HCC Medical Insurance Services
HCCMIS Producer Guide
Producer Guide
251 N. Illinois Street, Suite 600
Indianapolis, IN 46204
Phone: (800) 605-2282 or (317) 262-2132
Fax: (317) 262-2140
www.hccmis.com
Table of Contents
Table of Contents .................................................................................................................. 1 Chapter 1: Introduction ........................................................................................................ 3 HCCMIS Structure ............................................................................................................................................ 3 Purpose of this Guide ........................................................................................................................................ 3 Online Capabilities ............................................................................................................................................ 3 Chapter 2: The International Market .................................................................................... 5 Finding the Business ......................................................................................................................................... 5 The Contracting Process................................................................................................................................... 5 Producer Zone................................................................................................................................................... 6 Producer Commissions ..................................................................................................................................... 6 Language .......................................................................................................................................................... 6 Chapter 3: Product Focus – CitizenSecure® Plans ............................................................ 7 Eligibility ............................................................................................................................................................ 7 Effective Date/Date of Departure & Projected Length of Residence Outside of US......................................... 8 Quoting CitizenSecure®..................................................................................................................................... 8 The Application Process ................................................................................................................................... 9 Pre-existing Conditions ................................................................................................................................... 11 Client Confidentiality ....................................................................................................................................... 11 Deductible and Coinsurance ........................................................................................................................... 11 Maternity Benefits ........................................................................................................................................... 11 Optional Dental Rider ...................................................................................................................................... 12 Optional Hazardous Sports Rider ................................................................................................................... 12 Optional Term Life ........................................................................................................................................... 12 Renewal Options ............................................................................................................................................. 12 Reinstatement ................................................................................................................................................. 13 Cancellation..................................................................................................................................................... 13 Chapter 4: Product Focus – The Atlas Series .................................................................. 14 Plan Selection ................................................................................................................................................. 14 Application and Fulfillment .............................................................................................................................. 15 Extending or Renewing Coverage .................................................................................................................. 15 Home Country Medical Coverage ................................................................................................................... 15 Sports Rider .................................................................................................................................................... 16 Terrorism Coverage ........................................................................................................................................ 16 Atlas Group Travel .......................................................................................................................................... 16 Atlas Professional ........................................................................................................................................... 17 Policy Cancellation .......................................................................................................................................... 17 Chapter 5: Product Focus – Atlas Corporate Travel ........................................................ 18 How to Obtain a Proposal ............................................................................................................................... 18 Account Management System ........................................................................................................................ 18 Enrollment, Extending Coverage and Renewing a Policy .............................................................................. 18 Home Country Medical Coverage ................................................................................................................... 19 Optional Sports Rider ...................................................................................................................................... 19 Terrorism Coverage ........................................................................................................................................ 19 Chapter 6: Product Focus – StudentSecure® ................................................................... 20 Plan Selection ................................................................................................................................................. 20 Application and Fulfillment .............................................................................................................................. 20 Extending or Renewing Coverage .................................................................................................................. 21 Home Country Medical Coverage ................................................................................................................... 21 Organized Sports Activities ............................................................................................................................. 21 Terrorism Coverage ........................................................................................................................................ 21 Eligibility .......................................................................................................................................................... 22 Chapter 7: Product Focus – GroupSecure® ...................................................................... 23 1
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Group Eligibility ............................................................................................................................................... 23 Advantages of a Group Benefit Plan ............................................................................................................... 23 Completing the Request for Proposal Form.................................................................................................... 23 Enrollment and Participation ........................................................................................................................... 23 Chapter 8: Product Focus – HCC Life Short Term Medical (STM) .................................. 25 Policy Selection ............................................................................................................................................... 25 Pre-existing Conditions ................................................................................................................................... 25 Policy Eligibility ................................................................................................................................................ 25 Application and Fulfillment .............................................................................................................................. 26 Purchasing an Additional Policy ...................................................................................................................... 26 Consumer Benefits of America ....................................................................................................................... 26 Agent Licensing ............................................................................................................................................... 26 Chapter 9: Product Focus – Other Product Options ........................................................ 27 IC+ Term Life .................................................................................................................................................. 27 Other HCCMIS Plan Options .......................................................................................................................... 27 Chapter 10: Claims Procedures ......................................................................................... 28 Pre-Certification Requirement ......................................................................................................................... 28 Emergency Room Charges ............................................................................................................................. 28 Claims Submission Procedures ...................................................................................................................... 28 PPO Network & Provider Referrals ................................................................................................................. 29 Claims Appeals ............................................................................................................................................... 29 Chapter 11: Policy Administration & Customer Service.................................................. 30 HCCMIS’s World Service Center .................................................................................................................... 30 Application Submission ................................................................................................................................... 30 Application Processing – CitizenSecure®........................................................................................................ 30 Application Processing – Atlas, StudentSecure® and HCC Life STM ............................................................. 31 Application Processing – GroupSecure®......................................................................................................... 31 Application Processing – IC+ .......................................................................................................................... 31 Changes and Updates of Policyholder Information......................................................................................... 32 Languages....................................................................................................................................................... 32 Chapter 12: Departments of HCC Medical Insurance Services....................................... 33 Marketing and Sales ....................................................................................................................................... 33 World Service Center ...................................................................................................................................... 33 Underwriting .................................................................................................................................................... 33 Claims ............................................................................................................................................................. 33 Project Management ....................................................................................................................................... 33 Compliance ..................................................................................................................................................... 34 2
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Chapter 1: Introduction
HCCMIS Structure
The first thing to know about HCC Medical Insurance Services (“HCCMIS”, www.hccmis.com) is that we are a whollyowned subsidiary of HCC Insurance Holdings, Inc. (NYSE: “HCC”, www.hcc.com). Headquartered in Houston, Texas,
HCC is a leading international specialty insurance group with offices across the United States and in the United Kingdom,
Spain, and Ireland. HCC specializes in diversified financial products; group life, accident and health; aviation; London
market account; and other specialty lines of business. HCC's major domestic and international insurance companies have
a financial strength rating of "AA (Very Strong)" from Standard & Poor's Corporation. HCC's major domestic insurance
companies have a financial strength rating of "AA (Very Strong)" from Fitch Ratings, "A1 (Good Security)" from Moody's
Investors Service, Inc., and "A+ (Superior)" by A.M. Best Company, Inc. HCC trades on the New York Stock Exchange
under the symbol “HCC.” With assets of $8.8 billion and shareholders' equity of $3.0 billion at December 31, 2009, HCC is
well capitalized and well positioned to continue its success.
HCCMIS is a managing general underwriter for Lloyd’s, London (www.lloyds.com). All international health, travel, and
group benefit products offered by HCCMIS are fully insured by Syndicate 4141 at Lloyd’s, London; international life
insurance products are underwritten by Syndicate 308, also at Lloyd’s. Lloyd’s, the world’s oldest and largest insurance
market, is rated “A+ (Strong)” by Standard & Poor’s and “A (Excellent)” by A.M. Best Company. All product development,
policy administration, underwriting services, marketing, information technology service, commission payment, accounting,
customer service, and claims processing for all plans administered by HCCMIS is conducted in-house at HCCMIS.
The short term domestic plan, HCC Life STM, is underwritten by HCC Life Insurance Company (“HCC Life”,
www.hcclife.com), rated “A+ (Superior)” by A.M. Best Company. HCC Life has been an industry leader in medical stoploss and excess lines coverage for more than 30 years. HCC Life, an Indiana-domiciled insurer, has offices in Atlanta,
Boston, Dallas, Indianapolis, Minneapolis & Scottsdale and writes over $750 million dollars in premium annually. Product
development, administration, and claims processing for HCC Life STM are handled by HCC Life in the Indianapolis office.
Commissions are paid by HCCMIS.
Purpose of this Guide
This guide is designed to save our producers time and effort by helping them to better understand the HCCMIS products
as well as the processes and protocols HCCMIS uses in its everyday business operation. While no guide can offer
answers to every question in every situation, a thorough reading of this guide and regular consultation should help you
spend less time chasing paper and making phone calls and more time doing what you do best – selling more insurance.
This material is a living document and we at HCCMIS rely on you, the producer, to assist us in serving you more
effectively on an ongoing basis. Your communication to the HCCMIS Marketing Department is crucial to the continuing
development of this time-saving material. Feedback may be submitted to us via email at insurance@hccmis.com.
Online Capabilities
HCC Medical Insurance Services (HCCMIS) is a fully internet enabled insurance business model. Beginning with our
Instant Online Quoting and Application System, HCCMIS makes every effort to leverage the power of the Internet and
its functions and routinely reevaluates and refines our tools to make the experience for our producers and their clients
easy, secure and as efficient as possible. HCCMIS’s entire product portfolio is designed to resonate superbly in today’s
online environment and is available in PDF format as well as traditional print. When you submit a completed Producer
Agreement, a welcome e-mail will be sent containing instructions on how to access these attractive and useful marketing
materials via Producer Zone (discussed in Chapter 2).
Along with our Online Quoting and Application System, HCCMIS is also able to provide our producers with a Live Help
tool that both the producer and their client may utilize. This tool offers immediate assistance during business hours for
product questions that may arise. When it comes to finding the appropriate product, HCCMIS also offers our Product
Selection Tool. With just a few simple questions, the Product Selection Tool can point you in the right direction for the
product that fits the client’s needs. Both the Live Help and Product Selection Tools are customizable and available to
place directly on a producer’s website. You may contact your Account Executive for more information regarding either
tool.
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Whether you need customized electronic brochures and applications, access to your production history, a customized
version of our quoting system, Live Help, or Product Selection Tool for your website, HCCMIS stands ready to assist via
e-mail (insurance@hccmis.com), fax (317-262-2140), or telephone (800-605-2282 or 317-262-2132). As always, your
Account Executive is available to assist with any questions, concerns or comments that you may have.
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Chapter 2: The International Market
International health, travel medical, group benefit, and term life products are all designed for those who are
traveling internationally, for US citizens living abroad, and for foreign nationals living in many countries around
the world. The complexion of the world is changing, international travel is reaching all-time highs, and business
people are living as expatriates in ever-increasing numbers. Many public medical systems in the world cannot
respond to the needs of their constituents in a timely manner. This circumstance affords the enterprising
producer the opportunity to access an exciting and dynamic sector of today’s insurance industry.
International Students
A great source of
international business
may begin with your local
college or university.
Students, faculty and staff
at these institutions are
often involved in
international academic
travel. This is a readymade opportunity for the
enterprising producer to
establish him/herself as
an international benefits
specialist.
Finding the Business
The list of potential client sources is practically endless, bound only by your
imagination and creativity. The place to start is your existing book of business.
There is a strong likelihood that several of your clients have taken an international
trip during the last year. Other areas include: international trade organizations,
passport photo companies, au pair organizations, ethnic communities,
emerging multinational companies, professional marine crews, immigration
counselors, international sporting organizations, adventure travelers, the
Internet, and many more. Our international benefit portfolio offers a solution for the
unique needs of such individuals and organizations.
