WELCOME TO ULTIMATE HEALTH

A PLAN THAT DELIVERS

Medical Reimburseme

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Clinical Support Services

Travel & Medical

Emergency Support

Executive Physicals

Medical InformationHelping you make informed decisions and get questions answered

NavigationGuiding you to the most experienced and skilled specialists

ARMADA HEALTHCONNECTIONSSM

Virtual Second OpinionsPersonalized advice from leading medical minds

Facilitated AccessFacilitating appointments to get you access more quickly

TRAVEL & MEDICAL EMERGENCY SUPPORT

Take Me HomeFully paid medical air evacuation from anywhere to home*

Urgent Care ReferralsOver 50,000 pre-certified dentists, hospitals and doctors around the globe

*Available when hospitalized 100+ miles from home. Subject to FrontierMEDEX terms and conditions.

Member PortalInformation and tools to keep you prepared and safe while traveling

MEMBER TRAVEL PORTAL

Pre-Travel MedicalDestination Reports

Immunization Requirements

Secure Medical and Travel Records Storage

Country Specific Health & Security

Information

Drug Translation ToolCountry Medical Quality

And Security RatingsGlobal Pre-certified Hospital

and Provider Listings

DESTINATION MEDICAL REPORT

MEDICAL REIMBURSEMENT

Executive Physicals

Most 213(d)-Eligible Expenses

Rx Co-Pays andBrand Name Rx

Dental and Vision Out-of-Pocket Expenses

Out-of-Network Balance Bills

Deductibles, Co-Pays, Co-Insurance

EXPANDED COVERAGE

Adult and Child Orthodontia Crowns, Bridges and Implants

Rx: Co-Pays, Brand Name and Lifestyle

Chiropractic, Acupuncture and Massage Therapy

DeductiblesCo-InsuranceCo-PaysBalance Bills

WigsHearing Aids

Prescription Sunglasses Contact Lenses LASIK Surgery

Executive Physicals

In-Network

Dental

Vision

Prescriptions

Out-of-Network

Wellness

Exclusions &Limitations

SUMMARY OF PLAN BENEFITS

Platinum$5,000 Per-Occurrence

$50,000 Annual Family Maximums

Please see your certificate of coverage for a list of exclusions and limitations.

PRESCRIPTION MASTERCARD®

Swipe-and-Go ConvenienceUse• Still submit claim to primary plan first

• Use at pharmacies: in-store, online and mail order

• Use “credit” button at checkout

• Has certain limits per carrier; if depleted, use claim forms

• Not for over-the-counter items

• Not for physician, dental or vision co-pays

• Not for any prescription prior to card activation

Reminder:Your Rx card will come to you directly

from the bank.

Don’t Use For Anything Other Than Prescriptions

Reminder:We provide coverage

toward these physicals for you & your

spouse.

EXECUTIVE PHYSICALS

Top-to-Toe Physical ExamsWhat Are They?

• Detailed medical history and physical exam

• Lab screening and tests

• Conducted at Centers of Excellence

• Benchmark

• Review of available results and recommendations

Navigation ServicesHow We Help

• Locate center close to you

• Find specialists for any follow-up

SUBMITTING CLAIMS

Processed by your primary plan firstFirst Step • EOB is required• If no EOB, itemized bill and proof of payment required

Separate claim form for each personSubmit• Can include more than one claim on each form• Submit your claims via mail or fax

Takes 5 to 7 business days• Allow time for mailing each way

Reminder:Complete the forms & your designee can file claims on your behalf.

Processing

MEDICAL CLAIMS

Submit an EOBMost• Include all pages (footnotes and YTD summaries)

• Include even if the charge is denied by primary plan

• Indicate if the provider is out-of-network

• Include any balance bill invoice from the provider

Physician Co-PayException

• Use a detailed receipt instead of an EOB

• Show treatment/services received, date of service and patient name

• No cash or credit card receipts

If OON Out-of-Network

DENTAL AND VISION CLAIMS

Do you have:

Vision coverage?

Dental coverage?

no

Submit a detailed receipt• Show treatment/services received, date of service and patient name • No cash or credit card receipts

Submit an EOB

yesFor orthodontic claims, submit:

1) Treatment plans

2) Invoices with the entire amount you’re responsible for

3) Primary EOB (if applicable)

OTHER CLAIMS

Rx

Submit an

Rx slip.

Don’t black out drug name.

213(d)-Eligible

Expenses

Submit a prescription and detailed

receipt.

Executive Physicals

If accepted by insurance,

submit an EOB.

If not, submit the contract and invoice.

Manage Your Claims:1) Check your EOB from ArmadaCare® when it arrives in the mail.

2) Tell the person filing your claims when you receive payment or EOB.

Wallet Cards

Member Guide with FAQs

Specific Inserts At-a-Glance Prescription MasterCard®

Travel Portal Claim Submissions

Claim Forms and Envelopes

MEMBER WELCOME KIT

Note: Your Certificate of Coverage may be sent separately from your Member Welcome Kit.

CONTACT US

• Medical air evacuation• Other Travel and Medical

Emergency Support Services

Travel Support

• Claims• Coverage or eligibility

Member Services

One Number:

1-800-448-0085

Monday–Friday 8:30 a.m. to 6:30 p.m.

Eastern• Referral to a specialty physician • Center of Excellence (Executive

Physical)• Virtual Second Opinion

Armada Health

ConnectionsSM

THANK YOU

Insured by Transamerica Financial Life Insurance Company and Monumental Life Insurance Company is rated by A. M. Best as A+ (Excellent, 2 out of 16 categories) as of 4/13/12.

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