[PDF] Union Security Life Insurance Company of New York IMPORTANT





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MEDICARE SUPPLEMENT INSURANCE COMPANIES Please note

Companies are required to offer coverage to people under age 65 who are UNION SECURITY INS. COMPANY. A. F. G. N. Medicare Supplement Administrative ...



Aetna Senior Supplemental Insurance* Claim Submission Guide

Medicare uses the member eligibility file to verify any secondary insurance carrier. This process takes 15 days. • Medicare routes the appropriate claims to us 



Union Security Life Insurance Company of New York IMPORTANT

Follow your creditor's instructions for mailing the completed claim form. ONCE YOUR CLAIM IS RECEIVED. ?. YOU WILL RECEIVE A LETTER ACKNOWLEDGING RECEIPT OF 



Aetna Senior Supplemental Insurance* Home office directory

Home office directory - Medicare Supplement. This directory also applies to: Accendo Insurance Company part of the CVS Health® family of companies and Aetna 



UNDERWRITING GUIDELINES

Union Security Insurance Company Mailing Address for RENEWAL PREMIUMS ONLY ... Insurance Company. P.O. Box 14770. Lexington KY 40512-4770. Claims.



Medicare & Other Health Benefits: Your Guide to Who Pays First

How does retiree coverage compare to a Medigap policy? Private insurance companies sell Medigap policies which are optional insurance policies that fill “gaps” 



Medicare and You Handbook 2023

7 days ago and Part B after you get disability benefits from Social Security or ... insurance (like Medigap Medicaid





Medicare and You Handbook 2023

7 days ago and Part B after you get disability benefits from Social Security or ... insurance (like Medigap Medicaid



CARRIERS WITH APPROVED INDIVIDUAL MEDICARE

5 days ago Attn: Medicare Supplement ... www.lbig.com/health-insurance/medicare-supplemental-insurance ... Union Security Insurance Company. MEDICARE ...



Unions Security Medicare Supplement Plans for 2023

Mailing Address for RENEWAL PREMIUMS ONLY Make check payable to the appropriate underwriting company Reference policyholder name and policy number on all checks and correspondence Union Security Insurance Company P O Box 14770 Lexington KY 40512-4770 Claims Hours: M-F 7:00 AM-8:00 PM CST Phone: (833) 552 0827 (agents)



Medicare Supplement Insurance Policy

Union Security Insurance Company offers standardized Medicare Supplement plans A F G and N all with varying amounts of coverage Each plan is designed to fit a variety of client budgets and needs Plan costs vary based on the amount of coverage provided by a specific plan A Household Premium Discount may be available for eligible applicants



MEDICARE SUPPLEMENT INSURANCE COMPANIES Please note

UNION SECURITY INS COMPANY A F G N Medicare Supplement Administrative Office No pre-exist Attained age 800 Crescent Centre Dr Ste 200 Franklin TN 37067 1-833-552-0827 UNITED COMMERCIAL TRAVELERS OF A A F G 1801 Watermark Drive Suite 100 Columbus OH 43215-8619 800-848-0123 www utc

  • Union Security Insurance Company Medicare Supplement Plans

    Union Security Insurance offers Medicare Supplement insurance plansto those eligible for Medicare. Many Medigap plans help cover the Medicare Part A deductible, Medicare Part B deductible, and coinsurance.

  • Union Security Insurance Medicare Pros and Cons

    Pros

Does union security insurance offer Medicare supplement insurance?

Union Security Insurance offers Medicare Supplement insurance plans to those eligible for Medicare. Many Medigap plans help cover the Medicare Part A deductible, Medicare Part B deductible, and coinsurance. Suppose you’re receiving Medigap in a state that isn’t listed.

Who is union security insurance company (USIC)?

Union Security Insurance Company (USIC) is a national provider of Medicare Supplement insurance solutions that help customers manage and budget for their health care needs. USIC is part of TruStage ® Financial Group, Inc. Take the steps to ensure your medical needs don’t impact your financial future.

Does USIC offer Medicare supplement plans?

Health care services that Medicare approves the claim for will have coverage through the Medicare Supplement plan. USIC doesn’t offer Part C Advantage Plans or Part D prescription plans. However, you can buy a separate Part D plan with your Medicare Supplement insurance. You can get Part D through a different company than your Medigap provider.

Is union security a good insurance company?

Union Security Insurance Company has a B+ (stable) AM Best rating. S&P rates them as BBB+ (good). These ratings also come from people who use them for a life insurance company, not just Medicare. Since the government standardizes Medicare Supplement insurance plans, it doesn’t matter which Medigap carrier provides you coverage.