Other areas of possibility are US and foreign-based
multinational corporations, organizations, and nongovernmental organizations which need to offer a US
style group benefit plan (GroupSecure®) to their employees. Additionally, contacts in
countries other than the US offer a myriad of opportunities to offer high-value
annually renewable major medical insurance plans (CitizenSecure® and
CitizenSecure® Economy). These higher net worth individuals and their families can
recognize the inherent value in a private health insurance
plan that offers coverage as they travel at home and
Non-Governmental
abroad and allows them a global range of private health
Agencies (NGOs)
care options. Furthermore, in many US states, insurance
Organizations that
carriers restrict the enrollment of non-US citizens in their
operate without direct
health insurance plans. If these clients do not qualify for
government involvement,
often engaged in
domestic health insurance plans from a US carrier
humanitarian aid and
because of citizenship and residence, our CitizenSecure®
development, are
plan may work for them as well.
routinely referred to as
NGOs. These
organizations are suitable
candidates as they face
unique needs and
challenges to provide
adequate health
insurance for both their
career staff as well as
short and long term
volunteers.
Mission Sending
Organizations
Religious organizations
involved in missionary
work have special
needs for their
members who go
abroad. HCCMIS is
ready to respond to the
needs of both career
missionaries who may
need to account for
furlough schedules as
well as groups and
individuals involved in
short term mission
work.
The Contracting Process
The process for becoming a contracted producer with HCC Medical Insurance
Services (HCCMIS) is an easy one. Simply contact the HCCMIS Sales Department
to receive your contract. Review and complete it, and then fax (317-262-2140) back
to us along with copies of your Health and Life insurance licenses. Contracts and
their fulfillments are routinely processed within one business day. You will receive
notification of your producer number via e-mail as well as a unique, customized link
to our Instant Online Quoting and Application System. This is an invaluable
tool, offering you and your clients the ability to generate quotes, review coverage and submit applications for
insurance electronically. You will also have access to customized Adobe PDF format brochures and
applications for your use.
As the producer, it is important that you indicate your producer number in the space provided on all
applications. If you do not yet have your producer number, please be sure to indicate, at minimum, your name
and correct telephone number so that we can match the application with your number and credit you
appropriately.
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Producer Zone
Once your contract is processed, along with your producer number you will also receive a password to access
your personalized Producer Zone account. Within Producer Zone you have a multitude of tools and marketing
materials at your fingertips. From here you can create and print customized marketing tools and brochures and
access customized links for your Online Quoting and Application System, Live Help and Product Selection Tool.
Producer Zone also allows you to check the status of your commission and view a history of policies that you
have sold. You may access Producer Zone at https://zone.hccmis.com/producerzone/. Contact your
Account Executive for a tour of Producer Zone and to learn how to properly utilize its full potential today.
Producer Commissions
All commissions are paid via check by the 15th of every month for business effective in the previous month.
No commissions are paid on an application until it becomes effective; i.e. any application with a January
effective date will be paid on January commissions issued by the 15th of February. Direct Deposit accounts
are available if you have a checking account within the US and maintain a steady commission flow. All Direct
Deposits have a $50.00 minimum and all commission statements are sent via e-mail.
Wire transfers are available for International accounts. To be eligible for a repetitive wire transfer you must
maintain an average of $1,000.00 in commissions each month. No wire will be sent until the commission level
reaches at least $1,000.00. To see if you are eligible for a Direct Deposit account or repetitive wire transfer,
please contact your Account Executive who will review your account and provide the necessary information.
While we are always pleased to speak with you, frequent calling to check the status of your commissions can
impede our ability to issue commissions in a timely manner. The most efficient means to check your up-todate commission totals is to visit Producer Zone. If you have a question regarding your commission, we
encourage you to contact your Account Executive for assistance, or send your question via e-mail to
insurance@hccmis.com. In either event, please wait until after the 15th of the month when all commissions
have been posted.
Language
HCCMIS is staffed and ready to assist with real-time assistance in a myriad of different languages. When a
caller reaches the Indianapolis office during regular business hours, we can assist in English and Spanish.
Those callers with additional language needs will be assisted through a conference call with a translator.
At present, HCCMIS’s literature is available in English and Spanish. A limited number of materials are
available in Portuguese. HCCMIS is always willing to consider the development of materials in other
languages on a case-by-case basis. Our initial translations would be developed in the electronic environment
of the Internet, and subsequent development of traditional printed brochures and applications would be
undertaken upon validation of the market opportunity.
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Chapter 3: Product Focus – CitizenSecure® Plans
CitizenSecure® is HCCMIS’s major medical policy for individuals and their families traveling and residing
worldwide. The residency exclusions for CitizenSecure® are US citizens permanently residing in the US, or
non-US citizens residing in Florida. Such individuals are not eligible for an international policy and need to
consider domestic insurance companies. Additionally, non-US citizens residing in the US are subject to
eligibility restrictions, as described later in this chapter. The guidelines in this chapter apply to two plan
offerings: CitizenSecure® and CitizenSecure® Economy.
These plans offer different levels of coverage to accommodate an individual’s willingness to assume more or
less risk. As both plans feature a $5 million overall maximum, CitizenSecure® is the more comprehensive of
the two major medical products featuring optional coverage for inside the US and Canada. CitizenSecure®
Economy is a scheduled benefit plan with set coverage amounts per service providing major medical coverage
to clients who are looking for a less expensive policy.
Yacht Crew
Question:
The application asks
for an out of US
resident address, but
I don’t have one. I live
on a boat and travel
continuously. Am I
still eligible for this
plan?
Answer:
Yes, you may still be
eligible for this plan.
In place of the
resident address,
provide the name of
the sailing vessel or
yacht. If applying
online, please include
an itinerary in Part 3
of the application. If
submitting a manual
application, you may
send the itinerary on
a separate sheet.
Eligibility
All applicants must be at least 14 days but not older than age 74. If a person has a
policy at the time of their 75th birthday, the coverage automatically terminates on the
date of the 75th birthday. If a client reaches the age of 75 and has been covered by a
CitizenSecure® plan for at least 10 years, they may be eligible for the CitizenSecure®
Senior plan. The CitizenSecure® Senior plan offers the same benefits and limits with
the overall maximum limit reduced to $1 million, and the Human Organ Transplant and
Emergency Medical Evacuation benefits deleted.
US citizens must be residing outside of the US for at least six months of the Certificate
Period; however, this time is not required to be consecutive. US citizens residing in the
US must also leave the US no later than 30 days following the effective date of the
policy. Please note: Individuals with dual citizenship, where one of the citizenships is
US, must be treated as US citizens.
If one spouse is a non-US citizen and the other is a US citizen, both must qualify for the
plan under the eligibility rules listed. Otherwise, each will need to be on separate
plans, one domestic and one the CitizenSecure® plan.
Children born in the US – Children born in the US to non-US citizens are US citizens
and must purchase US domestic insurance (unless they meet the US citizen eligibility
requirements as described above) even if the parents are not US citizens residing here
and covered under a CitizenSecure® plan.
Residency: US Citizens
US citizens may reside in any country outside the US excluding countries restricted by U.S. economic
sanctions and embargo programs and/or other applicable trade sanction laws. US citizens residing in the US
territories of Puerto Rico and the US Virgin Islands are considered the same as any other US citizen for
eligibility purposes. We cannot offer the CitizenSecure® plan to US citizens residing in these US territories.
Residency: Non-US Citizens
Non-US citizens may reside anywhere, including their country of citizenship, except in countries restricted by
U.S. economic sanctions and embargo programs and/or other applicable trade sanction laws, the state of
Florida, or–if an Australian national–in Australia. If they reside primarily in the US or will be in the US for more
than 30 days following their effective date, they must not be eligible for domestic US insurance and the
Underwriting Department requires the producer to sign an Affidavit of Non-Availability certifying the
applicant’s lack of eligibility (because of citizenship/residence only…medical eligibility does not apply here).
The Affidavit must be completed with the applicant’s name, the date the application was signed, and the
applicant’s state of residence, and it must also be signed and dated by the producer. If the affidavit is
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submitted and is incomplete, the producer will be notified and asked to resend the document. Underwriting
will not fill in missing or incorrect information.
Effective Date/Date of Departure & Projected Length of Residence Outside of US
The underwriting guidelines allow for the effective date to be up to 30 days following the date of signature of
the application. Per the eligibility requirements, the effective date can be no more than 30 days preceding the
date of departure (for US citizens). Consequently, there is a potential two-month window from the date of
application to the date of departure for US citizens. For non-US citizens, the 30 day limit between the
application date and the effective date does apply, but there is no time limit following the effective date
because an Affidavit of Non-Availability is required if the departure date is more than 30 days from the
effective date.
For US citizens who have not established an international address prior to their departure, it will be necessary
to provide us with a projected itinerary and/or hotel, hostel, or friend’s address where they will be staying while
seeking a permanent address. For those who are in a profession which requires continual and ongoing travel,
such as professional marine crew, we will need a proposed itinerary of travel.
On the CitizenSecureSM application, we require the applicant to indicate their projected length of residence
outside of the US. Many times, applicants who are already residing outside of the US will indicate the time
they expect to elapse until their return. Clients in the US at time of application should indicate the time from
their date of departure to their anticipated date of return in total. If the client is already out of the US, the time
should begin with the approximate effective date to the date of return (projected length of residence).
Quoting CitizenSecure®
Quoting is easy. You may refer to the rate schedule located in the back of the brochures; those rates are
separated by deductible and gender. Easier still, simply utilize the unique link to our Instant Online Quoting
and Application System.
Payment Question
Question:
I have applied for a credit
card, but I don’t know the
number yet. Can I send a
check for the first
payment and provide the
card information later?
Answer:
UW will not approve the
policy without credit card
information. If the
application is sent without
a credit card for the
installments, it will be
pending until the payment
information is received.
The Instant Online Quoting and Application System is provided automatically
upon receipt of a completed Producer Agreement. This powerful system allows the
generation of free quotes, review of coverage options and accepts applications via
the Internet.
Once you determine the annual rate, the client must then select a payment option
(applications without premium attached will not be processed – contact your
Account Executive for trial applications). If the client wishes to pay with a check,
money order or wire transfer, the annual payment is due at the time of application.
All wire transfer fees are the responsibility of the applicant.
If the client wishes to pay with a credit card, they have the options of paying
annually, semi-annually, quarterly, or monthly. To determine the payment amounts
for the quarterly or semi-annual options, multiply the annual premium rate by .28 for
quarterly and by .55 for semi-annual payment methods. For monthly payments,
eleven payments will actually be drawn, but the first payment will be double the amount of the remaining 10
payments (no payment in the last month). Obtain the first payment amount by multiplying the annual premium
rate by .20; obtain the amount of the remaining 10 payments by dividing the annual amount by 10. For all
payment options, the first payment will be taken at the time that the policy is ready for approval just before
confirmation is sent. The credit card on file will be automatically debited on the remaining due dates unless
new credit card information is provided, in writing, before the payment is due.
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Quotes Involving Children
The CitizenSecure® plans allow for the youngest two children age nine and
under to be covered free of premium when both parents are covered by the
same plan. If only one parent is covered, the regular dependent child rate will
apply. All individuals applying together must be covered by the same plan
(CitizenSecure® or CitizenSecure® Economy) and have the same deductible
in order to qualify for these premiums. Children alone must pay the adult (1924) male rate for the selected deductible.
