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FAQs

  1. What is covered under my plan?

  2. What is 'Co-Insurance'?

  3. What is a 'Deductible'?

  4. Who is eligible for cover?

  5. My child is in college. Up to what age is he/she eligible for benefits?

  6. Are newborn children automatically added to the plan?

  7. Are immunizations and wellness checkups covered?

  8. What should I do if my doctor/dentist is told that I am not covered?

  9. Do I need to obtain pre-authorization before seeking care?

MEMBER COSTS

 

  1. What are the potential costs for my healthcare each year?

  2. Are there other costs for healthcare for which I may be responsible?

  3. What are reasonable and customary fees?

  4. Does Generali Worldwide pay the hospital/healthcare provider directly?

  5. What if my hospital/healthcare provider is not listed as a direct pay provider? How do I request to have them added?

 

CLAIMS 

 

  1. How do I submit a claim?

  2. Where can I find a claim form?

  3. How long do I have to submit a claim?

  4. What specific information should be included when submitting medical claims?

  5. What additional information may be required when submitting claims for basic or major restorative dental services?

  6. How are claims settled and reimbursed?

  7. How will I receive reimbursement for my claim(s)?

  8. How can I find out if my claim has been processed for reimbursement?

  9. What is an explanation of benefits (EOB)?

 

GLOBAL COVERAGE

 

  1. How do I access care around the world?

  2. How can I find specific global doctors, hospitals and specialists?

  3. How does Generali Worldwide evaluate global healthcare providers to determine quality and efficacy of care?

  4. What should I do if I lose my card?

  5. What do I need to do if I change my name?


FAQ's

 

What is covered under my plan?

 

The Generali Worldwide Health Plan provides comprehensive coverage on a local, regional and/or worldwide basis. Please refer to your specific Group Health Plan Summary of Benefits for a complete outline of covered benefits. For further details on plan terms and limitations, please refer to the Plan Document or consult your Human Resources representative.

 

 

What is 'Co-Insurance'?

Co-Insurance (expressed as a percentage) is an additional portion of certain medical expenses for which you may be responsible. Please consult your Group Health Plan Summary of Benefits to determine the Co-Insurance annual maximum on your plan, and which benefits require a Co-Insurance contribution.

 

 

What is a 'Deductible'?

A Deductible is another potential out-of-pocket cost you may be responsible for each year before the plan contributes towards the cost of healthcare services. Please consult your Group Health Plan Summary of Benefits to determine the Deductible level on your plan, and which benefits require a Deductible contribution.

 

 

Who is eligible for coverage?

 

Active employees and their dependent spouses and children are eligible for coverage (with Health Insurance Application forms submitted through your Employer’s Human Resources Department).



My child is in college. Up to what age is he/she eligible for benefits?

 

After turning age 19, dependent children who are full-time students are eligible for benefits up to age 24. After age 19, you are required to submit proof of full-time student status for each term of study (e.g. copy of course schedule, statement from the bursar, etc.). As of the 25th birthday, and up until the 30th birthday a notarized affidavit must be submitted along with the student proof. Please submit this to your Human Resources Manager or to Generali Worldwide and retain a copy for your records.

 

 

Are newborn children automatically added to the plan?

No, this is not automatic. You will need to submit the relevant documentation (i.e. birth certificate, and enrollment and changes form) to your local Human Resources Department within 30 days of the birth of the child.

 

 

Are immunizations and wellness checkups covered?

Yes. Wellness checkups and immunizations are covered under Outpatient charges/Medical Practitioner fees up to the limit indicated in the Group Health Plan Summary of Benefits.

 

 

What should I do if my doctor/dentist is told that I am not covered?

 

If you know you are insured under the plan and your healthcare provider has obtained information to the contrary, please contact our Generali Worldwide Cayman Service Centre or Global Assistance Centre and provide them with your Member ID number to personally confirm your eligibility.


Do I need to obtain pre-authorization before seeking care?

Pre-authorization is required for certain medical services. It is your responsibility to ensure that pre-authorization has been received prior to obtaining certain services.

For complete details on procedures requiring pre- authorization, please contact the Global Assistance Centre or you may refer to the back of your Member ID card or your benefits grid for additional information.