Union Security Life Insurance Company of New York

Administrative Office

P.O. Box 977122, Miami, FL 33197-7122

1.877.438.7085 Fax 305.252.6910

Attn: DFS Claims Department

INITIAL CREDIT/CLOSED END MONTHLY OUTSTANDING BALANCEDISABILITY CLAIM FORM All benefit payments are paid directly to your creditor. H1

C2140-1011Page 1 of 4DISABILITY - CREDIT - NY

To avoid late fees, continue to make your payments until you receive notification that your claim has been

approved.

If your claim is approved, a continuing claim form must be submitted every 30 days for additional payments to be made.

IMPORTANT NOTICEPLEASE READ CAREFULLY BEFORE COMPLETING YOUR CLAIM FORM

Failure to complete required sections and/or provide requesteddocumentation will delay processing of your claim.

(Check box after each item is completed.)

1. Complete Section A.

If you are receiving Social Security Disability, please provide us with a copy of your award letter or

verification that you are receiving SSDI. Complete attached Health Insurance Portability and Accountability Act (HIPAA) Authorization.

Attach a copy of your Certificate of Insurance (including health questions) and Application for Credit

Insurance if applicable.

2. Have your employer complete Section B.

3. Have your doctor complete Section C.

4. Have Section D completed by your creditor or by the financial institution where the coverage was purchased.

If this is a revolving account, have creditor provide print out showing amount due on the date of disability. If premiums are paid monthly, please submit a Statement of Account for the month in which disability occurred.

5. Follow your creditor's instructions for mailing the completed claim form.

YOU WILL RECEIVE A LETTER ACKNOWLEDGING RECEIPT OF YOUR CLAIM. THE LETTER WILLCONTAIN YOUR CLAIM NUMBER.

PLEASE ALLOW 15 BUSINESS DAYS FOR YOUR CLAIM TO BE PROCESSED.

AFTER YOUR CLAIM HAS BEEN PROCESSED, YOU WILL RECEIVE A LETTER ADVISING OFAPPROVAL, DENIAL OR REQUEST FOR ADDITIONAL INFORMATION.

NAME OF EMPLOYEEON WHAT DATE WERE YOU FIRST TREATED BY A PHYSICIAN

FOR THIS SICKNESS OR INJURY

WARNING:Any person who knowingly and with intent to defraud any insurance company or other person

files an application for insurance or statement of claim containing any materially false information, or

conceals for the purpose of misleading, information concerning any fact material thereto, commits a

fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five

thousand dollars and the stated value of the claim for each such violation.

I AUTHORIZE any employer, physician, hospital, clinic, other medical or medically related facility, the Medical Information Bureau, Inc.,consumer reporting agency, insurance or reinsuring company, insurer, law enforcement agency, fire department, Social SecurityAdministration, Internal Revenue Service, or other organization, or person having any records, data or information concerning this claim tofurnish such record, data or information to the insurance company issuing my policy as requested. I understand that in executing thisauthorization, I waive the right for such information to be privileged as it pertains to the processing or investigation of my claim(s).A photocopyof this authorization shall be considered as effective and valid as the original.

I understand and acknowledge that this authorization extends to all or any part of the records being requested, which may include treatmentfor physical and mental illness, alcohol/drug abuse, and/or HIV/AIDS test results or diagnosis and treatment.I expressly consent to the releaseof information as designated above.

The above information is true and correct. If in fact the furnished information is false thereby inducing payment of claim and the insurancecompany issuing my policy determines that the incorrect information constitutes an aiding and abetting the filing of a fraudulent claim, theinsurance company issuing my policy may furnish the above information to the appropriate state authorities to be used in its discretion as thebasis for action authorized under applicable state law. In addition, I agree any statements made on this or any other form found to be false,shall give the insurance company issuing my policy the right to void my policy.

I, or my authorized representative, have the right to receive a copy of this authorization. This authorization shall be valid for the duration of the claim. A. CLAIMANT'S STATEMENT FOR ACCIDENT OR SICKNESS CLAIMPLEASE PRINT NAME OF FINANCIAL INSTITUTION (WHERE PAYMENT IS TO BE MADE) CLAIMANT'S EMAIL ADDRESS (IF AVAILABLE)

DATE OF BIRTH

FULL NAME OF CLAIMANT

NAME, ADDRESS AND PHONE NUMBER OF THE EMPLOYER YOU WERE WORKING FOR WHEN YOUR DISABILITY BEGAN (IF UNEMPLOYED WHEN DISABILITY BEGAN, STATE NAME, ADDRESS

AND PHONE NUMBER OF LAST EMPLOYER)

