Frequently Asked Questions

Insurance FAQs
  1. How do you track cases as they are being underwritten?
  2. Can I obtain any effective date for coverage?
  3. Is payment required with enrollment materials?
  4. Are cases automatically denied for incomplete paperwork?
  5. What are the most common grounds for case denial?
  6. How does the appeals process work?
  7. What tax documents are acceptable for qualification?
  8. What is re-qualification?
  9. What is a Letter of Certification?
  10. Why do I need to sign a Late Paperwork Form?
  11. How does my group meet Dependent Student Requirements?
  12. Do I really need a Case Submission Coversheet?
  13. How do I make a plan change for a group?
  14. What is a "buy-up" or a "buy-down"?
  15. Can my group be reinstated for non-payment of premium?
  16. Can my group be reinstated retroactively?
  17. How do I add a new employee?
  18. How do employer waiting periods work?
  19. Must every potential insured own a business?
  20. Can a business with employees outside of NYS obtain coverage for everyone?
  21. Can 6-month coverage be written for "snow-birds" or individuals with dual residences?
  22. Can my group terminate coverage retroactively?
  23. Do I need to include my prior carrier statement w/new business submission?
  24. How long does it take to get a new case approved?
  25. When will the approval letter be issued?
  26. Why is there a five-day new business submission rule?
  27. What is the time frame from approval to when ID cards are mailed?
Customer Service FAQs
  1. I don't have my ID cards—how do I access coverage?
  2. My ID cards are wrong—what do I do?
  3. What is a pre-existing condition?
  4. How do I submit a claim and how long do I have to submit the claim?
  5. How does the claims-appeal process work?
  6. How does COBRA work?
  7. What are the rules for dependant coverage?
  8. What is the Dependent Student procedure?
  9. What is a specialist copay?
  10. I'm covered 100% out-of-network, why am I receiving a bill?
  11. What is a percentile and what is HIAA?
  12. How does mail order pharmacy traditionally work?
  13. What's a mandatory generic prescription requirement?
  14. What is an in-network deductible and when does it often apply?
  15. What are "hospital facility charges"?
  16. Is all emergency care covered?
  17. Is ambulance and/or air ambulance service traditionally covered?
  18. Am I covered for emergencies out of state? Internationally?
  19. I was admitted to a participating hospital but received bills from various physicians and tests. Why?
  20. What is pre-certification and why is it necessary?
  21. What does the term Coordination of Benefits mean?
  22. When do I qualify for Medicare?
  23. I'm retired; what serves as my primary coverage Medicare or my group policy?
  24. How do I avoid expensive diagnostic imaging costs?
  25. My physician is non-participating; can they become participants?