Occasionally, one parent and the children in a family may already be covered
on a CitizenSecure® policy. The dependent child rate applies to those
children, and none of the children will be covered free of premium as long as
only one parent is covered. If the other parent applies and is accepted, any
premiums for children that qualify for the free premium will be calculated
according to the Short Rate Cancellation Table so that the remaining time on
the policy may be covered at the “free” premium as long as both parents
maintain coverage.
The Application Process
The CitizenSecure® application may be completed online, manually or by
phone. It is important to understand that applications must be complete and
legible in order to be processed without delay. There is no better way to
ensure a swift response than by directing your clients to submit their
application for insurance to us via the Internet.
Adding members to a
Certificate
When a current policy holder
has a child, the parents will
need to complete a new
application for the child in
order to seek coverage for
the child.
The child will be subject to
complete medical
underwriting, and, if
approved, the child will have
his or her own Certificate
number and effective date.
The policies will be linked in
our system so that the
dependent child rate is
applied.
During the process of
application, UW will require
copies of the complete
medical records for all
children less than six
months of age.
The application may be printed from PDF Zone (a customized PDF brochure and application tool) which is
available to you through Producer Zone. You may then send the customized application via e-mail, fax, or
regular mail to your client for completion. Once the application is completed, it may be returned to HCCMIS by
fax (317-262-2140), e-mail (insurance@hccmis.com) or by regular mail.
Applying by Phone
A client may apply over the phone by calling 1-866-968-4668 (toll free) or 1-317-221-8098 (collect calls are
accepted). The underwriting representative will gather personal details, benefit choices, and medical history,
along with producer information: so be sure to provide the client with your contact information and producer
number. After all information is gathered, an applicant may be notified immediately of acceptance, or if
additional information is needed. In some cases, an application may be pended for additional medical review.
Within two business days following any telephone application, an e-mail will be sent to the client and the
producer regarding the status of the application and requesting verification of the application. If the client does
not meet the eligibility guidelines based on information collected during the call, they will be advised
immediately.
New York State Applicants
If a client is physically located in the State of New York, they are prohibited from applying or purchasing online
in order to comply with the NY Department of Insurance. It is acceptable for a client to use a NY mailing
address and proceed with the application as long as they are not physically located in NY when applying.
Application Review & Timeframe
When an application is processed, an e-mail notification of receipt is sent to the agent and to the applicant to
confirm that the application has been received. Within two business days, the application is reviewed and
notification of application status is sent. The status notification will be sent to the producer and the client by
e-mail when available or by fax if no e-mail is available. The notification will advise whether the application
has been approved, declined, or if more information is needed. Although you will routinely receive
correspondence from HCCMIS regarding the status of CitizenSecure® applications, producers may also view
the status of an application by logging into Producer Zone.
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Full Disclosure of Medical History
The CitizenSecure® plans have strict limitations on Pre-existing Condition coverage. It is important that the
client understand that they should be as forthcoming as possible and include conditions such as menopause,
thyroid and anything else for which they are taking medication. Even though the
Lifestyle Underwriting
client may not have sought treatment from a physician, the ongoing medication as
well as symptoms, signs and complaints may all be reason for denial of a claim if
Please note:
The Underwriting
they have not been disclosed on the application. The client should also ensure
department issues a 15complete disclosure of requested family history information on the application.
30 percent rate increase
Omission of information could result in rescission of the policy.
for individuals falling
outside of HCCMIS’s
underwriting guidelines
for medically acceptable
limits for body build.
Additional Information Requests
Additional information may be requested if the application was incomplete or if
some of the applicant’s responses were unclear. The Underwriting Department
Underwriting may also
may also request medical records regarding information provided on the
issue a percent increase
application. When additional information is requested, the application will be
for other certain factors.
pended until underwriting receives the information, the application is withdrawn, or
the application is declined due to lack of response. The Underwriting Department will send regular follow-ups
until the application is expired, at which time the application will be declined if no progress has occurred.
Medical Record Requests & Medical Examinations
Complete physical exam results are required for all applicants age 65
and older. The physical exam should include, but not be limited to, blood
lab results, urinalysis, mammogram/pap results or PSA level, cardiac &
respiratory work-up, general checks & observations, etc. If the applicant
has completed such an exam within the last six months prior to the
application, the copies of that exam may be submitted. If such an exam
has not been completed, the applicant will need to have an exam in order
to continue with the application.
Pediatric reports (medical records since birth) are required for all babies
under six months of age.
Riders
When UW reviews an application
for individuals who have or have
recently had various conditions,
they may attach exclusionary Riders
to the policy. Riders may be as
short as 12 months or in some
cases permanent.
If a Rider is to be attached to the
policy, the form is sent to the
producer and applicant as an
additional request. The applicant
must sign, date, and return the form
The underwriters reserve the right to request medical examinations on
any applicant; in most cases, however, such requests typically result from
insufficient information having been provided on the application. Records may
also be requested for complex conditions.
Obtaining medical records for the application process may involve costs. If the
provider charges for obtaining such records, the costs are the responsibility of
the applicant. Producers and applicants are advised of this responsibility in
writing at the time the request is made by the Underwriting Department.
Declinations
While we do our best to accept as many applications as possible, some will
inevitably be declined. HCCMIS’s primary responsibility is to protect the
interests of our insurer, Lloyd’s, London. By following good underwriting
practices, a company will be able to stay involved in the market for the long
term, lending strength and stability to your book of business. If an application
is declined, written notification will be sent to the producer and the applicant. If
a check was submitted for payment, the check will be voided and returned to
the party who wrote the check. No credit cards will be debited when an
application has been declined.
Approval of Applications
When an application is approved, written notification will be sent to the
Uninsurable Conditions
The following conditions
normally result in declination
for CS:
Š Angina/Heart Attack
Š Alzheimer’s Disease
Š Autism
Š Brain Damage/Tumor
Š Crohn’s Disease
Š Cystic Fibrosis
Š Depression (severe)
Š Diabetes
Š Epilepsy
Š Hepatitis or Liver Disease
Š Leukemia
Š Lupus
Š Malignant tumors
Š Morbid Obesity
Š Parkinson’s Disease
Š Schizophrenia
Š Spinal Cord Disorders
These are examples, not an
extensive list of uninsurable
conditions
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producer and the applicant. Following such notification, the Certificate documents will be prepared and mailed
within two business days. The documents are sent to the producer for delivery to the client or the producer
to forward to the sub-producer for delivery to the client. We are willing to make changes to this protocol if
within reason and upon request of the independent producer.
Once the application has been approved we will deposit checks and debit credit cards prior to sending a
confirmation of coverage to ensure that processing may be completed, even if the effective date is days or
weeks in the future.
Pre-existing Conditions
On the CitizenSecure® plan, Pre-existing Conditions are covered the same as any other injury or illness as
long as the conditions are fully disclosed on the application and not limited or excluded by a Rider or any other
provision of the policy. Please note that this is the information stated in the brochure as well as in the
Certificate wording. If a Pre-existing Condition is not fully disclosed on the application, the condition will not be
covered and may result in rescission of the policy. Be aware that the chances of a Pre-existing Condition
being accepted on the policy are very slim. However, it is possible for the policy to be issued with one or more
Riders, depending on the condition(s) and other variables involved.
On the CitizenSecure® Economy plan, Pre-existing Conditions must be fully disclosed on the application. Preexisting Conditions are then subject to a 24 month waiting period, after which they are covered up to $5,000
per Certificate Period, with a maximum coverage of $50,000 for the lifetime of the policy. Additionally, Acute
Onsets of a Pre-existing Condition are covered at $1,000 for the first Certificate Period and $2,500 during the
second Certificate Period. Unlike the CitizenSecureSM plan, exclusionary Riders are not attached to the
CitizenSecure® Economy Certificates.
Client Confidentiality
HCCMIS strives to respect and maintain the highest level of security and confidentiality of client information.
There are occasions when an applicant applies for insurance, but submitted medical records may indicate a
condition which will prevent the client from meeting HCCMIS’s underwriting guidelines. In the interest of
respecting the client’s rights to privacy, HCCMIS staff members cannot discuss with the producer the specific
details of a condition resulting in a policy exclusion, temporary or permanent, or which may render the client
uninsurable by HCCMIS.
Deductible and Coinsurance
The deductible on a CitizenSecure® policy may be $250, $500, $1,000, $2,500 or $5,000. All members on any
given certificate must have the same deductible. The deductible and coinsurance will be applied to each
individual on the policy.
Claims incurred within the US and Canada are subject to a coinsurance where the member pays 20% of the
next $5,000 of eligible expenses after the deductible. After the coinsurance portion, the plan then covers
100% of eligible expenses. The coinsurance will be waived for expenses incurred within the PPO network
when charges are submitted directly to HCCMIS. Coinsurance will not be waived when a client submits
charges for reimbursement, even if the expenses were incurred within the PPO. For all claims incurred
outside of the US and Canada, there is no coinsurance. The plan pays 100% of the eligible expenses after the
deductible.
Maternity Benefits
The CitizenSecure® plan offers coverage for Maternity after 12 months of continuous coverage. Benefits are
50% of the next $100,000 eligible expenses after the deductible, then 100% to a Lifetime Maximum of
$250,000. It is important to understand that the Maternity benefits are tied to dates of service. For example,
an insured woman becomes pregnant six months into the first year of her policy and, assuming normal
gestation, has her baby three months after her date of renewal. Any maternity related services with dates of
service prior to the date of renewal will not be covered, so in this case some pre-natal care would not be
eligible. The maternity-related services with dates of service after the renewal date would be covered
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according to the Certificate provisions and in this case would include some pre-natal care, the delivery and
post-natal care.
Newborns are included as part of Maternity benefits for a maximum of 60 days as long as the delivery was
covered. However, a separate application for the newborn must be submitted for review if the family wishes to
seek coverage for the child. Acceptance of newborns is dependent upon underwriters’ approval.
On the CitizenSecure® Economy plan, Maternity benefits are covered up to $5,000 per pregnancy after 12
months of coverage. Newborn care is subject to a $15,000 maximum during the first 60 days of life.
If a woman is pregnant at the time of application, she is not eligible for a CitizenSecure® plan. She will need to
wait until after the delivery of the baby before applying for a policy.
Optional Dental Rider
In our ever-evolving effort to match benefits provided by domestic major medical companies, the
CitizenSecure® plans offer a dental coverage option. This coverage includes preventative dental care for
children 9 -16, including routine oral exams every 6 months, fluoride treatment every 12 months, and bitewing
x-rays every 24 months. All family members are covered for Basic and Major Dental procedures. Basic
Dental procedures include periodontics, endodontics, fillings and extractions. Major Dental procedures include
restorations, crowns, bridges and dentures.
Optional Hazardous Sports Rider
The Optional Hazardous Sports Rider provides additional coverage for your clients with an extreme sports
lifestyle. The Sports Rider option will add coverage up to a lifetime maximum of $25,000 for activities such as
mountaineering, skydiving, or whitewater rafting which are excluded by the standard plan. Coverage for
contact sports, such as soccer or hockey, is added up to a lifetime maximum of $5,000. However, the Sports
Rider does not cover activities engaged in for wage, reward, or profit. If you have any questions on whether a
certain sport or activity will be covered, please refer to the Master Policy. As always, your Account Executive
is available for any questions you may have.
