Frequently Asked Questions

Coverage




















Claims








Contacts








Coverage 
1. Who can apply for coverage?

For our major medical plans, regular AVMA members who reside in the United States, under the age of 65 and Student Chapter members attending a full schedule of classes, may apply to insure themselves and their eligible dependents. Please be sure to review the plan descriptions which outline the eligibility requirements for each coverage.

2. How can I apply for coverage?

You may download the Enrollment forms and mail completed forms to:

P.O.Box 30475
Tampa, FL 33630-3475

or you may call the Trust office at 800-621-6360 and we will e-mail, fax or mail you an Enrollment form. Please be sure to complete all of the questions, sign the form and return it. Remember all questions must be complete You may also contact an agent. click here to find an agent in your area. 

3. Do I need to carry Medical coverage to enroll for Life or Disability coverage?

No. You may choose whatever coverages fit your needs. In fact, the AVMA GHLIT Life & Disability coverages could be a nice compliment to other non-Trust coverages.

4. In the event of a member's death, what happens to the coverage of the deceased member's insured dependents (spouse, domestic partner and/or children)?

The AVMA GHLIT policies contain a provision that allows the surviving dependents to remain insured under the policies for the coverages which were in force on the day the insured member died, if the contribution is paid. The Trust office must receive an original copy of the death certificate to obtain the date of death and to process claim benefits for any Life Insurance in force. The Trust office must also be notified of which coverages the surviving spouse/domestic partner and/or child(ren) wish to retain.

5. How long can my child be covered as my dependent?

In most states and on most plans, your child can remain a dependent under AVMA GHLIT coverage policy until he/she reaches the age of 26.

6. What is HIPAA?

HIPAA stands for Health Insurance Portability and Accountability Act of 1996, P.L. 104-91. This law on access to medical coverage relates to underwriting, pre-existing limitations, guaranteed renewal, COBRA and certification requirements in the event someone terminates from the plan. Learn more about HIPAA at the Department of Labor's website. - Please note this may take a few minutes to appear.

7. What is the purpose of HIPAA?

Commonly known as the "Kennedy-Kassebaum Bill," HIPAA establishes new requirements for self-funded, fully-insured group plans (including church plans) and Individual Health policies. The purpose of the law is to:

•Improve portability and continuity of health insurance coverage in the group and individual markets
•To combat waste, fraud and abuse in health insurance and health care delivery
•To promote the use of medical savings accounts
•To improve access to long-term care services and coverage
•To simplify the administration of health insurance
Learn more about
HIPAA at the Department of Labor's website. - Please note this may take a few minutes to appear.

8. Can my life insurance be assigned as collateral?

Yes. Simply call the Trust office and request the appropriate New York Life form.

9. Can I pay premiums by credit card?

You may pay your premium by check, money order or monthly EFT. We currently are not able to accept payment by cash or credit card.

10. Are prescription drugs covered?

Yes, prescription drugs may be covered under the GHLIT Major Medical plans. If you are enrolled in a Traditional Indemnity Plan or the HSA- qualified plan, you pay the full preferred price upfront for each prescription and are reimbursed according to the Traditional Indemnity Plan or the HSA-qualified plans provisions. With all Traditional Indemnity Plans, except Plan E, and HSA-qualified plans, prescription drug charges are subject to the deductible and co-insurance. Plan E participants, please refer to your schedule of benefits.

If you are enrolled in a PPO or PPO Value Plan you are responsible for paying a co-payment as outlined in your schedule of benefits.

11. Is my PPO hospital or physician in the network?

There are two ways to find out if your hospital or physicians are in the network. You can click on "Locate Providers" from the homepage and then select "UnitedHealthcare Options PPO Network", which will take you to the network site or you can call the toll free number at 1-800-621-6360.

12. Will my doctor's office need to see my I.D. Card?

Your I.D. card contains important information that your doctor will need: address to send claims; telephone number to call with questions; and your network logo which lets your doctor know what network your plan utilizes. It is important that you carry your I.D. card with you at all times.