The pre-authorization process can be initiated with a phone call to the Global Assistance Centre and requires the sharing of certain medical information by your doctor with Generali Worldwide in order for services to be approved for payment.

 

Requirements for advance notice: You must notify us at least five business days prior to the scheduled or elective treatment plan. If advance notice cannot be provided due to an Emergency, we must receive notification from you or your representative within the latter of 48 hours or the end of the first business day following the beginning of the service. If pre-authorization is not obtained and/or notice of emergency treatment has not been communicated within the time frame indicated above, cover for the services may be subject to a denial or a reduction in benefits up to 50%.

 

 

MEMBER COSTS

 


What are the potential costs for my healthcare each year?

Under your plan, you may be responsible for a Deductible and/or a Co-Insurance contribution, depending on the type of services received. For complete details on Deductible and Co-Insurance requirements under your plan, please consult the specific Group Health Plan Summary of Benefits for your Employer.


Are there other costs for healthcare for which I may be responsible?

You may be required to pay some additional fees including:

  • Costs for non-eligible expenses, i.e. services not covered under the terms of the plan or cost for services that exceed the coverage limits of the plan
  • Charges for medical services in excess of reasonable and customary fees for service
  • Benefit penalties resulting from failure to obtain pre- authorization from Generali Worldwide for certain medical services (please see the Group Health Plan Summary of Benefits for a complete list of services requiring pre-authorization)

 


What are reasonable and customary fees?

Reasonable and customary fees are local or regional norms for the cost of healthcare services. In some cases, doctors, hospitals and other healthcare professionals may charge in excess of reasonable and customary fees (in the Cayman Islands you may refer to the Standard Health Insurance Fees). In those instances, you may be responsible for the additional charges. Because of this, it’s important to understand expected fees up front whenever possible. We encourage you to work with our Service Centre(s) to help coordinate complex care and pre-determine the related pricing. At any time if you are in doubt about your coverage, anticipated cost of healthcare and your required contribution, please contact Generali Worldwide via phone, fax or email (contact details provided on your Member ID card).


Does Generali Worldwide pay the hospital/healthcare provider directly?

Whenever possible, Generali Worldwide will pay a hospital or healthcare provider directly for inpatient or other high cost services. Generali Worldwide has direct payment arrangements already established with 550,000+ providers in the USA and 10,000+ global providers around the world. In addition, Generali Worldwide maintains relationships with another 1.5 million+ global doctors, hospitals and clinics and routinely arranges direct payments with these and other providers of health services.


What if my hospital/healthcare provider is not listed as a direct pay provider? How do I request to have them added?

Where Generali Worldwide does not already have a direct payment agreement in place, we will work to establish one on behalf of the patient; however, it should be noted that acceptance of direct payment is at the discretion of the healthcare provider. To initiate this process yourself, please contact the Global Assistance Centre at least 10 days in advance of your scheduled service or treatment to request a direct payment for services.

 

 

CLAIMS


How do I submit a claim?

Please complete a Generali Worldwide claim form and submit the completed form, along with originals or copies of itemized receipts, to the Global or Generali Worldwide Cayman Service Centre, Key contact information including email, telephone and mailing address information is indicated on the back of your Member ID card.

Please note: We reserve the right to request the originals in order to complete the processing of your claim(s).

 


Where can I find a claim form?

The claim form can be found on our website generali-worldwide.com

 


How long do I have to submit a claim?

You will have up to 180 days from the date of service to submit your claim to Generali Worldwide for processing.

 


What specific information should be included when submitting medical claims?

Please submit itemized bills, receipts and/or invoices with your completed claim form. Bills/receipts/invoices should include the patient’s name, the doctor or hospital’s name/address/phone, date of service, amount charged, currency in which the claim was incurred, diagnosis or nature of illness and the procedures performed (i.e. office visit, lab test, surgery, etc.). If the diagnosis/nature of illness is not shown on the receipt or otherwise indicated by the healthcare provider, you may handwrite this on the bill/receipt/invoice and sign your name.

For your records, please retain originals.

Please note: We reserve the right to request the originals in order to complete the processing of your claim(s).


What additional information may be required when submitting claims for basic or major restorative dental services?

