Page 9 - AtlasEssential
P. 9
SPECIMENWhen we receive the appeal, we will review the claim and a written response will be sent to you.
After you receive our response to the appeal, you may initiate a second appeal. With our receipt of
the second appeal, medical and/or claims personnel who were not involved in the original claim
determination or the initial appeal will review the claim. A final determination will be made and a letter
will be sent to you.
Please note that appealing a claim is not a requirement to following the complaints procedure
detailed below.
COMPLAINTS PROCEDURE
We are dedicated to providing a high-quality service and want to ensure that it is maintained at all
times. If you feel that we or another party connected with this policy have not offered a first class
service please contact us and we will do our best to resolve the problem.
Please provide your written complaint online or by postal mail at the following:
http://service.hccmis.com/ or Tokio Marine HCC - MIS Group
P.O. Box 2005
Farmington Hills, MI 48333-2005
USA
You will be contacted within 3 (three) business days of receiving your complaint to inform you of
what action is being taken. We will try to resolve the problem and give you an answer within four
weeks. If it will take longer than four weeks we will tell you when you can expect an answer. If you
have not been given an answer within 8 (eight) weeks we will tell you how you can take your
complaint to the Financial Ombudsman Service for review. This complaints procedure does not affect
any legal right you have to take action. Once you have received your final response from us, and if
you are still not satisfied you can contact the Financial Ombudsman Service:
Financial Ombudsman Service
Exchange Tower, Harbour Exchange Square, London, E14 9SR
Phone: +44 (0) 20 7964 0500
Email: complaint.info@financial-ombudsman.org.uk
PRE-EXISTING MEDICAL CONDITIONS
This policy does not cover pre-existing conditions.
Pre-existing Condition means any
1. Condition for which medical advice, diagnosis, care, or treatment (includes receiving services and
supplies, consultations, diagnostic tests or prescription medicines) was recommended or received
during the 2 years immediately preceding the certificate effective date;
2. Condition that had manifested itself in such a manner that would have caused a reasonably
prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services
and supplies, consultations, diagnostic tests or prescription medicines) within the 2 years
immediately preceding the certificate effective date; or
3. Injury, illness, sickness, disease, or other physical, medical, mental, or nervous conditions,
disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed
at the time of application or within the 2 years immediately preceding the certificate effective date.
For the purposes of the Complications of Pregnancy coverage offered hereunder, pregnancy will
not be included within the definition of a pre-existing condition.
MEDICAL & REPATRIATION EXPENSES
Subject to the limits set forth in the Schedule of Benefits and Limits, and subject to the conditions and
restrictions contained in this provision, we will pay the following expenses incurred while this
insurance is in effect.
9 Atlas Essential Description of Coverage | Tokio Marine HCC - MIS Group
After you receive our response to the appeal, you may initiate a second appeal. With our receipt of
the second appeal, medical and/or claims personnel who were not involved in the original claim
determination or the initial appeal will review the claim. A final determination will be made and a letter
will be sent to you.
Please note that appealing a claim is not a requirement to following the complaints procedure
detailed below.
COMPLAINTS PROCEDURE
We are dedicated to providing a high-quality service and want to ensure that it is maintained at all
times. If you feel that we or another party connected with this policy have not offered a first class
service please contact us and we will do our best to resolve the problem.
Please provide your written complaint online or by postal mail at the following:
http://service.hccmis.com/ or Tokio Marine HCC - MIS Group
P.O. Box 2005
Farmington Hills, MI 48333-2005
USA
You will be contacted within 3 (three) business days of receiving your complaint to inform you of
what action is being taken. We will try to resolve the problem and give you an answer within four
weeks. If it will take longer than four weeks we will tell you when you can expect an answer. If you
have not been given an answer within 8 (eight) weeks we will tell you how you can take your
complaint to the Financial Ombudsman Service for review. This complaints procedure does not affect
any legal right you have to take action. Once you have received your final response from us, and if
you are still not satisfied you can contact the Financial Ombudsman Service:
Financial Ombudsman Service
Exchange Tower, Harbour Exchange Square, London, E14 9SR
Phone: +44 (0) 20 7964 0500
Email: complaint.info@financial-ombudsman.org.uk
PRE-EXISTING MEDICAL CONDITIONS
This policy does not cover pre-existing conditions.
Pre-existing Condition means any
1. Condition for which medical advice, diagnosis, care, or treatment (includes receiving services and
supplies, consultations, diagnostic tests or prescription medicines) was recommended or received
during the 2 years immediately preceding the certificate effective date;
2. Condition that had manifested itself in such a manner that would have caused a reasonably
prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services
and supplies, consultations, diagnostic tests or prescription medicines) within the 2 years
immediately preceding the certificate effective date; or
3. Injury, illness, sickness, disease, or other physical, medical, mental, or nervous conditions,
disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed
at the time of application or within the 2 years immediately preceding the certificate effective date.
For the purposes of the Complications of Pregnancy coverage offered hereunder, pregnancy will
not be included within the definition of a pre-existing condition.
MEDICAL & REPATRIATION EXPENSES
Subject to the limits set forth in the Schedule of Benefits and Limits, and subject to the conditions and
restrictions contained in this provision, we will pay the following expenses incurred while this
insurance is in effect.
9 Atlas Essential Description of Coverage | Tokio Marine HCC - MIS Group
