How Do Supplemental Insurance Claims Work? A Step-by-Step Guide
Supplemental insurance is designed to work alongside major medical insurance, but the two types of coverage work differently, especially regarding claims. Understanding your coverage before you need to file a supplemental health insurance claim can make the process easier to navigate.
Understanding your coverage before you need to file a supplemental health insurance claim can make the process easier to navigate.
Major medical insurance generally helps pay covered healthcare costs prior to or as you receive medical care. However, supplemental insurance is generally claim-based: after a qualifying accident, hospital stay, illness or other covered treatment or event occurs, you submit a supplemental health insurance claim. If the event qualifies under the terms of your policy, the plan provides the applicable benefit.
Depending on your coverage, that benefit can help with expenses you may face following an unexpected medical event. The amount and type of benefit you receive depends on the product and coverage you purchased, the terms of the your policy and premiums paid.
Before filing a claim, review your policy to understand:
- What events or services may qualify for benefits
- The benefit amounts associated with your coverage
- Your coverage effective date
- Any applicable waiting periods, limitations or exclusions
- Claim filing requirements
How Do Supplemental Insurance Claims Work?
The details vary by product, but the basic claim process is straightforward:
- A qualifying event or service occurs.
- You review your policy to verify benefits.
- Submit a claim with the required documentation.
- ManhattanLife evaluates the claim according to the terms of your policy.
Coverage must be in effect when the covered event occurs. Purchasing supplemental insurance after receiving treatment does not make past treatment covered. Additionally, all premiums for the policy must be paid prior to the medical event for the policyholder to be eligible for benefits.
If you are unsure how your coverage applies, your policy is your primary reference. Your agent and ManhattanLife’s policyholder resources can also help you better understand the coverage you purchased. You can also visit our company homepage to navigate to product overviews and brochures at manhattanlife.com.
How Do You File a Claim with ManhattanLife?
Keeping track of claim documents you receive during treatment, such as itemized bills, statements, an Explanation of Benefits (EOB), receipts and other treatment-related information, can be helpful. Having these records organized and readily available may make it easier to gather the supporting documentation required later for your claim. This process still applies if you have an annuity or life insurance product. For policyholders and contract holders, the claims process is as follows:
1. Search
You’ll begin by finding your claim form at: https://www.manhattanlife.com/File-A-Claim. To identify the correct form, you can use your policy information or the product category your policy is under.
2. Download
Download the applicable ManhattanLife claim form.
3. Complete
Completely fill out the downloaded claim form.
4. Send
Submit the form online through the Client Services portal at: https://clients.manhattanlife.com/#/. Or you can use the Easy Upload app for iOS and Android devices to file your claim.
Please Note: Providing complete information can help reduce delays related to missing documentation.
If you have questions about the decision or the appeal process, contact ManhattanLife Customer Care by email at CService@ManhattanLife.com or by phone at 1 800-669-9030.
What Happens After You File?
After your claim is received, ManhattanLife reviews the information provided to determine whether benefits are payable under your policy coverage.
If more information is needed, you may receive a request for additional documentation by postal mail. Processing time can vary based on the type of claim, its circumstances and whether all necessary information has been received.
Once the evaluation is complete, the policyholder is notified by postal mail if the claim is Paid or Not Paid.
If your claim is Paid, review the benefit information and keep the decision with your records. Depending on your plan and available payment options, benefits may be received by check or electronically.
If your claim is Not Paid, review the reason provided and compare it with your policy. Depending on your policy and the circumstances, you may also have the option to appeal the claim decision. Review the information provided with your claim decision for any applicable next steps.
Please Note: Not all policies have the option to appeal a claim decision.
Know Your Coverage Before It’s Needed
A claim often comes at a time when you already have plenty to think about. Learning about your coverage beforehand may help you know what to expect and where to turn.
For agents, helping customers understand their coverage at enrollment and encouraging them to stay familiar with it can provide clearer expectations about what the plan includes.
Supplemental coverage can be an important part of a well-rounded insurance portfolio. Take a few minutes today to review your policy, identify the benefits available to you and make sure you know where to find claim forms and other resources. If something isn’t clear, talk with your agent or use ManhattanLife’s website to learn more.
The better you understand the coverage you have today, the better prepared you can be should the unexpected occur. Remember, you own your coverage, so you have the freedom to decide how the benefits are put to work.