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Complete all fields and return to USAble Life Attention: Claims

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WEBas the MIB, Inc., benefit plan administrator, health plan, hospital, health care provider, pharmacy, laboratory, business associate, governmental entity

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Submit Wellness claims online!

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WEB21L-USAL-0139 Rated “A” (excellent) by A.M. Best for ten consecutive years Recognized as one of the ‘Ward’s 50” L&H Top Performers STEPS 3-5: STATEMENT, …

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Welcome to life less complicated. Welcome to USAble Life.

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WEBYou choose coverage that best fits your needs • coverage from $50 to $200 for inpatient hospital stays • coverage for sickness and accidents

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HOSPITAL CONFINEMENT OUTLINE OF COVERAGE

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WEB22L-USAL-0752 Consecutively ranked “A” (excellent) by A.M. Best Recognized as one of the “Ward’s 50” L&H Top Performers Understanding your plan

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Supplemental CRITICAL ILLNESS + CANCER Benefits

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WEB19L-USAL-0581 DIAGNOSIS OR TREATMENT PLAN PAYS Cancer Diagnosis 100% Heart Attack 100% Stroke 100% Major Organ Transplant 100% Bone Marrow Transplant 100%

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Group Administrator Guide

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WEBTable of Contents SECTION 1 Enrollment & Maintenance SECTION 2 Billing SECTION 3 Claims SECTION 4 Policy Features SECTION 5 More on USAble Life For Effective …

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ONLINE CLAIMS FOR HOSPITAL INSURANCE

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WEBSIX EASY STEPS: 1. Disclaimer (electronic delivery consent notice) 2. Demographics (name and policy number) 3. Employee Statement 4. Authorization for Release of

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Supplemental ACCIDENT Benefits

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WEBACCIDENT TREATMENT BASIC SELECT ULTRA Physician Office Visit (per visit, up to two per year) $125 $150 $225 Emergency Treatment 4 $125 $150 $225 Emergency …

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Your guide to administering group and voluntary TABLE OF …

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WEBa pretax benefit election under a Section 125 (cafeteria) plan. Such . changes are permitted only during specified enrollment periods or in . response to certain life events (childbirth, …

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Complete all fields and return to USAble Life Attention: Claims

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WEB1. Claim Form (all required sections) 2. Fraud Notice 3. Authorization Statement 4. Supporting Documentation • Physician’s Statement (one of the following documents may …

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CANCERCARE INSTRUCTIONS FOR FILING CLAIMS

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WEBAttention: Claims Department P.O. Box 1650 Little Rock, Arkansas 72203-1650 Telephone (800) 370-5856 Fax (501) 235-8416 E-mail: [email protected]

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Mail: Fax: ACCIDENT INSURANCE CLAIM FORM

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WEBas the MIB, Inc., benefit plan administrator, health plan, hospital, health care provider, pharmacy, laboratory, business associate, governmental entity

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INSTRUCTIONS FOR FILING A CLAIM FOR DISABILITY BENEFITS

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WEBCL-TDI-45 (5-14) Page 4 of 4 Rev 8-19 PART C – DOCTOR’S STATEMENT (Please type or print legibly) IMPORTANT: Please complete and mail within 7 working days after …

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LIFE INSURANCE CLAIM FORM

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WEBas the MIB, Inc., benefit plan administrator, health plan, hospital, health care provider, pharmacy, laboratory, business associate, governmental entity

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SHORT TERM DISABILITY CLAIM PROCESS

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WEBAUTHORIZATION FOR RELEASE OF MEDICAL RECORDS I hereby request and authorize any health plan, physician, health care professional, hospital, clinic, …

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CancerCare Elite

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WEBCancer. Care . Elite. CE-OC-HI (11-15) 999 Bishop Street, Suite 2701 PO Box 840 (96808-0840) Honolulu, HI 96813 | bshi.net

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Statement of Claim Eff Group Accident Insurance

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WEBGroup Accident Insurance. Attention: Claims Department. P.O. Box 1650 Little Rock, AR 72203-1650 Telephone (800) 370-5856 Fax (501)235-8416 Please type or print in blue …

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INTEGRATED LEAVE CLAIM WHERE TO SUBMIT YOUR CLAIM

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WEBINTEGRATED LEAVE CLAIM FORM: Section 1 PLEASE RETURN ALL STATEMENTS ATTENTION: Claims Department | P.O. Box 1650 | Little Rock, AR 72203.