How to Submit a Claim

A Step-by-Step Guide to the Claims Process for Members

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We strive to keep our shared claims experience as straightforward as possible. Our claims department processes claims based on the terms and conditions described in your policy.

Note that this step-by-step guide applies to domestic and international claims submitted both in-network and out-of-network. 

How to File a Claim


Claims Process for Claims Incurred Within the United States


1. Present your insurance ID card to your medical provider at the time of service.

2. Unless you are required to pay for medical treatment at the time of service, your provider will submit your claim directly to Tokio Marine HCC – MIS Group (TM HCC – MIS Group).

*If you are required to pay for medical treatment at the time of service, ask your medical provider for your complete medical records from the visit as well as the receipt for your payment.

Also request an itemized bill with the following information:

  • Provider name and address
  • Provider (if U.S.-based)
  • Your name, date of birth, and certificate ID number
  • Itemized charges
  • DX (diagnosis) code and CPT (Current Procedural Technology) code (these are the codes your physician’s office uses to tell our claims examiners which procedures, diagnoses, and services you received during your visit)

Keep your medical records, receipt, and itemized bill.

3. TM HCC – MIS Group will send you a letter notifying you that we have received your claim. We may also request a Claimant’s Statement and Authorization Form from you.

 *If you were required to pay for medical treatment at the time of service, we will also request receipts, invoices, and/or itemized bills from you.

4. You must complete and submit the following to TM HCC – MIS Group within 45 days of the original request:

  • The requested Claimant’s Statement and Authorization Form
  • Any other requested and supporting documents (receipts, itemized bills, and/or invoices)

*Be sure to keep a copy of all submitted documents for your records.

(Learn how to submit the Claimant’s Statement and Authorization Form and other documents to TM HCC – MIS Group.)

5. Once the fully completed Claimant’s Statement and Authorization Form is received, TM HCC – MIS Group may request medical records from the billing providers and/or any medical provider.  

*TM HCC – MIS Group requests to receive this information from the provider(s) within 45 days of the original request.

*If medical records are requested, you may reach out to the billing provider(s) and/or medical provider(s) to obtain copies—or submit to us the records you collected at the time of service. However, this is typically the provider’s responsibility.

6. TM HCC – MIS Group will complete the claims process once we have all the necessary information.

7. If the claim is deemed eligible, TM HCC – MIS Group will secure any preferred provider discounts (if applicable).

NOTE: During this process, you may visit Client Zone at zone.hccmis.com/clientzone or Student Zone at  zone.hccmis.com/studentzone to check the status of your claim. 


Claims Process for Claims Incurred Outside the United States


1. Present your insurance ID card to your medical provider at the time of service.

2. Unless the provider will be billing Tokio Marine HCC – MIS Group (TM HCC – MIS Group) directly, you will pay for treatment at the time of service. 

3. At the time of service, ask your medical provider for your complete medical records from the visit as well as the receipt for your payment.

Also request an itemized bill with the following information:

  • Provider name and address
  • Provider tax ID (if U.S.-based)
  • Your name, date of birth, and certificate ID number
  • Itemized charges
  • DX (diagnosis) code and CPT (Current Procedural Terminology) code (these are the codes your physician’s office uses to tell our claims examiners which procedures, diagnoses, and services you received during your visit)

Keep your medical records, receipt, and itemized bill.

4. To file a claim, you will complete and submit:

  • A Claimant’s Statement and Authorization Form
  • All medical records, receipts, itemized bills, and/or invoices

*Be sure to keep a copy of all submitted documents for your records.

(Learn how to submit the Claimant’s Statement and Authorization Form and other documents to TM HCC – MIS Group.)

5. Once the fully completed Claimant’s Statement and Authorization Form is received, TM HCC – MIS Group may request medical records from the billing providers and/or any medical provider.

*TM HCC – MIS Group requests to receive this information from the provider(s) within 45 days of the original request.