13. What if I go to the emergency room, and they only keep me a couple of hours, do I need to call my insurance company?

No. You only need to call if you are going to be admitted to the hospital for an overnight stay.

14. What happens if I have an emergency and get admitted to a hospital?

Emergency admissions are everyone's greatest concern. We all worry about many details in an emergency situation. The least of your worries should be "Do I need to notify my insurance company?" If your injury or sudden illness requires you to stay in the hospital overnight, contact the Trust Office at 800-621-6360 and you will be connected to a UMR representative. Notification should be made immediately following admission or on the first business day following weekend or holiday admissions. If you are unable to notify the Trust Office, anyone may phone on your behalf-your spouse, a relative, your doctor, or the hospital.

15. Who is supposed to contact UMR, Inc.?

Anyone of the following: Patient, patient's family, treating physician, or hospital may contact a UMR representative, although it is ultimately the member's responsibility to make sure one of the above does contact UMR, Inc.

16. What information do I give UMR, Inc. when I call for information on certification of hospital stays?

•Patient name, address and age
•Member name and certificate number
•Admitting physician and hospital name, address and phone number

17. Do I have to have Pre-ADMISSION Certification for a maternity admission?

Maternity admissions should be pre-certified. Please call UMR as soon as your due date is known, within the first three months. At that time United Healthcare Options UMR will evaluate your pregnancy to help determine risk factors and offer support and education according to your needs.

18. Who is UMR?

Representatives of UMR, Inc., a company specializing in health care coordination and management, evalute all acute care medical admissions, and all admissions for the treatment of mental health and substance abuse, to help determine that your proposed in-patient treatment is necessary.  This process will enable you to spend as much time as required in a health care facility but no longer than is necessary to allow you to get back to your family, work and personal responsibilites as quickly as possible.


Claims 
1. In the event of a death, where should I mail my life insurance claim?

Life insurance claims ONLY should be mailed to:
AVMA-GHLIT
P.O.Box 30481
Tampa, FL 33630-3481

All other claims should be mailed to:
AVMA GHLIT
P.O.Box 909720
Chicago, IL 60690-9720

2. How do I file a claim?

It's simple...to file a claim, answer each question on the Insured's Statement portion of the claim form and have your health care provider complete the Attending Physician portion. Then just mail the form and itemized bill to:
All claims:

AVMA-GHLIT
P.O.Box 909720
Chicago, IL 60690-9720

Claims are administered by UMR, Inc.

3. How are the covered charges on my Major Medical claims applied to my deductible?

The charges are applied based on the order in which they are received and adjudicated.

4. Will you send payment on my claims directly to my doctor?

Payment will be sent directly to your health care provider if you assigned benefits at the health care provider's office, or on the AVMA GHLIT claim form that was submitted to the Trust office.

6. Why am I always asked for "other insurance" information?

The AVMA plan coordinates benefits with other insurance plans which help keep claims costs down and assures that no one is reimbursed more than the charges incurred.

5. How often must I submit a claim form?

If your health care provider uses government standardized form (UB92 for hospital; HCFA1500 for all others), you do not need to fill out a claim form. If your health care provider does not use standardized forms, you must submit one completed claim form per calendar year for each family member incurring claims.


Contacts 
1. Is there an in-network hospital or physician in my area?

Hospitals and physicians in all areas of the United States participate in the United HealthCare Options PPO Network. To locate a hospital or physician near your home, office, or anywhere in the United States, use the UnitedHealthcare Options site or call 1-800-621-6360.

2. How do I locate hospitals or physicians participating in the UnitedHealthcare Options PPO Network?

You can use any of several tools available to you to locate a provider or determine whether your doctor is in the UnitedHealthcare Options PPO Network. Call 1-800-621-6360, and a UnitedHealthcare Options customer service representative will assist you in locating the electronic directory on the AVMA GHLIT website to look up providers who participate in the network.

3. When can I call UnitedHealthcare Options?

The UnitedHealthcare Options clinical management staff answers the phone from 7:00 AM - 7:00 PM CT, Monday through Friday.

4. Who will answer the telephone when I call UnitedHealthcare Options?

The UnitedHealthcare Options trained clinical management staff.