LIST ALL DOCTORS, CLINICS, AND HOSPITALS WHICH TREATED YOU IN THE PAST FIVE YEARS, FOR ANY INJURY, ILLNESS OR GENERAL CHECK-UPS-- INCLUDE COMPLETE ADDRESS AND

PHONE NUMBER (ATTACH A SEPARATE LIST IF ADDITIONAL SPACE IS NEEDED) ARE YOU NOW RECEIVING OR HAVE YOU APPLIED FOR:(IF YES, ATTACH A COPY OF THE AWARD LETTER) Social Security Disability Yes No Other Disability Benefits _______________________________________ X

STATE ZIP CODECITYSTREET ADDRESSTELEPHONE NUMBER

WHAT IS YOUR USUAL OCCUPATION DESCRIBE YOUR USUAL JOB DUTIES

ARE YOU RETIRED

Yes No

B. EMPLOYER'S STATEMENT(MUST BE FULLY COMPLETED) PLEASE PRINT

EMPLOYEE'S OCCUPATION/JOB TITLE

WHAT DATE DID EMPLOYEE RESUME FULL DUTIES

NAME OF EMPLOYER

SIGNATURE

X DATE

STREET ADDRESS

COMPLETED BY (PRINT NAME)CITY STATE

ZIP CODEFAX NUMBER

CREDIT - NY

C. DOCTOR'S STATEMENT(TO BE FURNISHED WITHOUT EXPENSE TO THE INSURANCE COMPANY)PLEASE PRINT

PATIENT'S FULL NAME

"I hereby certify that the above described information is based upon reasonable medical probability, and is true and correct to the best of my knowledge and belief."

FORM MUST BE FULLY COMPLETED AND SIGNED OR STAMPED BY DOCTOR'S OFFICE

DIAGNOSIS (CODE(S))

ICD-9_____ CPT_____ DSM III_____

X

TELEPHONE NUMBER

DATE PERFORMED

IF NOT, GIVE DATE PATIENT WAS RELEASED TO RESUME WORK

WHEN DID SYMPTOMS FIRST APPEAR

ESTIMATED DATE OF DELIVERY

IF YES, DATE OF ORIGINAL ACCIDENT

GIVE DATES OF TREATMENT FOR SIMILAR CONDITION (MM/DD/YY)HAS PATIENT EVER HAD SAME OR SIMILAR CONDITION

Yes No

GIVE EXACT DATES OF TOTAL DISABILITY (UNABLE TO WORK) FROM TO IN YOUR EXPERT OPINION, HOW WOULD YOU QUALIFY THIS PATIENT Permanently Disabled Temporarily Disabled Non-Disabled

GIVE EXACT DATES OF PARTIAL DISABILITY

FROM TO

His/Her Occupation

Any Occupation

IF PATIENT IS STILL UNDER YOUR CARE,

GIVE ESTIMATED DATE WHEN

PATIENT WILL RESUME WORK

FREQUENCY OF VISITS

Weekly Monthly

Other (specify) _______________________

X DATE

ACCOUNT # / LOAN # DUE DATE

POLICY EXPIRES

AGENT CODE BRANCH NO. CLAIM NUMBER

FORM # OF POLICY/CERTIFICATEA&H COVERAGE

Retro ______________ Days

Retro ______________ Days

D. CREDITOR'S INFORMATION(ATTACH A PHOTOCOPY OF POLICY/CERTIFICATE)PLEASE PRINT

LIST THE NAMES OF ALL PRESCRIBED MEDICATIONS FOR THIS DIAGNOSIS (ATTACH A SEPARATE SHEET IF NECESSARY)

Union Security Life Insurance Company of New York

Administrative Office

P.O. Box 977122, Miami, FL 33197-7122

1.877.438.7085 Fax 305.252.6910

Attn: DFS Claims Department

Authorization for Release of Protected Health Information

The Health Insurance Portability and Accountability Act (HIPAA) requires us to get your written permission to obtain specific

health information about you.We are requesting this information in order to process the claim you are presenting to our company.

Therefore, please complete in detail, sign, date, and return the following form to us.We cannot process your claim until we have

this form returned to us.I UNDERSTAND THAT THIS AUTHORIZATION IS VOLUNTARY

I hereby authorize the medical providers listed below to release the following information to Union Security Life Insurance

Company of New York.INSURED INFORMATION

NAME

STREET ADDRESS

DESCRIPTION OF INFORMATION TO BE RELEASED

ENTIRE MEDICAL RECORD

Yes No

X AND if signing on behalf of a minor or as legal representative of another:

C2140-1011Page 4 of 4

ONE FORM MUST BE COMPLETED FOR EACH MEDICAL PROVIDER Please photocopy this form if you need additional copies.quotesdbs_dbs14.pdfusesText_20
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