*If medical records are requested, you may reach out to the billing provider(s) and/or medical provider(s) to obtain copies—or submit to us the records you collected at the time of service. However, this is typically the provider’s responsibility.

6. TM HCC – MIS Group may request additional information from you (i.e. additional receipts, itemized bills, invoices, etc.) if it is required for the claim. You must submit the requested documents to TM HCC – MIS Group within 45 days of the initial request. 

*Be sure to keep a copy of all submitted documents for your records.

7. TM HCC – MIS Group will complete the claims process once we have all the necessary information.

NOTE: During this process, you may visit Client Zone at zone.hccmis.com/clientzone or Student Zone at zone.hccmis.com/studentzone to check the status of your claim.


How to Complete and Submit a “Claimant’s Statement and Authorization Form” and/or “Authorization Form for Use and/or Disclosure of Protected Health Information (HIPAA)”


You must complete, sign, and submit a Claimant’s Statement and Authorization Form for every incident.

 

IMPORTANT NOTE


If you are filing this claim on behalf of another person, you MUST include the Authorization Form for Use and/or Disclosure of Protected Health Information (HIPAA)—signed by the policyholder—in order to speak with us regarding any of the policyholder’s Protected Health Information (PHI). Without this signed form, we may only disclose to you the status of the claim.

You can complete and submit the Claimant’s Statement and Authorization Form and/or Authorization Form for Use and/or Disclosure of Protected Health Information in one of the following ways:


TM HCC – MIS Group is also happy to fax, e-mail, or mail the form(s) to you upon request.

 

IMPORTANT NOTE FOR STUDENTS


For eligibility purposes, you must submit the following along with a Claimant’s Statement and Authorization Form:  

  • A copy of your education-related visa (F1, J1, OPT, etc.) or valid I-20/DS2019
  • Proof of full-time student status (not necessary if submitting a valid F1 visa including OPT, or J1 visa)

If you have questions or need assistance, call global customer support at (800) 605-2282.  

IMPORTANT NOTE FOR UPFRONT PAYMENTS


If you paid for medical treatment upfront and wish to be reimbursed for an approved claim electronically, make sure you complete the section titled “Authorization Agreement Form – Wire Payments” on page 6 of the Claimant’s Statement. You’ll find this section under “Supplement C – Payment Forms.”

If you do not complete this section, you will receive a paper check for reimbursement of any eligible expenses to the name and address listed on file.


authorization-agreement-form-wire-payments.jpg

 

How to Submit the “Claimant’s Statement and Authorization Form” and “Authorization Form for Use and/or Disclosure of Protected Health Information (HIPAA)” via Client Zone/Student Zone

You can find the "Claimant’s Statement and Authorization Form" and "Authorization Form for Use and/or Disclosure of Protected Health Information" (also known as the HIPAA form) online via Client Zone or Student Zone, our self-service portals for policyholders.

To access Client Zone or Student Zone, you will first need to register an account. (Please refer to the How to Register for a Client Zone / Student Zone section of this document for registration instructions.)

If you have already registered your account, visit the Client Zone login page or the Student Zone login page to log into your account.


You will be presented with a welcome page that looks like this (Client Zone):



client-zone-account-login-screen.jpg

 

Or like this (Student Zone):

student-zone-login-screen.png

 

 

IMPORTANT NOTE ABOUT STUDENT ZONE


To access your Student Zone account, follow the same instructions outlined for Client Zone below. Note that you will see “Student Zone” instead of “Client Zone” at the top of each page if your email address or certificate number are associated with a student travel medical insurance policy.


Click “Log in” next to “Already registered with two-factor authentication?” You’ll find this below the “Next” button.

 

Client Zone login button



On the resulting “Sign In” page, enter the email address and password you used to create your account. Click “Sign In.”

 

Client Zone sign in page

 

After you log in, you will see the following screen. In the navigation bar, click on “Claims.” Then select “Claim Information” in the drop-down menu.

