing, within 45 days after receiving the explanation of denial or benefits. Underwriters will re-evaluate the claim in question and give a final written decision on the re-evaluation within 45 days, or 90 days, if additional information is required, after such request is received. If, after the expiration of 90 days, the additional information has not been received, the appeal will be considered closed, and no determination will be made at that time.
Still have a question? Call one of our friendly Customer Service Representatives who will be ready to assist you.
Health insurance plans are issued and underwritten by Lloyd’s, Sagicor and Nemwil – plus the UK’s top health Insurer, BUPA. All companies are AM Best ‘A’ rated Insurers.