Co-ordination of Benefits

Co-ordination of benefits refers to the process of managing payments when more than one coverage is in effect. The primary carrier will pay the majority of eligible expenses, and the secondary will absorb the lesser. The total reimbursement from both carriers will not exceed 100% of the expenses incurred.
On group insurance, In the case of the employee, the employer’s group plan is always primary. In the case of dependent children, the father’s plan is always primary (this can vary based on the company).

Calendar year versus Policy Year
Calendar year is the continuous period of time that begins January 1 and ends December 31. Policy Year commences on the effective date of the policy.

Pre-existing Condition
This is an illness or injury for which symptoms have been present or for which a member has received medical care/treatment or advice prior to the commencement of the policy.

Approval in advance by the Insurance Carrier for medically necessary covered services, subject to eligible charges.

Provider Network

This will be a listing of Physicians, hospitals, skilled nursing facilities or other healthcare providers who have contracted with the Carrier to provide care at an agreed price based on a Fee Guide.

This would be charges for the preparation, including cremation and return to the place of residence in the Bahamas of the remains of the deceased who was insured at the time of death.