 

Claims Information dropdown in Client Zone



On the Claim Information page, click the “Select” button in the Claim Forms section.

"Select" button in Claim Information page

 

After clicking the “Select” button, the following page will appear:

Claim Submission Forms page in Client Zone

 

You will be presented with two options for filling out the "Claimant’s Statement and Authorization Form" and/or "Authorization Form for Use and/or Disclosure of Protected Health Information (HIPAA)":

Section 1 – Complete and submit the form(s) via DocuSign (most efficient approach – learn more below)

                         - OR -

Section 2 – Print the form(s) to complete and mail or email (learn more below)

 

Section 1 - DocuSign Option

You will need to select the “Claimant’s Statement and Authorization Form” link or the “Authorization to Disclose Protected Health Information (HIPAA)” link in Section 1 to start the DocuSign submission process. You will then be instructed to complete the “PowerForm Signer Information” by entering your name and email address. 


PowerForm Signer Information page in Client Zone


You will receive an email notification and link to complete either the "Claimant’s Statement and Authorization Form" or the "Authorization Form for Use and/or Disclosure of Protected Health Information (HIPAA)" via DocuSign.

When completing the form via DocuSign, you will have the option to submit up to three supporting documents. To send additional documents, you may attach them to an email and send them to service@hccmis.com.

 

Section 2 - Print and Mail/Email Option

You will need to select the “Claimant’s Statement” link and/or the “Health Insurance Portability and Accountability Act (HIPAA)” link in Section 2 to download and print the form(s).

Then fill out and sign the form(s) and email to service@hccmis.com or mail to:

Tokio Marine HCC – MIS Group
Claim Department
Box. No. 2005
Farmington Hills, MI 48333-2005
U.S.A.

IMPORTANT NOTE


You are required to complete and sign the forms when sending by mail. If TM HCC – MIS Group receives the form without a signature, we will be unable to process the claim. 


Direct Billing and Claims Reimbursement Process

 

We encourage providers to bill us directly, rather than requiring immediate payment from you. While we are always willing to pay providers directly for eligible claims, we cannot guarantee that the provider will accept your proof of insurance at the time of service.

If Providers Are Willing to Bill Us Directly:

You must authorize the payment of medical benefits to the provider by signing and dating the section of the Claimant’s Statement and Authorization Form labeled “2C. Assignment of Benefits Authorization.” You will find section 2C under “Part C: Medical Record Authorization.”

Claim Form Part C 


Providers must mail itemized bills, including diagnosis, to:

Tokio Marine HCC – MIS Group 
Claim Department 
Box. No. 2005 
Farmington Hills, MI 48333-2005 
U.S.A.

 

If Providers Are Unwilling to Bill Us Directly: 

You must pay for medical treatment at the time of service and file a claim for reimbursement.

To file a claim, you must complete and submit a Claimant’s Statement and Authorization Form as well as all original itemized bills and paid receipts to Tokio Marine HCC – MIS Group.

 

IMPORTANT NOTE


If you are filing the claim on behalf of another person, you MUST include the Authorization Form for use and/or Disclosure of Protected Health Information signed by the policyholder in order to speak with us about the claim. Without this signed form, it is a violation of HIPAA for us to talk with you regarding Protected Health Information (PHI) for another person's insurance claim.


You can complete and submit the "Claimant’s Statement and Authorization Form" and/or "Authorization Form for Use and/or Disclosure of Protected Health Information (HIPAA)" in one of four ways:

  • Complete and submit electronically via Client Zone / Student Zone
  • Download and complete the form(s) and then upload them to the Submit Claim Request Form via the Customer Service page
  • Download and complete the form(s) and then attach and send via email to service@hccmis.com
  • Download, print, and complete the form(s) and send by mail to:

    Tokio Marine HCC – MIS Group 
    Claim Department 
    Box. No. 2005 
    Farmington Hills, MI 48333-2005 
    U.S.A.