Optional Term Life
Optional Term Life and Accidental Death and Dismemberment is available only to individuals residing outside
of the US (certain restrictions may apply to non-US citizens). If a member has a policy with the term life option
and the medical policy lapses or is cancelled, the term life portion lapses or cancels along with the medical
portion.
Renewal Options
The CitizenSecure® and CitizenSecure® Economy policies are annually renewable as long as the members
continue to meet the eligibility requirements and return the completed renewal forms with payment on or
before the renewal date. As long as such requirements are met, there are no medical questions at time of
renewal. If at the time of renewal a member no longer meets the eligibility requirements set forth at the
beginning of this chapter, including departure from the US within 30 days of renewal, the person is no longer
eligible for this international coverage and will need to seek other insurance coverage. For non-US citizens
residing in the US or in the US at time of renewal, a new Affidavit of Non-Availability will be required at each
renewal.
The renewal forms are mailed to the member’s most recent mail-forwarding and e-mail addresses on file
approximately 60 days before the renewal date. The forms are also sent via e-mail or fax to the producer.
The member is required to complete the forms and return them with payment. The renewal information cannot
be taken over the phone; the information must be provided in writing. Failure to return the forms with payment
or failure to fully complete the forms will delay the processing of the renewal. Renewals, including premium
debit, will be processed upon receipt of the completed renewal regardless of the actual renewal date.
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Renewal Changes
®
®
Renewals for the CitizenSecure and CitizenSecure Economy plans may also be
completed online with a credit card via Client Zone at https://zone.hccmis.com/clientzone/.
Renewing online through Client Zone is an easy and secure method to ensure an accurate
and timely renewal.
Renewal rates for individual insurance policies such as the CitizenSecure® plans almost
always increase each year. The renewal rates are calculated near the end of each calendar
year for use during the following calendar year. Everyone of the same age, gender, and
Certificate origination year is looked at as a group. The renewal rates are partially based on
the claims submission of each group, and everyone in a group has the same renewal rate.
Also factoring into the renewal rates are global inflation, increasing medical costs, and the
additional year of age.
Any changes of address should
be verified on the renewal forms.
Additionally, at time of renewal
members will have the option of
remaining at the same
deductible or changing to a
higher deductible. The member
is not allowed to change to a
lower deductible.
Other payment selections,
including method and mode of
payment, may also be altered at
renewal time.
Reinstatement
If a CitizenSecure® or CitizenSecure® Economy policy lapses, is cancelled, or is not renewed in a timely
manner, reinstatement will be required in order to continue coverage under the policy. Reinstatement normally
requires completion of a new application—which will be subject to complete medical review—as well as
submission of all back-premium due plus an additional $100.00 reinstatement fee. You and your client should
know that reinstatement is not guaranteed. Members whose coverage lapses, is cancelled, or is not renewed
are not eligible to take a new policy until 12 months after the expiration date of their previous CitizenSecure® or
CitizenSecure® Economy policy. Your client should not be under the impression that they can let their policy
lapse and then reapply using new business rates.
Cancellation
Cancellation Fees
It is important that you and
the client are aware of the
cancellation penalty.
Cancellation fees are
based on the Short Rate
Cancellation Table found in
the front of the member’s
Certificate.
Cancellation of a CitizenSecure® policy must be sent to our office in writing and
must be requested by the member 60 days prior to the cancellation date. The
request may be sent by e-mail, fax, or regular mail and should include the
member’s name, Certificate number, request and reason for cancellation, and the
date cancellation should take effect. Retroactive cancellation dates will not be
granted.
Premium adjustment will be made based on the Short Rate Cancellation Table
found in the front cover of the member’s Certificate. If the policy was paid
annually, some refund should be due. If the policy is paid semi-annually,
quarterly, or monthly, it is possible that additional premium may be due and will be
charged accordingly to the canceling member’s credit card on file.
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Chapter 4: Product Focus – The Atlas Series
The Atlas Series is HCC Medical Insurance Service’s international travel medical insurance policy designed to
cover individuals traveling outside their home country on a relatively short term basis, with initial Certificate
Periods ranging from 5 days up to 12 months with extension/renewal options for some clients. The Atlas
Series consists of three different individual plans: Atlas International—for US citizens and non-US citizens
traveling outside the US, Atlas America—for non-US citizens traveling into the US, and Atlas Professional—for
professional individuals taking many short trips abroad throughout the year. An Atlas Group version is also
available for groups of 5 or more.
The Atlas International and America plans are featured together in one brochure, entitled The Atlas Series.
The brochure includes plan highlights as well as an application and rate table. Be sure to check that the rates
are current – you will find the date for the current rates in the footer beneath the rate tables on the application.
The Atlas Series options are not designed to cover pre-existing medical conditions, but some benefit is
available for an Acute Onset of a Pre-existing Condition (see brochure for complete details). The Atlas Series
provides important benefits including Emergency Medical Evacuation, Repatriation of Remains and Accidental
Death & Dismemberment. These benefits are complimented by Travel and Medical Assistance Services
unique to the travel medical insurance industry. It is important that you familiarize yourself with the services
highlighted throughout the Atlas Series brochure and communicate them to your client. This knowledge alone
will improve your closing percentage dramatically, as these services are not available from HCCMIS’s
competition.
Plan Selection
Choosing between Atlas International and Atlas America is based solely on where coverage is needed. US
citizens must take Atlas International. At no time is the Atlas Series available to US citizens traveling within
the US (including all 50 states, the District of Columbia and the US territories of Puerto Rico and the US Virgin
Islands). If someone is a US citizen but a permanent resident of another country, they still are not eligible for
Atlas coverage when traveling inside the US. However, non-US citizens who reside outside of their country of
citizenship are eligible for coverage when traveling to their country of citizenship. Non-US citizens may take
either Atlas International or Atlas America, depending on their travel destination. If a non-US citizen is
traveling into the US, they must take Atlas America. If a non-US citizen is traveling outside the US, they
should take Atlas International.
Pre-existing Conditions
The Atlas Series is a non-medically underwritten policy. The plan does not cover illnesses or injuries which
existed at the time of application or for any condition or resulting complications relating to an illness or injury
which occurred during the two years prior to the effective date.
However, a limited benefit is available to some clients for an Acute Onset of a Pre-existing Condition. This
benefit is offered to individuals under age 70. Coverage is available up to a lifetime maximum of $15,000 for
eligible medical expenses and up to a lifetime maximum of $25,000 for Emergency Medical Evacuation.
An Acute Onset of a Pre-existing Condition is a sudden and unexpected outbreak or recurrence of a Preexisting Condition which occurs spontaneously and without advance warning either in the form of Physician
recommendations or symptoms. Treatment must be obtained within 24 hours of the acute onset.
Trips Lasting Fewer Than 5 Days
A minimum purchase period of 5 days is required for the Atlas Series. Additional time will go unused, as the
Atlas Series terminates upon return to the member’s home country.
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Application and Fulfillment
Mixed Citizenships Among
Family Members
It is important to know that
families consisting of both
US and non-US citizens must
submit separate applications
as the online system does
not provide for mixed
citizenship during the quoting
and application process.
The Atlas Series is fully Internet-enabled through the use of our Instant Online
Quoting and Application System. Through the use of this system, your client can
generate free quotes, review the coverage, and submit an electronic application
for insurance. Approved online applications receive a complete electronic
fulfillment with all of the necessary travel documents, including a welcome letter,
a receipt for the transaction, and an identification card; these documents appear
at the time of purchase in the Internet browser of the individual submitting the
application. A duplicate copy of the fulfillment is delivered to the e-mail address
provided on the electronic application. The information should be printed at time
of application; when electronic fulfillment is selected, we do not send any paper
fulfillment through the mail.
New York State Applicants
In order to comply with the NY Department of Insurance, if a client is physically located in the State of New
York, they are prohibited from applying or purchasing online. It is acceptable for a client to use a NY mailing
address and proceed with the application as long as they are not physically located in NY when applying.
Please note: To comply with US government regulations, we are unable to sell policies in countries restricted
by U.S. economic sanctions and embargo programs and/or other applicable trade sanction laws.
Extending or Renewing Coverage
HCCMIS Terminology
Atlas America and Atlas International policies are extendable. Extensions
must be transacted online through Client Zone
(https://zone.hccmis.com/clientzone) and paid by credit card. Policies may be
extended in daily increments (5 day minimum) up to completion of a 12month Certificate Period.
After 12 months of coverage, individuals covered under Atlas International
may renew up to another 12 months, again in daily increments (5 day
minimum). After 24 months, a final period of up to 12 months may be
purchased. Moving into the next 12 months of coverage can only be
completed in the last month before the end of a Certificate Period.
Certificate Period
Time from the effective date
to either the term date or the
12 month renewal date
Extending Coverage
Adding days/months to a
policy within a 12 month
Certificate Period
Renewing Coverage
Moving into a second or third
12-month period after a
complete 12 months of
coverage.
When a policy is extended, the deductible and coinsurance will continue until
the end of the 12 month Certificate Period. At renewal time, the deductible and coinsurance will start over, but
Pre-existing Conditions will not. At the end of the maximum 36 months of coverage time, a new policy must be
purchased via new application, and deductible, coinsurance, and Pre-existing Condition consideration will
begin anew.
If a policy is not extended or renewed prior to term date, the client must start over with a new application. If
the client is not eligible for extension or renewal, a new application will be required. All benefits will begin
anew with each new policy purchase.
Home Country Medical Coverage
It is very important that both the producer and the client understand that the Atlas Series is designed as single
trip coverage (with the exception of Atlas Professional). The Atlas Series offers three types of coverage in
the home country. All three types are restricted to medical expenses only; benefits such as Hospital
Indemnity, Trip Interruption, or Accidental Death & Dismemberment will not apply in the home country.
Incidental Home Country Medical Coverage
For every 3 months of coverage purchased, the Atlas Series provides members up to 15 days of Incidental
Home Country Medical Coverage. This allowance offers coverage for trips home during the course of the
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covered trip lasting not more than 15 days and requires continuation of the international trip. This portion may
not be used for the last 15 days of the client’s trip. Because the Atlas Series plans are designed as single trip
plans, if the client returns and is not eligible for the Incidental Home Country Medical Coverage, or is eligible
but stays in their home country for more than 15 days, the policy will have terminated upon the traveler’s initial
return. It should also be noted that the trip(s) home must be for a purpose other than seeking medical
attention for a condition that began while abroad.
End of Trip Home Country Medical Coverage
Clients who are covered on an Atlas policy and are outside of their home country continuously (except for an
Incidental Trip, if applicable) for at least 6 months may pay the premium to have coverage up to 30 days within
their home country at the end of the plan. For example, Jan Smith has just graduated from college and is
planning to backpack through Europe for eight months and then return home to the US. Jan may want to
consider purchasing nine months of the Atlas plan because she will be able to utilize the last 30 days of the
policy within the US, allowing her time to find employment and get resettled in her home while not leaving her
uninsured. The extra month of coverage can be purchased later in the policy if the client is eligible to extend
coverage.
Benefit Period Medical Coverage
Completely separate from either of the Home Country Coverages explained above is the Atlas Series Benefit
Period of 180 days for any covered illness or injury. As long as the initial treatment for a particular injury or
illness was covered, and occurred while abroad, subsequent eligible medical expenses related to that same
condition will be covered for up to 180 days beginning from the first covered treatment date, even if the policy
has terminated due to expiration of time purchased or the member’s return to home country. However, upon
the return to the member’s home country, other insurance may be primary.
