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Panamed

  • Panamed FAQ

    • Who is eligible?

      All actively at work employees working 15 or more hours per week.

    • Is there a waiting period for new hires?

      Yes, standard waiting period for new hires is first of the month following 90 days of continuous employment. Participants should check with their employer.

    • How does a Group cancel their coverage with Pan-American Life?

      Groups are required to give Pan-American Life 31-day written notice prior to cancellation date.

    • How do participants cancel their coverage?

      Participants should contact their Human Resources department to cancel their coverage.

    • When will a participant’s coverage end?

      If the participant terminates prior to the 15th of the month, he or she will be terminated retroactive to the 1st of the current month. If the participant is terminated after the 15th of the month, he or she will be terminated the 1st of the following month.

    • Is PanaMed portable?

      No, unless the employer qualifies for COBRA.

    • Is PanaMed subject to COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985)?

      Yes, COBRA applies to an employer with over 20 eligible participants. COBRA administration is the employer’s responsibility; Pan-American does not perform COBRA administration. The employer may contact an outside administrator about COBRA service.

    • What benefits are offered under COBRA?

      The participant will receive the benefits that he or she had at the time their employment ended. Neither Life, AD&D, Disability nor Accident will be included.

    • How can a participant apply for a life conversion policy?

      Upon termination the participant should contact Pan-American Life within 31 days of termination date. If the participant meets the eligibility requirements as per the policy we will send an application and rate information. The completed sign application along with premium will need to be returned. Our Individual department will issue a Whole Life policy.

  • Dependant Questions & Answers

    • Who is eligible under dependent coverage and what are the child age limits?

      A covered participant’s spouse, unwed child(ren) from 10 days until 19-years-old, or an unwed child up to age 26 if he or she is a full time college student. Ages may be subject to state mandates.

    • What needs to be supplied for a full time student over age 18 to receive dependent coverage?

      A registration document from the university/college is required. The document must be for the current semester and must include dependent name and number of hours indicating full time status.

    • Should the registration form be submitted with the application?

      No. Proof is only requested when a claim is submitted.

    • Are domestic partners covered?

      Domestic partners can be covered under this plan, if all Pan-American requirements are met and the Employer recognizes Domestic Partnership for plan benefits. All domestic partnerships must meet our definition of Domestic Partner. Verification of Domestic Partner relationship is also required by completing Pan-American’s Affidavit of Domestic Partner. Contact your agent for full details and proper forms.

    • Can a participant cover their parents as dependents?

      No. Only the participant, legal spouse and children may be covered under the plan. Parents, siblings and other family members are not eligible.

    • Can a participant elect dependent coverage only?

      No. In all cases, an employee must be covered under the plan in order to cover his/her dependents.

    • If a participant or his dependents are covered under a different plan and then they lose coverage under the plan, would they be treated as a late entrant?

      Yes, they would be a late entrant and require evidence of insurability.

    • Does PanaMed recognize common law marriages?

      Only in the states that are required by law.

  • Benefit & Claims Questions

    • Does a participant have to complete a medical claim form for every claim?

      No. Only one claim form is required per claimant each calendar year.

    • Does PanaMed pay the participant or the doctor/hospital?

      The provider will be automatically paid the benefit unless the participant makes the proper authorization on the claim form./p>

    • Is there a list of doctors and hospitals?

      No. The participant is free to use any U.S. accredited doctor or hospital. There are no networks.

    • Are there any co-pays or deductibles?

      No co-pays or deductibles apply.

    • Can non-U.S. citizens legally working in the U.S. receive coverage?

      Yes. The participant will be covered in the state where the policy is issued.

    • Is a participant covered if they went to Hospital outside of the U.S.?

      No. Our policy provides an indemnity benefit with respect to hospital confinement. A hospital is defined in the policy as an institution that is approved by the Joint Committee on the Accreditation of Health Care facilities. The Joint Committee does not approve hospitals outside of the U.S. Therefore the policy would not provide benefits for a hospital confinement.

    • Does PanaMed qualify as a Major Medical Plan?

      No. PanaMed is a scheduled first dollar benefit reimbursement Plan and not a major medical plan. Benefits are limited by calendar year max.

    • Is Outpatient Surgery covered?

      Yes, surgery is covered as an inpatient or outpatient, subject to selection of the Surgical Benefit and plan limits.

    • Is the yearly maximum for some benefits based on Calendar year or Plan year?

      All Plan maximums are Calendar Year. There are no “Plan Year” maximums.

    • Does PanaMed coordinate with other inforce plans?

      No. The Scheduled Indemnity Provisions do not coordinate with other inforce plans.

    • Is there any Pre-existing condition clauses?

      No. There is no pre-existing condition clause in the PanaMed policy. However, pregnancies will only be covered if conception occurs after the covered person’s effective date of coverage. This is subject to state availability.

    • Is maternity coverage included?

      Yes, maternity is covered as any other illness, up to Plan limits. The primary maternity charge for the delivery is covered under the surgical benefit, if that benefit is selected and included as part of PanaMed plan. However, pregnancies will only be covered if conception occurs after the covered person’s effective date of coverage. This is subject to state availability.

    • Is Urgent Care covered?

      Urgent Care visits are covered if performed in a doctor’s office visit, up to Plan limits.

    • How are Emergency Room visits covered?

      ER accident visits are covered only under the “Accident Benefit,” up to Plan Limits

    • How are Emergency Room Sickness visits covered?

      ER Illness benefit visits are covered when not as the result of an accident, when selected up to Plan Limits. Illness is defined as a disorder or disease of the mind or body, or a pregnancy. Not available in all states.

    • How are Accident Coverage benefits paid?

      Accident benefit pays 100% of charges incurred within 90 days of an accident occurring off the job, when selected up to the plan’s benefit maximum amount per accident. There is no maximum on the dollar amount per year or on the number of accidents that can occur.

    • Does the Plan pay for on the job-related injuries and illnesses?

      No. This plan is non-occupational only. Benefits are not covered under the Plan for any Injury or Illness arising out of or in the course of work.

    • Where can I get a claim form?

      Your employer has a supply and on the Pan-American Life website. The address is www.panamericanlife.com.

    • How do I file a claim?

      Instructions to file a claim are on the back of the form. All claims must include an original bill of service with patient name, date of service and diagnosis code. A UB92 form is required for Hospital stays. For accident claims include accident details on how and when the accident occurred.

    • What is the turnaround time for a claim?

      Claims are processed within 30 days of receipt.

    • Who is Member Health RX?

      Member Health Rx is a Prescription Benefits Manager. Member Health RX issues prescription ID Cards and process your prescription claims. They can be reached at 1-888-868-5854.

    • How can you contact Pan-American Life?

      Our Toll-free number is 1-877-569-3075, Monday – Friday, 8:30 AM – 5:00 PM Central Standard Time.

    • What is the claims mailing address?

      • For claims only
        Pan-American Life Insurance Company
        P.O. Box 61070
        New Orleans, LA 70130

        For all other correspondence
        Pan-American Life Insurance Company
        P.O. Box 60003
        New Orleans, LA 70130