Click here or scroll up to the “How to Complete and Submit a Claimant’s Statement and Authorization Form and Authorization Form for Use and/or Disclosure of Protected Health Information (HIPAA)” section to see detailed submission instructions.

We encourage you to make copies of all of the documentation (Claimant’s Statement and Authorization Form(s), bills, and receipts) you send to us for your own records.

 

IMPORTANT NOTE


It is common for the claims department to request copies of medical records related to a claim or to your medical history. If you sought treatment outside the U.S., our claims department may require you to obtain the medical records related to your claim and submit them to us.

If we request additional information, further processing time may be necessary, depending on the response time of the parties from whom we requested the information.

We are not able to pay a provider in advance of services rendered. While you may contact us at any given time to verify your benefits, this is not a guarantee that the charge is covered. We must have the ability to investigate a claim before determining whether it is eligible for payment.

 

Claims Review Process

A TM HCC – MIS Group claims examiner will review the claim to determine if it can be processed or if more information is needed. 

If more information is needed, the examiner will send a “Request for More Information” letter by mail to you and/or the medical provider.

NOTE: You can see any letters you have on file in the “Letters” section of Client Zone under the “Claims” tab. (Learn more about letters sent from Tokio Marine HCC – MIS Group.)

You may respond to the “Request(s) for More Information” by taking one of the following actions:


Refer to the exhibit in Appendix 2 to reference the various types of letters sent out to members by TM HCC – MIS Group.

NOTE: If you or the medical provider do not respond within 45 days of the initial request for more information, the claim may be closed.


How to Register for a Client Zone / Student Zone Account

ClientZone and Student Zone allow you to view and track your claim status as well as update your personal information. In order to access this functionality, you must first register for an account.

If you already have a Client Zone or Student Zone account, jump ahead to the How to View Your Claim Status section of this page.

Registering a New Account

If you have a travel medical policy, you will register a Client Zone account at zone.hccmis.com/clientzone. Then follow the instructions outlined below.

If you have a student travel medical policy, you will register a Student Zone account at zone.hccmis.com/studentzone. Then follow the same instructions outlined for Client Zone below. Note that you will see “Student Zone” at the top of each page instead of “Client Zone.”

 

NOT SURE WHETHER TO REGISTER FOR A CLIENT ZONE ACCOUNT OR A STUDENT ZONE ACCOUNT?


If you’re not sure which type of policy you have, visit Client Zone and continue following the instructions below. You will be redirected to Student Zone if the email address or certificate number you enter is associated with a student travel medical insurance policy.


You will see a welcome page that looks like this:

 

Screenshot of the page where you enter your email address in Client Zone.

Enter the email address you used to purchase your policy or another valid email address. Then hit “Next” and follow the below instructions for registering your new account.

 

Register for a new account in Client Zone

 

Registering a New Account – Step 1 (image shown below)

  1. Enter the certificate number located on your fulfillment documents or ID card.
  2. Click the calendar icon to enter your date of birth. First, choose the decade in which you were born. Then choose the year. Then choose the month, followed by the day.
  3. Click "Next."

Steps for registering a new account in Client Zone

 

Registering a New Account – Step 2 (image shown below)

  1. Enter your email address.
  2. Enter a password that has at least 8 characters, a lowercase letter, an uppercase letter, and a number. No part of your password may include your username.
  3. Enter your password again to confirm.
  4. Read through the terms and conditions and select the checkbox if you agree.
  5. Click “Register.”

Step 2 of registering a new Client Zone account

 

You will receive an email at the email account you used to register welcoming you to Client Zone or Student Zone.



Registering a New Account – Step 3 (image shown below)

  1. Enter the email address you used to create your Client Zone account.
  2. Enter the password you created.
  3. Click “Sign In.”

Sign In page in Client Zone

 

Registering a New Account – Step 4 (image shown below)

  1. To add an additional layer of security when signing into your account, choose your preferred multifactor authentication method.

