Contact our Customer Service Center where our staff is ready and eager to assist you by calling our toll-free number at 1-800-527-5504. Representatives are available from 8:00 AM 5:00 PM in all time zones, Monday through Friday. You can also send an email or standard mail to our offices at P.O. Box 982010, North Richland Hills, TX 76180. Responses to emails will usually be sent within one business day.
How do I appeal a decision or action taken by the company?
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While we strive to make the fairest decisions possible with the information we are provided, we understand that sometimes you may disagree with the outcome. If you would like to file an appeal, you may do so by logging into our website and submitting your appeal online or you may complete the
Request an Appeal form and mail it into our Consumer Affairs Department at the address indicated on the form. All appeals must be submitted in writing, however, if you need assistance completing the form, please contact our Customer Service Center at 1-800-527-2845 from 8:00 AM 5:00 PM in all time zones, Monday through Friday.
How can I get information, or a quote, for purchasing Health Insurance?
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You can find information on our affordable health insurance products by clicking on the Products link on our homepage or by calling our Customer Service Center at 1-800-527-5504.
What types of coverage do you provide and what is the benefit of each?
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The Company provides a variety of customizable health plans to allow customers flexibility in obtaining the coverage they wish to obtain at an affordable price. Plan availability will vary by state, and not all plans will include all options. A licensed insurance agent is the best person to explain the details of the coverage options available from The MEGA Life and Health Insurance Company. The following coverage options may be available:
Preventative Care: routine care provided to avoid serious illness and disease. Examples may include annual exams and immunizations.
Outpatient care for illness: care provided to determine the diagnosis of specific symptoms. Examples may include doctor office visits, diagnostic labs and x-rays and physical, speech, or occupational therapy.
Inpatient hospital care: care resulting from the admission into a hospital for longer than 24 hours. Covered expenses may include room and board, surgery, and miscellaneous charges.
Emergency room: care administered in a medical emergency where failure to receive care could result in a permanent disability or fatal result.
Ambulance Coverage: partial coverage of medical ground transportation when admitted to the hospital as a result of the transport.
First time users will need to register to access the "members" section of the website. To establish a Login ID and Password, set up your account by providing the requested personal information.
Do you have translator and interpretation services?
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We provide, upon request, interpreter and translation services related to administrative procedures and claims processing. This service is available to you when you contact our Customer Care Department at 1-800-733-1110 or our Claims Customer Service Department at 1-800-733-8880.
Offer to review your coverage- Frequently Asked Questions
What is your Offer to Review Coverage program?
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"Coverage Review" is a complimentary, no-obligation service we are offering our members. If you would like to know more about your plan or other plan options that may be available to you, please call our Claims Customer Service Center at 1-800-527-2845 from 8:00 AM 5:00 PM in all time zones, Monday through Friday, and a representative will review your benefits. You will not be referred to, or contacted by an insurance agent if you participate in the review.
If you are interested in learning more about your plan or other plan options that may be available to you, please call our Claims Customer Service Center at 1-800-527-2845 and a representative will review your benefits with you. If you do not wish to take advantage of this offer, you do not need to do anything and your coverage will not be affected.
Understanding your Health Plan Benefits- Frequently Asked Questions
When does my coverage begin? / Has my coverage been approved?
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For information specific to a plan you have purchased, please contact our Customer Service Center at 1-800-527-5504 or submit a request from the Contact Us page.
How do I order a copy of my current contract/plan benefits, coverage, or ID Cards?
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You may order a copy directly through the "members" section of this website (once you have logged in) from the "My Plan" tab. Please have your Health ID number ready. You may also call our Customer Service Center at 1-800-527-5504 or submit a request through this website from the Contact Us page.
Please call our Customer Service Center at 1-800-527-2845 from 8:00 AM 5:00 PM in all time zones, Monday through Friday, so that we may go over your plan benefits with you and answer any questions you may have. You may also order a copy of your contract directly through the "members" section of this website (once you have logged in) from the "My Plan" tab. Please have your Health ID number ready.
Plan options and availability vary by state and may be subject to approval by our underwriters. Please call our Customer Service Center at 1-800-527-5504 to speak to one of our customer service representatives who can go over plan options and any underwriting requirements with you.
How can I make a coverage change to my health insurance plan?
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Some coverage changes may require approval by our underwriters, while some can be completed over the phone. Please call our Customer Service Center at 1-800-527-5504 and we will walk you through the process.
Who do I contact if I have a question about my prescription drug benefits?
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Please contact Caremark® at www.caremark.com or by calling 1-877-348-0578.
Who do I contact if I have a question about my vision benefits?
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Once the company receives my application, how long will it be before I receive notification of coverage?
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We will contact you by first class mail within 14 business days to confirm receipt of your application. If additional information is required, please allow up to 3-6 weeks after we receive your application for processing. If you have any questions during the approval process, please contact our underwriting department at 1-888-336-2893 from 8:00 AM 5:00 PM CST, Monday through Friday and a representative will be happy to answer questions regarding your application.
What if I forgot to include information, medical conditions or a new condition develops after my application has been submitted?
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When you submit your application for coverage, the law requires you to notify us of all known medical conditions. If you forget to note a condition, or a new one develops, you may call our underwriting department at 1-888-336-2893 from 8:00 AM 5:00 PM CST, Monday through Friday, to advise updates to your information.
How soon after my coverage is issued will I receive my insurance documents?