Sports Rider
The Atlas Series does cover illnesses or injuries associated with non-contact amateur sports participated in for
recreation as well as downhill and cross country snow skiing on groomed slopes and marked trails as a routine
part of the policy coverage. For your adventurous client, we offer the Sports Rider. This rider will cover the
traveler up to the overall maximum limit for sports activities, with the exception of participation in competitive
and professional sports, otherwise excluded from the standard Atlas plan. The Accidental Death &
Dismemberment benefit on the Atlas Series is deleted during participation in such activities.
Terrorism Coverage
Acts of Terrorism, subject to certain conditions, are automatically covered by Atlas America and Atlas
International as well as by the Atlas Group Series. This coverage may be added to the Atlas Professional for
an additional charge. This benefit does not offer coverage in countries where a travel warning has been
issued, but it is valuable in other countries where there is a chance of an occurrence but no general reason to
expect one. Limitations of this coverage include participating in terrorism, being in a country that has had a
travel warning issued for it by the United States government within 6 months before the date of arrival,
chemical, nuclear and biological terrorism, and unreasonably failing to leave a country following the date a
warning has been issued.
Atlas Group Travel
For those traveling as a group, we offer the Atlas Group Travel plan. For groups of 5 or more, we are pleased
to offer a discounted travel insurance rate for individuals traveling together to the same destination and for the
same time period. You may direct your clients to the Atlas Group Travel link provided as part of the Instant
Online Quoting and Application System, or you may provide them with the PDF or paper brochure and
allow them to complete a manual application. Fulfillment is available in electronic or hardcopy for travel
groups. For groups of 5 or more who are traveling at different times and/or different destinations, we are
pleased to accommodate their particular needs as well. However, payment for the entire group must be made
by means of a single check or credit card prior to the date of first departing member(s) trip.
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Atlas Professional
Atlas Professional is very similar to the rest of the Atlas Series, with a particularly important difference: it is
designed as an annual, single-premium policy for those taking multiple trips during the year, with no trip lasting
more than of 30 days (in the event a member has an Atlas Professional policy but will be traveling for more
than 30 days, the individual is welcome to purchase a regular Atlas plan for the additional travel time). Atlas
Professional offers a fixed deductible of $250 which begins anew each time the member departs on a trip.
Atlas Professional also has a $1 million overall maximum limit for the annual Certificate Period and is available
to applicants through age 65.
Atlas Professional is available to individuals of any citizenship (except as restricted by U.S. government trade
regulations). All members enrolled in the Atlas Professional plan are required to maintain domestic insurance
in their home country in order to be eligible for the plan. Other than the Benefit Period allowance, no home
country coverage is provided by Atlas Professional.
The benefit schedule for Atlas Professional is virtually identical to the other Atlas Series plans, with a few
differences. This plan does not offer any coverage for physical therapy, but it does offer doubled benefit for
Accidental Death & Dismemberment in the event of death resulting from hijacking, kidnapping or attempted
kidnapping. Additionally, US citizens have some coverage available for an Acute Onset of a Pre-existing
Condition. This benefit offers up to a lifetime maximum of $5,000 for eligible medical expenses and up to a
lifetime maximum of $25,000 for Emergency Medical Evacuation related to an Acute Onset of a Pre-existing
Condition.
For the active traveler, Atlas Professional does offer the Sports Rider for an additional set premium surcharge.
The Terrorism coverage that is included in other Atlas Series plans is available as a Rider on Atlas
Professional for an additional set premium surcharge.
The right market for Atlas Professional is typically the routine business traveler, who frequently makes
international trips and seeks coverage that does not require a new application for each short travel period.
Atlas Professional is very economical and should be a part of a traveling executive’s benefit package. Access
to the Atlas Travel Assistance Services alone makes this a very attractive package.
Policy Cancellation
If a client wishes to cancel their Atlas Travel or Atlas Group policy, a cancellation request must be submitted in
writing to HCC Medical Insurance Services to receive a refund of premium. To be eligible for a full refund, the
request for cancellation must be received prior to the effective date. If a cancellation request is received after
the effective date, a $25 cancellation fee will apply, only the unused portion of the plan cost will be refunded,
and only members who have no claims are eligible for premium refund. Atlas Professional policies can only
be refunded prior to departure from the client’s home country or prior to the effective date.
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Chapter 5: Product Focus – Atlas Corporate Travel
Atlas Corporate Travel is designed to meet a company’s need to provide travel insurance to multiple
employees who travel abroad throughout the year. Atlas Corporate Travel, a sister product of our industryleading Atlas Travel Series, offers the same superior coverage while allowing the company to purchase
blocks of days at a set rate as well as offering the flexibility to distribute them at a moment’s notice. In
addition, Atlas Corporate offers coverage to any employee or guest who meets the eligibility requirements
along with the option of extending coverage up to 12 months. This new innovative product provides coverage
for Emergency Medical Evacuation, Accidental Death and Dismemberment, Acts of Terrorism and Natural
Disasters along with state of the art travel and emergency medical assistance services as a part of every Atlas
Corporate plan.
Employee Eligibility
Any employee who is traveling outside of his or her Home Country and is under 66 years old is eligible for
coverage. Dependents and guests of the employees are also eligible for coverage, provided they meet the
same eligibility requirements as the employee, with the approval of the company.
Please note: To comply with US government regulations, we are unable to sell policies in countries restricted
by U.S. economic sanctions and embargo programs and/or other applicable trade sanction laws.
Pre-existing Conditions
Like the Atlas Travel Series, Atlas Corporate is a non-medically underwritten policy. The plan does not cover
illnesses or injuries which existed at the time of application or for any condition or resulting complications
which had occurred during the two years prior to the effective date. However, a limited benefit is available to
some clients for an Acute Onset of a Pre-existing Condition. This benefit is automatically included for
employees who are US citizens. At the time of application you may choose optional coverage for your
employees who are non-US citizens for an additional premium.
How to Obtain a Proposal
An Atlas Corporate Request for Proposal form may be found inside the Atlas Corporate brochure or by
request. Within the Request for Proposal, the group must provide employee and company information along
with their desired benefits. Once completed, simply return the form to HCC Medical Insurance Services by fax
at 317-262-2140 or by mail.
The client will then receive a daily rate based on the estimated annual travel and location of the company. To
purchase a policy at the rate provided, an application would then need to be completed and submitted. A
minimum purchase of 100 days is required to begin an Atlas Corporate account and all days are valid
throughout a 1 year policy period. A policy period begins on the Effective Date requested on the corporate
application and lasts one year.
Account Management System
The online Account Management System is a unique system designed specifically for Atlas Corporate
Travel. When a company begins a policy they will receive their account confirmation, password and login
information for their customized Account Management System. Within the system a designated company
administrator will have access to enroll employees, extend coverage, add days into the bank, view account
history, print individual ID cards and Visa Letters, and much more.
Enrollment, Extending Coverage and Renewing a Policy
Employees are enrolled for coverage through the online Account Management System. Coverage can begin
as early as the day the information is submitted up until the last day of the annual policy period. Within the
system the company administrator will have access to enroll employees. A company may distribute as many
or as few days to an employee up to a maximum of 12 months. Once an employee is enrolled, their
information will remain in the system for future travel.
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If a trip is cut short, any unused days may be credited into the bank with proof of early return, such as a copy
of a passport stamp or airline ticket. Proof of early return may be submitted via fax or mail accompanied by a
brief request in writing to credit the days.
Extending Coverage
A company may extend coverage for an employee through the online Account
Management System up to a maximum of 12 months from the initial Effective
Date, subtracting the number of days extended from your balance. Provided
there is no break in coverage, the employee will not be required to re-satisfy the
Deductible and Coinsurance nor will benefit limits be reset.
HCCMIS Terminology
Extending Coverage
Adding days/months to an
employee’s policy within a 12
month Certificate Period
Renewing a Policy
Renewing a Policy
The company renewing their
Within 30 days prior to the termination date a company may renew their Atlas
Atlas Corporate policy for an
additional 12 months
Corporate policy via the online Account Management System. In order to renew
a policy a minimum of 100 days must be purchased. Any unused days as of the
termination date will roll over into the new policy period. Daily rates are subject to change at time of renewal.
If a renewal is not desired, unused days will be refunded up to a maximum of 20% of the initial purchase of
days for the final policy period.
Home Country Medical Coverage
Atlas Corporate will provide limited Home Country Coverage during a Benefit Period. A Benefit Period begins
on the first date a diagnosis or treatment of a covered Illness or Injury is received while outside his or her
Home Country and lasts for 180 days. If a Benefit Period starts while coverage is in effect, the employee is
covered only for Medical expenses related to the same covered Illness or Injury for the duration of the Benefit
Period, regardless of whether they are at home or abroad.
Home Country Defined – If the employee is a US citizen, his or her Home Country is the United States,
regardless of the location of their Principal Residence. If an employee is a non-US citizen, his or her Home
Country is the country where they principally reside and receive regular mail.
Optional Sports Rider
The Optional Sports Rider is available for the adventurous employees who are traveling. Atlas Corporate
Travel covers illnesses or injuries associated with non-contact amateur sports done for recreation only. This
rider is selected at time of application and will cover the employee up to the overall maximum limit for all
hazardous sports activities, with the exception of participation in competitive and professional sports. The
Accidental Death & Dismemberment benefit on the Atlas Series is deleted during participation in such activity.
Terrorism Coverage
Acts of Terrorism, subject to certain conditions, are covered by Atlas Corporate. This benefit does not offer
coverage in countries where a travel warning has been issued, but is valuable in other countries where there is
always a chance of an occurrence but no general reason to expect one. Limitations of this coverage include
participating in terrorism, being in a country that has had a travel warning issued for it by the United States
government within 6 months before the date of arrival, chemical, nuclear and biological terrorism, and
unreasonably failing to leave a country following the date a warning has been issued.
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Chapter 6: Product Focus – StudentSecure®
StudentSecure® is designed specifically to meet the needs of full-time international students providing
coverage in monthly increments with the ability to extend and renew up to four years. StudentSecure® is
appropriate for the international student or scholar and meets or exceeds most government and visa
requirements. Two levels of coverage, Select and Budget, ensure the desired and necessary coverage is
obtained.
The StudentSecure® Select and Budget plans are featured together in one brochure. The brochure includes a
thorough plan description as well as an application and premium table. Be sure to check that the rates are
current–you will find the date for the current rates in the upper left hand corner of the premium tables.
StudentSecure® provides coverage for important benefits such as Maternity and Newborn Care, Organized
Sports Activities, Emergency Medical Evacuation and Repatriation of Remains. Accidental Death and
Dismemberment is covered by the Select plan. These benefits are complimented by our strong Travel
Assistance Services, unequalled in the travel medical insurance industry. It is important that you familiarize
yourself with the services highlighted throughout the StudentSecure® brochure and communicate them to your
client.