    Options Include:

    – Okta Verify – Click “Setup” if you wish to enter a single-use code from the mobile app
    – SMS Authentication  – Click “Setup” if you wish to enter a single-use code that is sent to your mobile phone
    – Voice Call Authentication  – Click “Setup” if you wish to authenticate via phone by following voice instructions
    – Security Question  – Click “Setup” if you wish to answer a security question

  2. Follow the setup instructions of your chosen multifactor authentication method.

 

Set up multifactor authentication in Client Zone

 

Once you’ve set up multifactor authentication, you will receive an email notifying you that you have successfully enrolled.

Registering a New Account – Step 5 (image shown below)

  1. On the resulting page, choose a “Forgot Password” question. Make sure you select a question that has only one correct answer that you’ll be able to easily remember.
  2. Type the answer into the blank box below “Answer.” You will need this answer to access your account if you ever forget your password and need to change it.
  3. Click “Create My Account.”

 

Choosing a "Forgot Password" question in Client Zone

 

Once you have created a new account, you may enter your credentials and log into Client Zone / Student Zone. 

How to View Your Claim Status via Client Zone / Student Zone


On the Client Zone or Student Zone login page, select “Log in” next to “Already registered with two-factor authentication?” You’ll find this below the “Next” button.

 

Log in to view your claim status

 

On the resulting “Sign In” page, enter the email address and password you used to create your account. Click “Sign In."

 

Signing into Client Zone


You can find claims-related information in the main navigation bar titled “Claims.”

 

Claims dropdown menu in Client Zone

 

  • Claim Information: View and submit claim forms, search medical referrals, or review frequently asked questions.
  • Claims & Explanation of Benefits: View the status of an ongoing or completed claim (learn more below).
  • Letters: See any letters you have on file (see Appendix 2 to view the types of letters sent by Tokio Marine HCC – MIS Group).



Claims & Explanation of Benefits


To view the status of a claim, navigate to the Claims & Explanation of Benefits section under “Claims” in the dropdown menu.


Claims & Explanation of Benefits in "Claims" dropdown menu

 

Here’s an example of what you will see in the Claims & Explanation of Benefits section:

 

Claims & Explanation of Benefits page in Client Zone

 

This section is populated with the following information:

LABEL/HEADING PURPOSE
Certificate Number Certificate number issued by TM HCC – MIS Group
Patient Patient name of record
Claim Number and Link to Explanation of Benefits (EOB) Claim number generated by TM HCC – MIS Group (a link to the EOB will be provided when the claim has been finalized)
Provider Provider name (includes total charges and payment amounts to provider)
Status/Reason

Indicates if a claim is in a “pending” or “completed status” (includes reason codes)

Date(s)

Dates:

Incurred – Actual date of service that you received treatment

Received – Date TM HCC – MIS Group received the claim

Processed – Date the claim was finalized

 

Additional Functionality within the Claims & Explanation of Benefits Section

How to View an EOB

When finalized, each claim will have an Explanation of Benefits (EOB) associated with it. To view the EOB, click on “EOB ” under the Claim # section.

 

How to view an EOB

 

After clicking on the "EOB" icon, a message will appear notifying you that the EOB is downloading.

 

EOB downloading message in Client Zone

 

You can open the downloaded PDF document on your computer or mobile phone to view the EOB. You may also save the EOB document to a device or print it.

An Example EOB is shown in Appendix 1 below which displays the various data elements contained within a standard EOB from TM HCC – MIS Group.

 

Claims Appeals Process


There may be situations when you choose to appeal how a claim was processed. You may appeal your claim decision using one of the following methods:

  • Fill out and submit the Claimant Appeal Request form online – Visit https://service.hccmis.com and select “Submitting a Claim or an Appeal” under the “Contact Us” header. Click “Submit Appeal.” Fill in the requested information on the Claimant Appeal Request Form and upload additional documentation that supports your reasoning and position (medical records, receipts, etc.). Click “Submit”.
  • Download the Claimant Appeal Request form, complete it, and submit it via email or mailDownload the form here. Or visit service.hccmis.com and scroll down to the “Claim and Appeal Forms” header. Click the link beside “Claimant Appeals Request Form” to download the form.