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You will receive your insurance documents in 7 to 10 business days after coverage has been approved. Your certificate of coverage and other information will arrive via first class mail delivery. Once received, you should thoroughly review your insurance contract and all other materials included in the packet. If you notice any discrepancy between the documents you receive and what you expected to receive, please call our underwriting department at 1-888-336-2893 immediately and a representative will assist you.
Underwriting is a comprehensive review of a person's medical history to determine their insurability. Once this review is complete, the company determines if insurance will be issued and what the cost of coverage will be for the selections made by the applicant.
Premiums and Rates Frequently Asked Questions
I'm changing my bank account. What do I do?
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A new "payment authorization form" must be filed with the company. To download the proper form, log into the members section of our website using your login ID and password and click on "Forms" to print out the Bank Draft Authorization form. Complete the form, attach a preprinted voided check, and mail it to the address provided on the form. Changes will be processed within 5 business days of receipt.
You can make changes to your payment schedule by contacting our Customer Service Center at 1-800-527-5504 or by submitting a request through this website from the Contact Us page. Your Health ID number is required to make changes to your payment schedule.
Can someone other than myself send in payment for my coverage?
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Payment guidelines may vary by state. In most cases, anyone can submit a premium payment on another's behalf if the payment is accompanied by a signed statement declaring the relationship between the person paying the premium and the applicant. However, an employer cannot make a direct payment on behalf of an individual for their health insurance policy.
Can I pay my premium from a savings account?
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Yes, if a bank authorization form with your savings account information is on file with our company.
Can I mail my monthly premium instead of using a bank draft?
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We only accept monthly payments via bank draft*. We can accept mailed payments made on a quarterly, semi-annual, or annual payments schedule. We apologize for any inconvenience this may cause you.
* Due to regulatory requirements, the Company will accept monthly payments made via mailed checks from residents in Maine.
Who must sign the bank draft authorization form?
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The person signing the bank draft authorization form must be authorized to sign on the account being drafted.
Typ
ically your medical provider will submit claims on your behalf
. You or your medical pr
o
vider should
refer to the bac
k of the Health ID card for the mailing addre
ss to submit your clai
ms. There are many variations of plans and locations to submit claims based on the member's choice of insurance. If you are unable to locate the Health ID card, please call our Claims Customer Service Center at 1-800-527-2845 for assistance.
Typically your dental provider will submit claims on your behalf. You or your provider should use the provider's standard dental form when
submitting claims for itemized charges incurred. Please refer to the back of your dental ID card for the claims mailing address or contact our Claims Customer Service Center at 1-800-527-2845 for assistance.
Generally, claims should be filed within 15 months of the date of the medical service. To verify the amount of time allotted by your plan, please call our Claims Customer Service Cente
r at 1-800-527-2845 and a representative will assist you.
Claim status is available on the members' website after logging in, by selecting the 'My Claims' option. Members may also call our Claims Customer Service Center at 1-800-527-2845, Monday through Friday from 8:00 AM to 5:00 PM in all time zones.
What is the phone number for a provider to verify an insured's benefits?
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Health care providers can log into the provider section of the website by clicking here or by calling 1-888-757-0703. Eligibility for benefits is determined at the time the claim is adjudicated.
I need information regarding my network PPO provider. What do I do?
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Your network's web site should be noted on your ID card. Please visit the network's website to find information on participating providers. However, a provider's network status may change. In order to maximize your benefits, we strongly recommend that you re-verify your provider's current status with the network and/or provider prior to seeking treatment.
What is our 'Medical Management/Care Assistance program'?
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Medical Management/Care Assistance is the coordination of medically necessary care between the patient, the provider, and the facility resulting in improved
management of medical costs.
Pre-certification is an industry recognized service that helps the insured manage their medical costs and get the most value out of their health insurance plan. It allows coordination of care between the insured, the provider and the hospital. The provider is asked to notify the insurer or representative on any emergency or non-emergency hospital admission to be sure that the planned care is medically necessary. An insured's continued stay in the hospital is monitored to see that the ongoing care is medically appropriate. In addition, the service may include developing plans for discharge and home care when appropriate.
Pre-notification is a process where an insured or provider notifies the insurer or a representative of the upcoming inpatient admission prior to the actual admission to the hospital.
Who can request pre-certification for an insured if noted on the Insured Persons Health ID card?
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The provider (i.e. Physician or Facility), the insured, or the insured's legal representative should phone
1-866-813-8620. When pre-certification is started by the insured or the legal representative, follow-up contact will be made with the provider to gather the
required clinical information. Insureds or their legal representatives should remind providers to call the number on the back of their Health ID card to provide required clinical information.
When should my provider phone for pre-certification?
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First, refer to the back of the Insured Person's Health ID card to determine if pre-certification is needed.
Does a pre-certification of an inpatient service or stay guarantee a payment?
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No. Insureds of The MEGA Life and Health Insurance Company should phone the Customer Service department at 1-800-527-2845 to verify
benefits. Providers should phone 1-888-757-0703 for benefit verification at The MEGA Life and Health Insurance Company.
PLEASE NOTE THAT VERIFICATION OF BENEFITS IS NOT A GUARANTEE OF PAYMENT. ACTUAL BENEFITS WILL BE DETERMINED UPON RECEIPT OF THE
ACTUAL CLAIM. PRE-EXISTING LIMITATIONS AND EXCLUSIONS MAY APPLY. * The insured is not penalized for failure to have any hospital admissions pre-certified.
