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  • Info requested on Patriot America Plus

    Hi,

    I am considering buying Patriot America Plus comprehensive insurance plan (covering upto $50000) for my mother for the duration of her stay in the USA. But before making the purchase I had a few questions. Could you please answer the same?

    Following are the details:

    Age of Mother : 61 years
    Citizenship : Citizen of India
    Date of her Arrival in USA : 12th Dec 2017
    Planned date of departure from USA: 6th June 2017
    State of Residence in USA: Washington

    Following are my questions:

    1) I understand once I have paid the premium online, I'll be sent a set of documents by post by Sirius International / IMG which have to be filled up and signed by my mother ? After that, can I scan and send the documents to Sirius International / IMG by e-mail or do I have to send the same by post or courier to Sirius International / IMG ? Also, after Sirius International / IMG has approved the application, do they send their written acceptance again by post or by e-mail ?

    2) After the premium has been paid online , generally how many days does the entire process of postal communication and Sirius International / IMG approving the filled up application form take ? In other words, while paying the premium online should I mention the Start Date of insurance to be a date which is a few days later ( say, around 10 days later which will result in a lower premium as compared to if the start date is mentioned as the immediate next day ) taking into account the delay that will be involved in postal communication and Sirius International / IMG approving the filled up application form ?

    3) I understand before obtaining treatment, one has to comply with pre-certification requirements wherein Sirius International / IMG has to be informed and their approval taken before begining the treatment. Does the insured person need to inform Sirius International / IMG here or does the hospital within the PPO network do this on behalf of the insured person ?

    4) How much time does Sirius International / IMG generally take to approve pre-certification before treatment can begin ?

    5) After the treatment, do the hospitals within the PPO network generally submit the claim directly to Sirius International / IMG ( with all proof of claim ) and does Sirius International /IMG directly reimburse the hospital ? Or do the hospitals expect the insured person to pay them from their own pocket and then claim the money from Sirius International / IMG ?

    6) As indicated in the 'Exclusions' section (point no. 21) of the Certificate Wording , is there any tax, surcharge etc. imposed by the government in case Sirius International / IMG reimburses the hospital directly for the treatment and if so, what is the percentage of tax , surcharge etc. imposed by the goverment ?

    7) In case a claim is denied by Sirius International / IMG after treatment has been completed in a hospital within the PPO network and the insured person has to pay the hospital from his own pocket, does the insured person still get the discounted rate in the PPO network or not ?

    8) Do I have to pay any commision to Insubuy while buying the insurance or does Insubuy collect commision only from Sirius International / IMG ?

    9) Certificate Wording (Exclusions section, point no. 26) says that Accidental Death or Dismemberment as a result of infection is not covered. I understand although Accidental Death or Dismemberment as a result of infection is not covered , cost of treatment of the Insured person to treat the infection should still be covered , right ? Please confirm.

    Regards,

  • #2
    Thank you for contacting Insubuy for your insurance needs. Please see the answers to your questions below .If you have additional questions please feel free to contact our office and speak with a licensed agent.

    1) I understand once I have paid the premium online, I'll be sent a set of documents by post by Sirius International / IMG which have to be filled up and signed by my mother ? After that, can I scan and send the documents to Sirius International / IMG by e-mail or do I have to send the same by post or courier to Sirius International / IMG ? Also, after Sirius International / IMG has approved the application, do they send their written acceptance again by post or by e-mail ?

    These plans are an instant purchase. There will not be any documents that will need to be signed and returned. The documents that you will receive in the mail are going to be policy documents.

    2) After the premium has been paid online , generally how many days does the entire process of postal communication and Sirius International / IMG approving the filled up application form take ? In other words, while paying the premium online should I mention the Start Date of insurance to be a date which is a few days later ( say, around 10 days later which will result in a lower premium as compared to if the start date is mentioned as the immediate next day ) taking into account the delay that will be involved in postal communication and Sirius International / IMG approving the filled up application form ?

    Please see the answer to question 1

    3) I understand before obtaining treatment, one has to comply with pre-certification requirements wherein Sirius International / IMG has to be informed and their approval taken before begining the treatment. Does the insured person need to inform Sirius International / IMG here or does the hospital within the PPO network do this on behalf of the insured person ?

    In most cases the hospital or provider will obtain pre-authorization on your behalf. You will just want to make sure that it is done.

    4) How much time does Sirius International / IMG generally take to approve pre-certification before treatment can begin ?

    Pre-authorization can be done within a couple of business days. Keep in mind that even approval does not guarantee payment of claims. Final claims determination is made by the claims department based on certificate wording and medical records.

    5) After the treatment, do the hospitals within the PPO network generally submit the claim directly to Sirius International / IMG ( with all proof of claim ) and does Sirius International /IMG directly reimburse the hospital ? Or do the hospitals expect the insured person to pay them from their own pocket and then claim the money from Sirius International / IMG ?

    Yes, hospitals generally submit the claims directly to the claims department and then for a covered medical expense the hospital would be paid directly.

    6) As indicated in the 'Exclusions' section (point no. 21) of the Certificate Wording , is there any tax, surcharge etc. imposed by the government in case Sirius International / IMG reimburses the hospital directly for the treatment and if so, what is the percentage of tax , surcharge etc. imposed by the goverment ?

    No, the US government does not charge a tax for hospital billing but there are a few states that charge a state tax. You can check with your state to find out if they impose any tax.

    7) In case a claim is denied by Sirius International / IMG after treatment has been completed in a hospital within the PPO network and the insured person has to pay the hospital from his own pocket, does the insured person still get the discounted rate in the PPO network or not ?

    No, the insured would not get the negotiated rate since the claim would not be sent to the network for processing unless it was a covered service. You could negotiate with the hospital directly for any service provided that is not covered by the plan.

    8) Do I have to pay any commision to Insubuy while buying the insurance or does Insubuy collect commision only from Sirius International / IMG ?

    No, you don’t pay any commission to Insubuy. You only pay the cost of the premium.

    9) Certificate Wording (Exclusions section, point no. 26) says that Accidental Death or Dismemberment as a result of infection is not covered. I understand although Accidental Death or Dismemberment as a result of infection is not covered , cost of treatment of the Insured person to treat the infection should still be covered , right ? Please confirm.

    Yes, you are correct it should be covered under the medical benefits as long as it’s a new illness or injury that occurs after the effective date of the plan.
    Last edited by Antonise; 11-24-2017, 03:10 PM.
    Thanks & Regards
    Insubuy
    Toll Free: (866) INSUBUY
    Local: (972) 985-4400
    Fax: (972) 767-4470
    Website: http://www.insubuy.com

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