    Fill out the form and email it, along with additional documentation that supports your reasoning and position (medical records, receipts, etc.), to service@hccmis.com.

    Or mail the form and supporting documents to:

    Tokio Marine HCC – MIS Group
    Claims Department
    Box No. 2005
    Farmington Hills, MI 48333-2005
    U.S.A

  • Write a letter of appeal and submit it via email or mail – Write a letter of appeal following the appeal procedure instructions outlined in your certificate of coverage. Email this written letter of appeal, along with additional documentation that supports your reasoning and position (medical records, receipts, etc.), to service@hccmis.com.

    Or mail the form and supporting documents to:

    Tokio Marine HCC – MIS Group
    Claims Department
    Box No. 2005
    Farmington Hills, MI 48333-2005
    U.S.A

Please note that submission of the appeal will lead to re-evaluation of your claim but does not guarantee that the initial benefit determination will be altered.

 

Appendix 1: EOB Example  
            

Explanation of Benefits example

 

Appendix 2: Most Common Types of Letters     
            

Review the chart below to see the most common types of letters sent by Tokio Marine HCC – MIS Group. For each letter, you’ll see the:

  • Type of letter
  • Purpose of the letter
  • Required actions you must take

Please note that this is not an exhaustive list. If you have questions about a specific letter, please contact our customer service department.

 

Type of Letter Why Am I Receiving This Letter from Tokio Marine HCC – MIS Group? Do I Need to Take Action as the Insured After Receiving This Letter?

Claimant’s Statement and Authorization Form – Member Request

This letter asks you to submit the Claimant’s Statement and Authorization Form for a specific incident of care.


The letter also contains instructions on how to submit the form.

Yes. Please complete the Claimant’s Statement and Authorization Form and submit it to Tokio Marine HCC – MIS Group via one of the methods outlined in the letter.

If you are a StudentSecure policyholder, please also submit the required student documentation as requested within the letter.

Additional Information – Member Request  

 This letter asks you to submit additional information. The requested information could be several different items, but some common requests include:

  • A copy of your passport
  • Medical records from your doctor in your home country
  • Receipt of payment for a submitted claim (if requesting reimbursement)

 Yes. Please submit all information requested within the letter to Tokio Marine HCC – MIS Group.

Medical Records – Provider Request

This letter notifies you that we have requested medical records and other supporting documentation from specific providers for certain incidents of care.

The requested medical records and supporting documentation are necessary so we can determine benefits for the associated claims.

No. You are not responsible for submitting the information we requested from specific providers.

This letter serves only to notify you of our request.

Medical Records – Provider Request for UHC-Priced Claims

This letter is relevant for claims priced using the UnitedHealthcare Network.

It notifies you that we have asked UnitedHealthcare to request medical records from specific providers for certain incidents of care so that we can determine benefits for the associated claims.

No. You are not responsible for submitting the information UnitedHealthcare will request from specific providers.

This letter serves only to notify you of our request.

Overpayment Return – Provider Request

This letter notifies providers when we have overpaid on a claim. The letter requests a refund from the provider to eliminate the overpayment.

No. You are not responsible for submitting the overpayment refund.

The provider will send the overpayment refund to us directly.

 

KHE2FFFYH6SP-152-1622

Tokio Marine HCC - MIS Group international insurance products are underwritten by Lloyd’s. Tokio Marine HCC - Medical Insurance Services Group (MIS Group) is a service company and a member of the Tokio Marine HCC group of companies. Tokio Marine HCC - MIS Group has authority to enter into contracts of insurance on behalf of the Lloyd’s underwriting members of Lloyd’s Syndicate 4141, which is managed by HCC Underwriting Agency Ltd.