Welcome to the Performance Insurance Benefits Claims Education Center!
We have provided explanations below and are working on videos to help guide you through the claims process and answer questions that you might have when it comes to how health insurance claims work. For Group plans, please reference your “Fringe Benefits Summary” for a detailed overview of the policies offered to your company.
HIPAA Release Form
CLICK HERE to download a HIPPA RELEASE FORM so we may assist you with your claim OR be able to be an advocate on your behalf
Medical Insurance Claim Form
CLICK HERE to download a multi-purpose medical insurance claim form. This form will be useful for medical insurance claims that did not get submitted by the provider OR Non-Network Claims
Supplemental “Gap” Insurance
We understand that it can be a bit confusing when it comes to using supplemental gap insurance along with your primary health insurance policy. An important thing to keep in mind is that you can present multiple insurance ID cards/policies to whoever is providing you services at the time of your visit. However, not all providers have the ability to bill both your primary health insurance provider as well as your secondary (supplemental) insurance for services that are performed due to limitations within the information processing systems that they use. It is still ideal that you attempt to have both billed initially as it will save you from having to file a Gap insurance claim later on. If you are unable to have the provider of services bill your supplemental insurance directly, you can fill out a Gap claim form and submit it to the insurance company before or after you pay the provider for services. On the Gap claim form, you have the option to designate whether you would like the supplemental insurance to pay the provider directly or to pay you instead. In most cases you will only have the supplemental insurance pay you directly if you are being reimbursed for what you already paid to the provider at the time of service.
Supplemental Gap Claim Paperwork
After you have obtained and filled out a claim form for your Gap policy, you will need to obtain an itemized bill(s) from the provider that has the diagnosis and procedure codes from your visit. The supplemental insurance provider uses those diagnosis and procedure codes to determine if your visit qualifies for benefits under the policy you possess. In addition to supplying the itemized bill(s) with codes to the insurance carrier, you will need to attach copies of your Explanation of Benefits (EOB) to the claims paperwork that you submit. Your EOB is a document that breaks down how the provider billed your insurance carrier and what balance is left over after your insurance was billed. It also provides explanation as to why certain services may or may not have been covered under your insurance policy. The important thing on the EOB is the remaining balance that is designated as your responsibility. Your supplemental insurance will only provide payment for the remaining balance that was not paid by your primary health insurance carrier up to the amount of benefit that it supplies.
See the corresponding Gap policy paperwork for each carrier below:
TransConnect Claim Form – Claim form used to file a Transconnect Gap Claim
TransConnect Brochure – Employee Brochure outlining benefits under a Transconnect Policy
TransConnect ID Card Template – Template of what a Transconnect ID card looks like
Other Supplemental Insurance Policies (Accident, Cancer, Critical Illness, Disability, Etc.)
Policies other than Gap provide benefits that are independent of the costs associated with your benefits. For example, you may receive set benefits under your Accident policy that satisfy a certain diagnosis or injury criteria. A fundamental difference between these supplemental policies and a Gap policy is that you do not need an Explanation of Benefits (EOB) from your primary health insurance carrier because you are not being reimbursed for the actual costs of services. However, you still need itemized bills that have the procedure and diagnosis codes that the insurance company will use to determine what benefits you qualify for under your policy. In some cases, you will also be required to obtain and submit the doctor’s notes from the visit if you are requesting benefits for something that is requesting more detailed benefits (i.e. multiple fractures or a burn that qualifies for increased benefit based on its size).
For Cancer and Critical Illness claims, you will also need a pathology report that designates that you have been accurately diagnosed with an illness that is payable under the policy. Please review the claim paperwork and instructions associated with the specific type of claim that you are filing to avoid receiving a letter of denial for benefits not covered and possibly having to submit additional paperwork.
TransAmerica – Accident
TransAmerica Accident Claim Form – Form for a TransAmerica Accident Claim
TransAmerica Accident Plan Summary – With $30 Follow-up and Physical Therapy Benefits
TransAmerica Accident Plan Summary – With $60 Follow-up and Physical Therapy Benefits
TransAmerica – Cancer
TransAmerica – Critical Ilness
TransAmerica Critical Illness Claim Form – Claim form for a TransAmerica Critical Illness Claim
TransAmerica Critical Illness Claim Instructions – Instructions for submitting a TransAmerica Critical Illness Claim
A Note about the Cancer and Critical Illness Wellness Benefit
For Cancer and Critical Illness policies, you qualify for annual wellness benefits ($50 under a Critical Illness policy and $150 under a Cancer Select policy). In order to receive the wellness benefit under these policies you must have one of the tests listed on the brochure performed at your visit.
TransAmerica Wellness Brochure for Cancer and Critical Illness Policies – Brochure that lists qualifying tests for wellness benefits under Cancer or Critical Illness Policies
Summary and Conclusion
This information is designed to provide a brief overview of the claims process and what is needed to file certain claims with your insurance carrier. We understand that this page may not answer all your questions. If you have additional questions, please contact us and we will assist you through the claims process.
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Phoenix , AZ 85024
Phone : 602-595-1451
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