Plan Selection
Choosing between the Select and Budget plans depends on what level and what area of coverage your client
desires. The Select plan has a higher Certificate Period maximum and maximum benefit per injury or illness,
and greater coverage for Routine Nursery Care of a Newborn, Emergency Medical Evacuation, Emergency
Reunion and Repatriation of Remains compared to the Budget plan. The Select plan also provides Accidental
Death & Dismemberment coverage whereas the Budget plan does not. Additionally, the premium is reduced
for a coverage area that excludes the US.
Pre-existing Conditions
StudentSecure® will provide coverage for Pre-existing Conditions after 12 months of continuous coverage. A
Pre-existing Condition is any injury or illness which, within the 12 months prior to the effective date of
Coverage, manifested itself, exhibited symptoms, or required medical treatment or medication, or for which a
Physician was consulted.
Trips Lasting less than One Month
A minimum purchase of one month is required for StudentSecure®. If the student is traveling for less than one
month, he or she will need to purchase a full month, and additional time after the return to home country will go
unused, as StudentSecure® terminates upon return to the member’s home country.
Application and Fulfillment
StudentSecure® is fully Internet enabled through the use of our Instant Online Quoting and Application System.
Through the use of this system, your client can generate free quotes, review the coverage, and submit an
electronic application for insurance. Approved online applications receive a complete electronic fulfillment with
all of the necessary travel documents, including a welcome letter, a receipt for the transaction, and an
identification card; these documents appear at the time of purchase in the Internet browser of the individual
submitting the application. A duplicate copy of the fulfillment is delivered to the e-mail address provided on the
electronic application and is available for retrieval at any time through Client Zone. The information should be
printed at time of application; when electronic fulfillment is selected, we do not send any paper fulfillment
through the mail.
New York State Applicants
If a client is physically located in the State of New York, they are prohibited from applying or purchasing in
order to comply with the NY Department of Insurance. The applicant may purchase after they depart NY to
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begin the trip. It is acceptable for a client to use a NY mailing address and proceed with the application as
long as they are not physically located in NY when applying.
Please note: To comply with US government regulations, we are unable to sell policies in countries restricted
by U.S. economic sanctions and embargo programs and/or other applicable trade sanction laws.
Extending or Renewing Coverage
StudentSecure® policies are extendable. Extensions must be transacted online through Client Zone
(https://www.hccmis.com/students.asp) and paid by credit card. Policies may be extended in monthly
increments to completion of a 12-month Certificate Period.
If the policy was purchased by a single, up-front payment, extension will also need to be paid by a single
payment. These students will need to provide credit card information when they extend. Students who
purchased with monthly payments will simply add additional scheduled payments, using the credit card
already on file, when they extend. The credit card on file for scheduled payments may be updated at any time
through Client Zone.
When a policy is extended, the deductible and coinsurance will continue until the end of the 12-month
Certificate Period. At the first renewal time, the deductible and coinsurance will start over, and the Pre-existing
Conditions coverage will begin. At the second and third renewal times, the deductible and coinsurance will
start over, but the Pre-existing Conditions restrictions will not. The renewal transaction must be completed
within the last 30 days prior to the expiration date of the policy.
If a policy is not extended or renewed prior to the termination date, the client must start over with a new
application. If the client is not eligible for extension or renewal, a new application will be required. All benefits
will begin anew with each new policy purchase.
Home Country Medical Coverage
StudentSecure® offers two types of coverage in the home country. Both types are restricted to medical
expenses only; benefits such as Hospital Indemnity, Trip Interruption, or Accidental Death and
Dismemberment will not apply in the home country.
Incidental Home Country Medical Coverage
StudentSecure® offers limited home country coverage. Medical expenses only can be covered during
incidental visits of up to 15 days. The member must return abroad, either to the Host Country or another
country en route to the Host Country, no more than 15 days after the return to the home country in order to be
eligible for this benefit. Return to the home country must not be taken for the purpose of obtaining treatment
for an injury or illness that began outside of the home country.
Benefit Period Medical Coverage
If your client is hospitalized as Inpatient on their coverage Termination Date, StudentSecure® will provide a
Benefit Period of 60 days for that condition only. The Benefit Period begins on the first date that they receive
diagnosis or treatment for the condition and continues for 60 days, regardless of whether they are abroad or
return to their home country.
Organized Sports Activities
StudentSecure® will cover eligible medical expenses for injuries or illnesses sustained while participating in
intercollegiate, interscholastic, intramural, or club sports up to a maximum of $5,000 per injury or illness.
Covered organized sports are: basketball, baseball, cross country, dance team, football, golf, kickball, soccer,
softball, swimming, tennis, track, volleyball, weight training, and wrestling.
Terrorism Coverage
Acts of Terrorism, subject to certain conditions, are covered by StudentSecure® up to a $50,000 Lifetime
Maximum. This benefit does not offer coverage in countries where a travel warning has been issued but is
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valuable in other countries where there is always a chance of an occurrence but no general reason to expect
one. Limitations of this coverage include participating in terrorism, being in a country that has had a travel
warning issued for it by the United States government within 6 months before the date of arrival, chemical,
nuclear and biological terrorism, and unreasonably failing to leave a country following the date a warning has
been issued.
Eligibility
To be eligible for StudentSecure®, participants must be must be a Full-time Student at a college or university,
excluding online colleges and universities, or within 31 days of being a Full-time Student at a college or
university. Participants must be residing outside their home country for the purpose of pursuing international
educational activities; and must not have obtained residency status in the Host Country.
Full-time Student is defined as a student at a college or university who is taking 10 credit hours
(undergraduate students) or 6 credit hours (graduate students). Full-time Student status for individuals
enrolled at colleges or universities that do not use a credit hour system must provide documentation of Fulltime Student status.
Full-time Scholars may also be eligible participants. An individual who is affiliated with an educational
institution and is engaging in educational activities, such as performing research in an area of specialty or
teaching temporarily, for at least 30 hours per week qualifies as a Full-time Scholar.
The participant’s home country is the country of principal residence as declared on the application form. The
home country is the country of the participant’s true, fixed, and permanent home.
Dependents must be the participant’s legally married spouse, or be the participant’s unmarried child under
age 19 years and chiefly dependent on the participant for support and maintenance. The dependent must
accompany the participant abroad on a similar visa or passport while the participant engages in international
educational activities and be temporarily located outside the participant’s home country. (The Dependent’s
home country is the same as that of the participant, regardless of principal residence.) The dependent must
not have obtained residency status in the Host Country as well.
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Chapter 7: Product Focus – GroupSecure®
For multinational organizations needing a US-style group benefit product, HCCMIS offers GroupSecure®.
GroupSecure® provides a comprehensive, flexible schedule of benefits for members in conjunction with the
service component of GroupSecure® Assistance Services, which are unavailable to members of any other
international group benefit plan. GroupSecure®, formally MultiNational Group Benefit Plan (MGBP), now
allows an organization to choose their desired coverage, limits, and deductible as well as remove benefits to
provide the desired coverage for their employees.
Group Eligibility
The eligible group would likely consist of either a US-based corporation or organization which employs US
employees abroad, local country nationals (LCNs) in a country other than the US, or third country nationals
(TCNs) working in a country other than their home country but not within the US. These organizations are
faced with the daunting task of recruiting, hiring, training and retaining employees from these disparate groups
and providing them with a benefit package that will keep them on a competitive par to avoid turnover that can
be devastating – particularly in an international setting.
Groups consisting of at least three employees and a single billing location and payer source can be
considered for GroupSecure®. HCCMIS requires at least 80% participation of the eligible group.
Please note: To comply with US government regulations, we are unable to sell policies in countries restricted
by U.S. economic sanctions and embargo programs and/or other applicable trade sanction laws.
Advantages of a Group Benefit Plan
Many times, there is a perception that there is a cost advantage to the client by purchasing a group benefit
plan like GroupSecure® when compared to the purchase of a number of individual health insurance policies
like the CitizenSecure® plans. In actuality, this perception may or may not be the case. The main reason an
organization should consider a GroupSecure® plan is its value in recruiting and retaining qualified employees.
Additional benefits to the plan include a monthly billing cycle, the ability to easily add and delete employees
from the coverage, flexibility when selecting coverage, and slightly more flexible underwriting in comparison to
individual major medical coverage.
Completing the Request for Proposal Form
Prior to generating a quotation for GroupSecure®, the underwriters must receive a completed Request for
Proposal form. While the form is self-explanatory, it bears emphasizing that to provide an accurate and timely
proposal we need to have the correct dates of birth, gender, and employee status (e.g. employee & spouse,
family, etc.). If the group is requesting a takeover provision—that is, for HCCMIS to take over an existing
group thereby waiving the waiting periods for Maternity and Mental Health benefits and/or any Pre-existing
Condition exclusions—HCCMIS will need to have a copy of the existing schedule of benefits as well as the
most recent month’s billing invoice and a copy of the group’s itemized claims experience, preferably for the
last 3 years. While it may seem like quite a bit of information to collect, it serves the interest of the producer
and the client because this allows us to generate the most accurate proposal possible. As soon as it becomes
available, a proposal for GroupSecure® will be sent to you via e-mail; the quote will also include dental and life
insurance options.
Enrollment and Participation
Upon acceptance of the proposal, each member of the group will need to complete an enrollment form. These
forms must be completed and forwarded to the company. For groups with fewer than 10 employees, parts 1, 2
& 3 of the enrollment form must be completed. For groups of more than 10 employees, only parts 1 & 3 are
required. Enrollment forms must be completed, signed and received by HCCMIS within 30 days. Enrollment
forms signed more than 30 days in advance of receipt must be reviewed, signed and dated again to ensure
that we have correct information on file. Electronic—rather than paper—enrollment is encouraged and offers
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the client an efficient and simple submission method. Contact your Account Executive or one of HCCMIS’s
group underwriters for details.
Groups of 10 or fewer employees are required to accept at least $10,000 of term life insurance per employee.
Groups based in the US will require complete citizenship and residency information on each employee.
Generally, no more than 20% of the group may be composed of US residents for groups based in the US.
There are some exceptions, such as if the employees are non-US citizens and are unable to obtain other US
domestic coverage.
Dependents of group members who are over 18 years of age will need to provide proof of full time student
status to be eligible through age 22. Those dependents over the age of 22 will not qualify as dependents on
GroupSecure®, regardless of student status.
If the group is based in the US, satisfactory Certificates of Creditable Coverage must be received from the
insured members to waive or reduce the waiting period for the Pre-existing Condition exclusion. It is important
that this requirement is stressed to the group, as many individuals become frustrated if they have submitted a
claim and it is denied because of Pre-existing Condition exclusions.
Upon selection of a GroupSecure® option, the group will need to provide a check to HCCMIS for 1/12th of the
selected premium option desired, along with the completed enrollment forms and a completed group
application.
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Chapter 8: Product Focus – HCC Life Short Term Medical (STM)
HCC Life Short Term Medical (STM) understands the needs of recent graduates, the self-employed and many other
individuals and families who lack adequate coverage. HCC Life STM is a domestic temporary health insurance program
designed for individuals inside the US in transition without health insurance. HCC Life STM is insured and administered by
HCC Life Insurance Company (HCC Life), an industry leader in medical stop-loss and excess lines coverage for more than
30 years. HCC Life STM offers an appropriate solution for those who were previously insured by our international products
while abroad and have returned to the US looking for temporary coverage. HCC Life STM is also a suitable option for
those who are looking for a substitute to COBRA.
