Claims Resource Center

Frequently Asked Questions

Our World Service Center offers emergency assistance and referrals 7 days a week. Please contact us at 1-800-605-2282 and a representative will be available to assist you.

We also accept collect calls from anywhere in the world at 1-317-262-2132. Or, if you are traveling in a country outside of the United States, search here for a list of worldwide toll-free numbers.

You are always free to use the medical providers of your choice. When seeking treatment within the U.S., however, you may reduce your out-of-pocket costs by visiting a provider within your preferred provider organization (PPO). This is an organized network of hundreds of thousands of highly qualified medical practitioners and well-recognized hospitals in the U.S.

Refer to the "Schedule of Benefits and Limits" in the Description of Coverage for your plan to determine your coinsurance responsiblity for in-network and out-of-network payments within the U.S.

Then visit our "Find a Doctor or Hospital" page to find U.S.-based providers within your preferred provider organization (PPO).

Note that there is no preferred provider organization (PPO) for those traveling outside the U.S.

Many providers are willing to bill us directly, and we are happy to work directly with the provider. The provider should submit to us original itemized bills. You, the patient, will still need to submit to us a completed “Claimant’s Statement and Authorization” form.

If the provider does not accept an upfront payment, it’s important that you obtain an itemized bill that contains diagnosis and/or procedure information and send it directly to us, along with a completed “Claimant's Statement and Authorization” form.

Note: For plans that offer a coinsurance waiver for expenses incurred in-network, the provider must bill expenses directly to us.

You may submit all claim-related documents to us in one of two ways:

  • Submit electronically via Client Zone at https://zone.hccmis.com/clientzone/

  • OR

  • Mail to:

  • Tokio Marine HCC – MIS Group
    Claims Department
    Box No. 2005
    Farmington Hills, MI 48333-2005
    U.S.A.

Learn more about the claims process by reading "How to Submit a Claim: A Step-by-Step Guide to the Claims Process for Members."

Yes. We can define the benefits that are available within your coverage. However, we cannot pre-approve any treatment or guarantee payment in advance.

The "Authorization Form for Use and/or Disclosure of Protected Health Information" (HIPAA) gives Tokio Marine HCC - MIS Group permission to disclose and release protected health information (PHI) to anyone specified on the form.

We require that the "Authorization Form for Use and/or Disclosure of Protected Health Information" (HIPAA) is signed and thoroughly completed if you wish for your PHI to be disclosed and/or released to a specified person. You may complete and submit the form via DocuSign by visiting Client Zone or download the form, print it, and mail it to:

  • Tokio Marine HCC - MIS Group
    Claim Department
    Box. No. 2005
    Farmington Hill, MI 48333-2005
    U.S.A.
See More Claims Related Questions

The "Claimant's Statement and Authorization" form is a document that we request when we receive a claim for a new medical condition or episode of care. Your submission of a thoroughly completed "Claimant's Statement and Authorization" form provides us with information so that we can properly evaluate whether the claim is eligible under your policy.

This form also allows us to request medical records from your medical providers.

You may complete and submit a "Claimant's Statement and Authorization" form electronically by logging into Client Zone. You may also print the form and mail it to us.

If you do not have access to the internet, please feel free to contact us at 800-605-2282 so that we may send a form to you by fax or mail.

No, you should submit one “Claimant's Statement and Authorization” form to us for each different condition.

You may submit all claim-related documents to us in one of two ways:

  • Submit electronically via Client Zone at https://zone.hccmis.com/clientzone/

  • OR

  • Mail to:

  • Tokio Marine HCC – MIS Group
    Claims Department
    Box No. 2005
    Farmington Hills, MI 48333-2005
    U.S.A.

We require a completed “Claimant’s Statement and Authorization” form for each different condition or episode of care. Therefore, if you have completed a “Claimant’s Statement and Authorization” form for a particular episode of care, you do not need to resubmit.

However, if you received treatment for a different condition or episode of care, you will need to complete a new “Claimant’s Statement and Authorization” form.