  • Date of service
  • Dentist’s narrative report (if a narrative report is not available, x-rays may be sent)
  • The date(s) of extraction of teeth involved (for dentures and bridges)
  • The date of prior placement and the reason for the replacement of a dental device (e.g. for denture or bridge replacement). If the claim is for a denture or bridge, we will need a chart of all other missing teeth in the mouth and their dates of extraction
  • For periodontal services (gum disease), you must submit x-rays and periodontal charting along with your claim form
  • For services received as the result of an accident, you must include pre-treatment x-rays and accident details

 


How are claims settled and reimbursed?

Reimbursement:

When submitting your claim, your reimbursement will be in the currency of your policy - US Dollars and paid via cheque. For some policies, wire transfer reimbursement is also available. Please consult the Global Assistance Centre to confirm your available reimbursement options and any applicable fees.

 

Claim settlement:

Most claims are processed within 10-15 business days, if the claim form is accurately filled in, correct and accompanied by itemized receipts/bills.

 

Currency conversion:

Currency conversions will be performed at the exchange rate applicable on the date the service was rendered.

 

Translation of claims and receipts/bills/invoices:

Your claims and original receipts/bills/invoices may be submitted in any currency and/or any language, and will be translated by our service centre for processing. If not already indicated on the original receipt/bill/invoice, you should note the currency in which the claim was incurred.

 

Claims submission to another insurer:

If you or your eligible dependents have submitted a claim to Generali Worldwide after it has already been submitted to another insurer, you must attach a copy of the bills that were submitted to the other insurer and the Explanation of Benefits you received from the other insurer.

 

How will I receive reimbursement for my claim(s)?

Your reimbursement will be paid via cheque or (where available) via wire transfer. If you have requested a wire transfer, the reimbursable amount will be deposited directly to your bank account. Please be sure to provide complete details for issuing a wire transfer to your bank account at the time you submit your claim.

 

Note: Please consult our Global Assistance Centre to determine if wire transfer reimbursement is available under your plan and any applicable fees.


How can I find out if my claim has been processed for reimbursement?

Please login to the online Generali Worldwide Member Portal to track submitted claims at https://services.hi- techhealth.com/GWW/pages/signon.shtml

 

To login you will be asked your username and password. Your username is your Member ID number which can be found on your Generali Worldwide Member ID card. Your temporary password is your 8 digit date of birth (e.g. May 7, 1970 would be entered as 05071970). After your initial login you will be asked to change this password.

 

If you forget your ID/password and need this resent or reset, please contact our Global Assistance Centre via email, phone or fax (contact details are indicated on your ID card).

 


What is an Explanation of Benefits (EOB)?

You will receive an Explanation of Benefits (EOB) after your claim has been processed. The EOB will show you which health expenses have been covered and at what level. Copies of EOBs can also be accessed electronically through our password protected Member Portal.

 

 

GLOBAL COVERAGE


How do I access care around the world?

Please refer to your specific Group Health Plan Benefit Summary for full details on your access to local, regional and/or global care. If you have further questions regarding access to care on a global basis, please contact the Global Assistance Centre.


How can I find specific global doctors, hospitals and specialists?

To find clinicians in the United Sates you may search our online provider database or contact the Global Assistance Centre for guidance and direction to global providers. Global provider information can be found online at generali-worldwide.com.


How does Generali Worldwide evaluate global healthcare providers to determine quality and efficacy of care?

In the USA, Generali Worldwide has established a national network of more than 550,000 doctors and hospitals. US hospitals are accredited by the Joint Commission Center for Transforming Healthcare, a USA and internationally recognized regulatory authority that evaluates efficacy of care, safety and compliance of US healthcare providers.

 

Note: Please consult your specific Summary of Benefits for more information on access to U.S. care through your group plan.


What should I do if I lose my card?

If you lose your card, you can request a new card through your Human Resources department or via email, fax or phone, which will be shipped to your office, typically within 10-14 business days. In the meantime, until you receive the new card, you can print a temporary ID card from within the portal as well. You can also request a verification of coverage letter from Generali Worldwide through your Human Resources department or via email, fax or phone.


What do I need to do if I change my name?

Please contact your local Human Resources department who will provide you with the appropriate form to complete.

 

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