With HCC Life STM, clients can choose from a wide range of deductibles, select the exact length of coverage required,
and receive treatment from the doctors and hospitals of their choice. HCC Life STM provides coverage for Inpatient and
Outpatient charges, including Inpatient prescription drugs, as well as charges for emergency local ambulance and
expenses related to Mental and Nervous Disorders.
Policy Selection
HCC Life Short Term Medical (STM) offers several policy options so that coverage can be tailored specifically to the
needs of your clients. Clients may select a 6-month or 11-month policy, depending on the state, choose either a monthly
payment or single up-front payment option, and select the exact number of months or days of coverage they will need. In
some states, coverage is limited to 6 months per policy. Check the current rate table for coverage length availability in
specific states.
Deductible options vary based on the method in which the client submits his or her application. Standard deductible
options for paper applications are $500, $1,000 and $2,500, with an added $250 deductible on all 6-month policies, and
$5,000 deductible on all 12-month policies. Furthermore, HCC Life STM offers additional deductible options of $5,000 or
$7,500 for applications submitted online.
HCC Life STM also offers coinsurance options of 80/20 of the next $5,000 of eligible expenses or 50/50 of the next $5,000
of eligible expenses. The available Coverage Period Maximums are $1 million and $2 million.
Pre-existing Conditions
Pre-existing Conditions are not covered under HCC Life STM and have a look back period ranging from 6 months to 5
years (varying by state). A Pre-existing Condition is any injury or illness which, prior to the effective date of Coverage, has
manifested itself, exhibited symptoms, or required medical treatment or medication, or for which a Physician was
consulted.
Policy Eligibility
Applicants are eligible for HCC Life STM if they meet the following requirements:
• are between 2 and 64 years of age
• are legally residing in the United States
• are not pregnant or an expectant father
• are not planning on adopting
• are not covered under other medical insurance
• are not a member of the armed forces of any country, state or international organization, unless on reserve duty
for 30 days or less
• answer “no” to the medical questions on the application.
Spouses under age 65 and dependents under age 19 are eligible for coverage, provided they meet the same
requirements. An unmarried child who is under age 25 may also be included as a dependent if the child is enrolled fulltime in an accredited school or college (student requirements and maximum age vary by state).
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Application and Fulfillment
HCC Life Short Term Medical (STM) applications are accepted through the Instant Online Quoting and Application
System or via paper application. When using the Instant Online Quoting and Application System your client can generate
free quotes, review the coverage, and submit an electronic application for insurance. Approved online applications
receive a complete electronic fulfillment containing plan documents, including a welcome letter, a receipt for the
transaction, an identification card, and a Certificate of coverage; these documents appear at the time of purchase in the
Internet browser of the individual submitting the application. A duplicate copy of the fulfillment is sent to the e-mail
address provided on the electronic application. Additional copies of the fulfillment may be obtained at any time through
Client Zone. When electronic fulfillment is selected, paper fulfillment is not sent.
Purchasing an Additional Policy
HCC Life STM is not extendable or renewable; however, a client may purchase another policy if they have not been
covered by two HCC Life STM policies in the last 12 months (additional purchase may not be available in some states).
Consumer Benefits of America
In most states, HCC Life STM is available only to members of the Consumer Benefits of America association.
Membership in the association will offer your client discounts of up to 40% off regular retail prices on most short-term and
long-term prescription drugs. Discounts are available from over 59,000 participating pharmacy providers nationwide or by
mail service. If the client is not already a member, enrollment in the association is easy and comes with enrollment in
HCC Life STM. Details about membership benefits will be sent to your client following enrollment in HCC Life STM.
Agent Licensing
In order to sell HCC Life STM, all producers must have a license in the state where HCC Life STM is sold. If a policy is
sold without proof of a license, HCCMIS will hold the commission up to 60 days until proof of license is obtained. A copy
of the license may be e-mailed to your Account Executive or to insurance@hccmis.com, faxed to us at 317-262-2140 attn:
Compliance Department, or mailed to us at:
HCC Medical Insurance Services
Attn: Compliance Department
251 North Illinois Street, Suite 600
Indianapolis, IN 46204
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Chapter 9: Product Focus – Other Product Options
IC+ Term Life
HCCMIS offers a “stand alone” life insurance plan for individuals living outside the United States. We offer level term
policies for these clients for up to 10 years in practically any face amount. We do not publish a rate schedule for this plan;
however, rates can be easily generated through our Instant Online Quoting and Application System found through the
unique link we will forward to you upon contracting with HCC Medical Insurance Services (HCCMIS). There are countries
which are considered too “hot” for us to place a policy. If the online system will generate a quote for your client based
upon the answers to the questions on the quoting system, the policy can be written provided the client qualifies medically.
Dependent upon the face amount, the underwriters may require that a physical examination be performed and complete
results forwarded along with the application. Costs involved for this examination are born by the client. A completed
financial questionnaire will also be required to obtain this policy when the requested amount is $350,000 or more.
Other HCCMIS Plan Options
Administrative Service Only (ASO) – HCCMIS is an experienced and exceptional third party administrator. For large, selffunded international group benefit plans, it just makes sense to work with a company like HCCMIS with over 40 years of
combined experience in global claims administration. Contact the HCCMIS Marketing Department to discuss the quoting
process for ASO benefit administration.
War Risk Coverage – Should you encounter a substantial opportunity for clients working or traveling in countries impacted
by war, civil unrest, riot or other uncertainties, contact HCCMIS to learn how we can construct a valuable benefit package
which will mitigate your client’s exposures in these high risk areas.
Non-Governmental Organization (NGO) – Organizations involved in humanitarian and rebuilding efforts in troubled areas
of the world face unique and specific challenges. HCCMIS can help you respond with solutions. Call, e-mail or fax the
HCCMIS Marketing Department to assist you with solving difficult situations for your NGO clients.
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Chapter 10: Claims Procedures
When clients become ill or injured and are in need of medical assistance, they may visit any provider of their
choice. Neither HCC Medical Insurance Services (HCCMIS) for international products nor HCC Life Insurance
Company (HCC Life) for HCC Life Short Term Medical requires clients to use specific providers. However,
financial incentives are offered for some international products. (See PPO Network & Provider Referrals later
in this chapter.) There are, however, a few key points to be aware of relative to the claims procedures.
Please note: Unless otherwise specified, “us”, “we”, and “our” are used to represent the claims procedures of
HCCMIS for international products and HCC Life for HCC Life STM.
Pre-Certification Requirement
All products contain a Pre-Certification requirement. This provision states that the member – or a family
member or a provider representative – must contact us prior to any surgery, certain diagnostic tests, and all
Inpatient confinements. In the event of pregnancy, we require certification within the first 90 days and again
within 48 hours following the delivery. Please refer to the specific policy wording
for full details about Pre-certification requirements.
Pre-certification Penalty
The member must
understand that failure to
pre-certify will result in a 50
percent decrease in medical
expense coverage and all
other expenses will be
forfeited. Notifying the
producer is not enough. If
the producer is notified he or
she must relay that message
to our offices immediately.
In the event of an emergency hospital admission, or surgery, or any other service
that requires prior certification, we must be contacted within 48 hours after the
admission, or as soon as is reasonably possible. All Emergency Medical
Evacuations and Transplants must be pre-certified in advance. We encourage
our members to carry their insurance card with them at all times, so that in the
event of hospitalization of a member who is unconscious, a hospital
representative will know to contact us per the insurance card.
Our World Service Center will receive the call from the member, or member
representative, and note the Pre-certification information in our system as
required by the plan. We also accept Pre-certification through Client Zone and by e-mail, fax or voice mail. Our
service representatives are available 24 hours a day, 7 days a week for Pre-certification, and our office
accepts all domestic and international collect phone calls.
To pre-certify through Client Zone, the member may log in and then go to the “Claims Information” section and
complete a form with information regarding the procedure or hospitalization. Within two business days, a
service representative will send an e-mail confirming that the information was received.
Emergency Room Charges
It is important that our members understand that, on international plans, Emergency Room charges in the US
are not covered for an Illness if they are not admitted to the hospital. For HCC Life STM, an extra deductible
applies to Emergency Room charges. The member may instead choose to visit the doctor’s office or go to
emergency Outpatient care centers which are available in many parts of the US. In the event of a covered
Injury, eligible charges for the Emergency Room are covered. Members should also keep in mind that a policy
exclusion only means that the insurance will not pay for the expenses. It
Claim Documentation
does not prevent them from receiving the treatment.
It is common for the claims
department to request copies of
medical records relative to a claim or
a part of the patient’s medical history.
Consequently, we encourage
individuals seeking treatment outside
of the US to obtain the medical
records at time of treatment and
submit them along with the other
documentation for the claim.
Claims Submission Procedures
A completed Claimant’s Statement and Authorization is required for every
claim and is available for download at our website. We will also be happy
to fax, e-mail or mail a Claimant’s Statement to the member. If providers
are willing to accept payment directly from us, the member must sign the
“Authorization” section in Part C of the Claimant’s Statement in order for us
to make a direct payment.
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While we are always willing to settle the claim directly with the healthcare provider, we can never guarantee
that the provider will accept proof of insurance as sufficient and accept assignment of benefits.
We are not able to pay a provider in advance of services rendered. We must have the ability to adjudicate the
claim properly and, while we will verify benefits at any given time, it is never a guarantee of payment. Because
we do require pre-certification, this contact puts us in touch with the provider, and we then begin to negotiate
fees for services. This process may encourage a provider to settle the claim directly with us rather than
requiring immediate payment from the member.
In the case that a provider is unwilling to settle the claim directly with us, the member will simply need to
complete a Claimant’s Statement and Authorization, attach the original itemized bills and paid receipts, and
mail it to us. Assuming we have all of the information necessary to accurately determine benefits, we will
process the claim and send a check for any reimbursement due within 15 business days.
We encourage members to make copies of all of the documentation (claim forms, bills, and receipts) that they
send to us to retain for their own records. After the claim is received in our office, the Claims Department will
need at least 10 working days to review the submitted documentation. If additional information is requested,
further processing time may be necessary depending upon the response time of the parties from whom the
additional information was requested. Charges for medical records requested as part of the claims process are
borne by HCCMIS or HCC Life.
PPO Network & Provider Referrals
For Atlas, CitizenSecure® and GroupSecure® products, we are pleased to offer the money-saving benefit of
waiving the coinsurance for covered services provided in the US by a provider within the Preferred Provider
Organization (PPO). All expenses must be submitted to HCCMIS directly in order for the coinsurance to be
waived. If a charge is submitted to HCCMIS for reimbursement, the coinsurance will not be waived, even if the
expenses are incurred within the PPO. HCCMIS utilizes CMN as its PPO network administrator. Participating
providers in CMN’s networks may be searched through the HCCMIS website, or our service representatives
are available to assist when Internet access is not available. As discussed previously, use of a PPO network
is not required.
HCCMIS representatives are available 24 hours a day, 365 days a year to assist with doctor and specialist
referrals. Please keep in mind, however, these referrals are neither guarantees that the provider will accept
direct payment nor guarantees that the services will be covered by the insurance.