Once you have signed and submitted your Claimant’s Statement and Authorization form, our claim’s examiners will review your information typically within 30 days of the receipt of the claim.

The initial review of your claim will determine whether it will be paid, denied, or if more information is needed to make a final decision. We may request more information of you or your medical providers before your claim is paid or denied.

Final processing time of your claim is dependent upon multiple factors. However, you can assist us in reducing your claim pending time by ensuring that we receive all requested information timely and quickly.

To check your claim status, please visit ClientZone at https://zone.hccmis.com/clientzone, email your inquiry to [email protected], or contact us at 800-605-2282.

While we may have received a completed “Claimant’s Statement and Authorization” form from you, we may be waiting on medical records from your providers. Each time we request additional information, you will receive a letter notifying you of what is being requested.

You may assist us with these requests by contacting the medical provider to request that the medical records be expedited to us.

The EOB is not a bill. Rather, it is an explanation of how your claim has been processed.

For each claim we receive, we will send you an acknowledgement letter notifying you of our receipt of your claim. The acknowledgement letter will also notify you of any additional information that we need or information that is still outstanding from a prior request.

Additionally, each time we request information from you or your medical providers, we will send you a letter to notify you of the request.

There may be situations when you choose to appeal how a claim was processed. In order to appeal, you may:

  • Visit https://service.hccmis.com and submit your appeal using the "Claimant Appeal Request" form, along with additional documentation that supports your reasoning and position (medical records, receipts, etc.)

  • OR

  • Send a written letter of appeal, along with additional documentation that supports your reasoning and position (medical records, receipts, etc.) to:

  • Tokio Marine HCC - MIS Group
    Claims Department
    Box No. 2005
    Farmington Hills, MI 48333-2005
    U.S.A.

In order for our claims department to review the appeal, you must provide additional documentation or information to support a reversal of the denial.

Please note that submission of the appeal will lead to re-evaluation of your claim but does not guarantee that the initial benefit determination will be altered.

Our policies are not subject to the Patient Protection Affordable Care Act. They do not contain many of the coverages required by PPACA and therefore may contain a pre-existing condition exclusion.

See Fewer Questions

Understanding the Claims Process

How to Submit a Claim: A Step-by-Step Guide to the Claims Process for Members

Explore our claims "how-to" guide to learn:


How to File a Claim Outside the United States

Follow Michelle’s journey through the claims process to understand what happens if you receive medical care outside the United States.


How the Claims Process Works in the United States

If you received medical care within the United States, watch the video and follow along with Will to learn how the claims process works.

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  • Authorization Form for Use and/or Disclosure of Protected Health Information - an authorization form that gives the insurer permission to disclose and release protected health information to anyone specified on the form. Tokio Marine HCC - MIS Group requires that this form be signed and thoroughly completed if the member wishes for their protected health information to be disclosed and/or released to a specified person.
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  • Certificate Period — this is the period of time beginning on the date and time your insurance becomes effective and ending on the date and time your coverage is terminated.
  • Coinsurance — specifies the percentage amount the insurer pays for eligible expenses and the percentage amount the insured pays for eligible expenses once the insured has met their deductible.
  • Copayments (Copays) — the fixed amount the insured person must pay out of pocket for specific medical services, such as use of an emergency room for an illness.
  • Claimant — a person or entity making a claim under a policy.
  • Claimant Statement and Authorization Form — an authorization form that asks for claimant information, medical information, and authorization for the release of medical records. It is completed by the claimant and submitted to the insurer. Tokio Marine HCC - MIS Group requires a Claimant's Statement and Authorization form for each incident.
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  • Deductibles — the dollar amount of eligible expenses the insured must pay per certificate period before eligible expenses are paid.
  • Date of Service — the date that a medical service was received. This date may differ from the date that the medical claim is filed with the insurance company.
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  • In Network — refers to physicians and medical facilities who have a contract with the insurer. If you visit an in-network provider, you may receive medical services at a discounted rate.
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  • Member - an individual who is covered under an insurance policy.
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  • Out of Network — refers to physicians and medical facilities who do not have a contract with the insurer and therefore charge the full rate for their services.
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