Claims Appeals
While HCCMIS and HCC Life take every effort to provide the accurate benefit to each claim, there may be
situations when the member chooses to appeal how a claim was processed. In order to do so, the member
may submit a written letter of appeal with additional documentation (medical records, receipts, etc.) to support
their reasoning and position. The letter should be sent to:
Claims Appeal Department
P.O. Box 863
Indianapolis, IN 46206
Please note that submission of the appeal will lead to re-evaluation of the claim but does not guarantee that
the initial benefit determination will be altered. For HCC Life STM, additional grievance procedures may apply
in some states. Please see the Certificate wording or contact us to determine if additional or alternate
procedures apply.
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Chapter 11: Policy Administration & Customer Service
All policy administration for the international plans of HCC Medical Insurance Services (HCCMIS) —
CitizenSecure®, Atlas, StudentSecure®, GroupSecure®, and IC+ Term Life — takes place right in our office,
located in Indianapolis, IN. Our team, which includes underwriters, claims analysts, and service
representatives, is active in administration from the receipt of an application through the duration of a
Certificate. Our team also works closely with the administrators of HCC Life STM, HCC Life Insurance
Company. Please feel free to contact our professionals with your questions and concerns.
HCCMIS’s World Service Center
Calls to our standard telephone numbers (800-605-2282 and 317-262-2132) come in to the HCCMIS World
Service Center, which seeks to provide quality customer service when responding to the needs of our
members and producers. Service representatives are available 24 hours a day, 7 days a week to assist with
application completion, provide verification of benefits, answer coverage questions, and handle requests for
Travel and Medical Assistance Services. Whether your client needs a new ID card, is seeking a provider
referral, has a coverage question, or needs assistance with an Emergency Medical Evacuation, our team is
eager to respond to these and other customer needs.
Additionally, the full HCCMIS team is available 8:00 am to 6:30 pm Eastern Time Monday through Friday and
is happy to assist with additional questions and concerns, including claims or application status, producer
contract information, and supply order status.
Application Submission
A producer or an applicant is welcome to mail, fax or e-mail an application directly to HCC Medical Insurance
Services. As the producer, it is important that you indicate your producer number in the space provided on the
application. If you do not have your producer number, please be sure to indicate, at minimum, your name and
correct telephone number so we can match the application with your number and credit you appropriately.
Before sending an application to HCCMIS, please review the application and be certain that the application is
completed in full and clearly legible. Omissions on any application will delay our ability to process the
submission.
Application Processing – CitizenSecure®
When a CitizenSecure® application is received, it will be set up and reviewed within two business days. During
the set-up process, an e-mail notification will be sent to the producer and the applicant verifying that the
application has been received. Status information will then follow by e-mail to the producer and applicant after
the application review. This status e-mail will advise of approval, declination, or will request additional
information.
If additional information is requested, the producer is encouraged to contact the applicant and assist in
obtaining the requested details. Underwriters will not be able to proceed further with the application until the
requested information is received. In some cases, especially if medical records are requested, additional
information may be requested after the details are received. If medical records are requested during the
application process, any costs involved in obtaining those records are the applicant’s responsibility. Physical
exams are required for any individual age 65 and above, and complete pediatric reports are required for all
children under 6 months of age.
In some cases, we are unable to accept an applicant. If an applicant is declined due to medical reasons, the
declination notice provides only a general reason for the declination because of the patient confidentiality
involved with medical information. Applicants who have questions regarding such declinations may contact
the Underwriting Department to discuss the declination. Underwriters may offer to continue reviewing the rest
of the individuals on an application. If the family wishes to continue without the declined individual, they must
notify the Underwriting Department in writing so that the review process may continue.
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When an application is ready for approval—and not before—the payment of premium will be processed. An
e-mail confirming coverage is sent after premium has been secured. If overnight/express delivery has been
selected, the Certificate documents are generally sent out on the next business day. When overnight/express
delivery has not been requested, the documents are sent within two business days. The documents are sent
via regular mail to the producer for delivery to the client or the general agent to forward to the producer for
delivery to the client if one is involved as a routine matter of course. A general agent may request to have
policy documents sent directly to each individual producer, however, we are unable to mix the two delivery
methods.
The Certificate documents include a Certificate booklet containing the declaration page, Certificate wording,
and a copy of the application as well as an ID card, a Claimant’s Statement, an “Important Information”
document, and a receipt for payment of premium.
Application Processing – Atlas, StudentSecure® and HCC Life STM
The Atlas Series, StudentSecure® and HCC Life STM are guaranteed-issue policies as long as the applicant
meets the eligibility requirements and pays the necessary premium. Applications that are placed manually via
fax or regular mail will be fulfilled by mail and sent directly to the member at the mailing address specified on
the application. Manual applications are processed no later than the second business day following the
receipt of the application. If a manual application requesting overnight/express delivery is submitted before
3:00pm Eastern Time, the application will be processed and documents sent via courier on the same business
day. Such requests received after 3:00pm will be processed and sent on the following business day.
Online applications may be fulfilled by mail when requested but are otherwise fulfilled electronically, which
means that the policy documents—welcome letter, ID card, policy description, and receipt—appear onscreen
after the credit card has been processed. Overnight/express delivery is also available for online purchases.
Application Processing – GroupSecure®
GroupSecure® processing begins with the interested group submitting a Request for Proposal (RFP) form and
any other additional information necessary (please see Chapter 7: Product Focus – GroupSecure® for more indepth details of required information). The Underwriting Department will provide a proposal as soon as
possible for review by the producer and presentation to the group.
Upon acceptance of the proposal, each member of the group will need to complete an enrollment form that
must be forwarded to HCCMIS. The group will also be responsible for submission of the appropriate premium
and a completed group application.
Following receipt of all of the necessary enrollment forms and related information, the Underwriting
Department will perform a post-sale underwriting review. If no changes are necessary, the group Certificate
and the benefit information for the individual employees will be prepared. All of the information will be
packaged together and sent to the producer for delivery to the group.
Application Processing – IC+
IC+ applications are best submitted through the online application process. The online system allows you and
your client to generate a quote based on citizenship and resident information. There are countries which are
considered too “hot” for us to place a policy. If the online system will generate a quote for a client based upon
the answers to the questions on the quoting system, the policy can be written provided the client qualifies
medically.
When the application is received, it will be reviewed within two business days by the Underwriting Department.
Underwriting may require additional information depending upon the face amount requested. After an
application is approved and premium is secured, the Certificate documentation will be prepared and sent to
the producer for delivery to the insured.
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Changes and Updates of Policyholder Information
HCCMIS must receive written notification when members change addresses, whether for their residence or for
mail. We must also be informed of any other contact information change so that the policyholder’s file remains
up-to-date. Prompt written communication of such changes enhances our ability to appropriately direct any
correspondence necessary.
New credit card information must be submitted to us in writing from the member or cardholder. For policies
with scheduled installment payments (CitizenSecure®, CitizenSecure® Economy, HCC Life STM and
StudentSecure®), credit card information may be updated through Client Zone or submitted to us in writing.
Under no circumstance can HCCMIS or HCC Life accept credit card information over the phone.
Languages
Our offices are ready to serve our producers and their clients in a variety of languages. Customer service and
assistance is available in English, Spanish, German, French, Dutch, Russian and the rest of the world’s major
languages. No matter what language is spoken, HCCMIS service leadership comes through loud and clear. If
there is a particular language need for your base of business, please contact the HCCMIS Marketing
Department to determine our particular capabilities in any specific language or dialect.
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Chapter 12: Departments of HCC Medical Insurance Services
Marketing and Sales
The Marketing and Sales Department of HCC Medical Insurance Services (HCCMIS) consists of a versatile
mixture of specialists. From policy guidance, to technical support, to agent materials assistance, department
members pride themselves in constantly searching out new business and in supporting the business already in
place. A major focus is placed on maintaining strong relationships with those insurance agents that have
aligned themselves with HCCMIS. Although a producer may specifically contact a member of the Underwriting
or Claims Departments or the World Service Center, they can also get in touch with their Marketing or Sales
contact directly if intervention is desired. From assisting an agent in placing a link on their website to mailing
additional product materials out, the Marketing and Sales Department is one of the principal driving forces that
allow HCCMIS to flourish in the international insurance market.
World Service Center
HCCMIS’s approach to improving our standing in the international insurance market is to provide astonishing
customer service—service that will impress and please our customers. We hope to build our business by
encouraging our customers to be repeat customers and to recommend us to others.
The World Service Center helps support all HCCMIS departments, especially the Marketing and Sales, Claims
and Underwriting Departments. The primary support is provided through handling lower-level inbound phone
inquiries including quotes, claim status, and general questions about applying for insurance. Additional
support is provided through e-mail responses, sending of faxes, and follow-ups to prior inquiries.
We are the first contact when calling HCCMIS. Even if we cannot provide the answer that the customer wants
to hear—indeed, this situation may happen often—we provide it in a friendly, professional manner.
Underwriting
The Underwriting Department handles incoming applications, renewals, and cancellations for all policies
administered by HCCMIS. Underwriting representatives pride themselves on providing helpful and efficient
service to all of our clients and producers. For each product that we offer, our staff is dedicated to providing
accurate processing in a timely manner. Additionally, representatives in the Underwriting Department are
always willing to assist with questions, especially when more detailed information or explanation is necessary.
Our medical underwriters give fair consideration to each and every applicant, even if the result is that coverage
is not able to be offered. HCCMIS’s Underwriting Department is made up of individuals who operate within the
guidelines of insurance but without failing to recognize that each client is an individual deserving of our
attention.
Claims
HCCMIS’s Claims Department is staffed with individuals, who together have over 20 years of insurance claims
experience. The department adjudicates claims for all products offered by HCCMIS. Because HCCMIS’s
products offer a variety of benefits, the claims staff is well-versed with knowledge of each product’s benefit
structure. Although the World Service Center handles the majority of the incoming phone calls, the Claims
Department is available for complex calls, or any situation which would require a claims specialist. Members
of the Claims Department are in contact with agents and members via e-mail communication, assisting in the
understanding of the insurance benefit, or of how a claim was processed. The Claims Department pride
themselves on providing astonishing customer service by resolving most claims within 10 business days of
receipt.
Project Management
The Project Management Department provides structure and support during new product development as well
as during portfolio product changes. This department is also involved in coordinating projects that increase
client and producer online capabilities—such as enhancements to Client and Producer Zone and quoting
system functionality—as well as projects for internal system improvements to ensure that the HCCMIS staff is
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fully enabled to assist you and your clients. All Spanish translations are also handled directly within the
Project Management Department through our Linguistic Specialist to ensure that the high-demand of
requested Spanish materials is met. Additionally, Project Management provides support throughout the
company, including providing employees with valuable customer service techniques and training, which
focuses on ensuring HCCMIS’s astonishing service.
Compliance
The Compliance Department is an integral part of HCCMIS ensuring all guidelines and regulations are
followed, from contracting producers to making sure HCCMIS is in compliance with federal laws such as
HIPAA. The Compliance Department maintains all HCC Medical Insurance Services licenses. All producer
contracts and licenses are entered and maintained by the Compliance Department. Along with making sure
our producers are properly licensed, the Compliance Department makes sure HCCMIS is in compliance with
all state insurance regulations and guidelines for all products. The Compliance Department also reviews files
in which potential application omissions have been found.
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