How to Submit a Claim

A Step-by-Step Guide to the Claims Process for Members


Jump to Section:


We strive to keep our shared claims experience as straightforward as possible. Our claims department processes claims based on the terms and conditions described in your policy.

Note that this step-by-step guide applies to domestic and international claims submitted both in-network and out-of-network.


How to File a Claim


Claims Process for Claims Incurred Within the United States

If your Provider Will Bill Tokio Marine HCC - MIS Group Directly
  • Click to view instructions
    1. Present your insurance ID card to your medical provider at the time of service.

    *Make sure that you provide your name in the same format as provided for your insurance policy. You can see your insured name format on your ID card, as well as your fulfillment documents and in Client Zone. 

    1. Unless you are required to pay for medical treatment at the time of service, your provider will submit your claim directly to Tokio Marine HCC – MIS Group (TM HCC – MIS Group).
    2. TM HCC – MIS Group will send you a letter notifying you that we have received your claim.
    3. We will also request a Claimant’s Statement and Authorization Form or other information from you. If the information requested from you is not received by us within 45 days, your case may be closed.

    Click here to learn how to submit the Claimant’s Statement and Authorization Form and other supporting documents to TM HCC – MIS Group.

    Once the fully completed Claimant’s Statement and Authorization Form is received, TM HCC – MIS Group may request medical records from the billing providers and/or any medical provider.

    *TM HCC – MIS Group requests to receive this information from the provider(s) within 45 days of the original request.

    *If medical records are requested, you may reach out to the billing provider(s) and/or medical provider(s) to obtain copies—or submit to us the records you collected at the time of service. However, this is typically the provider’s responsibility.

    1. TM HCC – MIS Group will complete the claims process once we have all the necessary information.
    2. If the claim is deemed eligible, TM HCC – MIS Group will secure any preferred provider discounts (if applicable).
If You're Required to Pay for Medical Treatment at the Time of Service
  • Click to view instructions

    We encourage providers to bill us directly, rather than requiring immediate payment from you. While we are always willing to pay providers directly for eligible claims, we cannot guarantee that the provider will accept your proof of insurance at the time of service.

    1. Present your insurance ID card to your medical provider at the time of service.
    2. Ask your medical provider for your complete medical records from the visit as well as the receipt for your payment. Request an itemized bill with the following information:

    a. Provider name and address

    b. Provider tax ID (if U.S.-based)

    c. Your name, date of birth, and policy/certificate ID number

    d. Itemized charges

    e. DX (Diagnosis) code and CPT (Current Procedural Technology) code. These are the codes your physician’s office uses to tell our claims examiners which procedures, diagnoses, and services you received during your visit.

    Keep your medical records, receipt, and itemized bill.

    1. You must complete, sign, and submit the Claimant’s Statement and Authorization Form for every incident. Once the fully completed Claimant’s Statement and Authorization Form is received, TM HCC – MIS Group may request medical records from the billing providers and/or any medical provider.

    Click here to learn how to submit the Claimant’s Statement and Authorization Form and other supporting documents to TM HCC – MIS Group.

    *If medical records are requested, you may reach out to the billing provider(s) and/or medical provider(s) to obtain copies—or submit to us the records you collected at the time of service. However, this is typically the provider’s responsibility.

    *TM HCC – MIS Group requests to receive this information from the provider(s) within 45 days of the original request


    1. We will also request receipts, invoices, and/or itemized bills from you. You will have 45 days to send us the information.

    *Be sure to keep a copy of all submitted documents for your records.

    1. TM HCC – MIS Group will complete the claims process once we have all the necessary information.
    2. If the claim is deemed eligible, TM HCC – MIS Group will secure any preferred provider discounts (if applicable).
Claims Processed for Claims Incurred Outside the United States
  • Click to view instructions
    1. Present your insurance ID card to your medical provider at the time of service.

    *Make sure that you provide your name in the same format as provided for your insurance policy. You can see your insured name format on your ID card, as well as your fulfillment documents and in Client Zone. 

    1. Unless the provider will be billing Tokio Marine HCC – MIS Group (TM HCC – MIS Group) directly, you will pay for treatment at the time of service.
    2. At the time of service, ask your medical provider for your complete medical records from the visit as well as the receipt for your payment.

    Also request an itemized bill with the following information:

    a. Provider name and address

    b. Your name, date of birth, and certificate ID number

    c. Itemized charges

    d. DX (Diagnosis) code and CPT (Current Procedural Terminology) code (these are the codes your physician’s office uses to tell our claims examiners which procedures, diagnoses, and services you received during your visit)

    Keep your medical records, receipt, and itemized bill.

    1. You must complete, sign, and submit the Claimant’s Statement and Authorization Form for every incident. Once the fully completed Claimant’s Statement and Authorization Form is received, TM HCC – MIS Group may request medical records from the billing providers and/or any medical provider.

    Click here to learn how to submit the Claimant’s Statement and Authorization Form and other supporting documents to TM HCC – MIS Group.

    *If medical records are requested, you may reach out to the billing provider(s) and/or medical provider(s) to obtain copies—or submit to us the records you collected at the time of service. However, this is typically the provider’s responsibility.

    *TM HCC – MIS Group requests to receive this information from the provider(s) within 45 days of the original request.

    1. We will also request receipts, invoices, and/or itemized bills from you. You will have 45 days to send us the information.

    *Be sure to keep a copy of all submitted documents for your records.

    1. TM HCC – MIS Group will complete the claims process once we have all the necessary information.

How to Complete and Submit the Claimant's Statement and Authorization Form and Supporting Documents


You must complete, sign, and submit a Claimant's Statement and Authorization Form for every incident.


If you are filing this claim on behalf of another person, you MUST fill out the section of the Claimant's Statement and Authorization Form labeled "Supplement D - Authorization Form for Use and/or Disclosure of Protected Health Information (HIPAA)." This section must be signed by the policyholder in order for us to speak with you regarding any of the policyholder's Protected Health Information (PHI). Without this signed form, we may only disclose to you the status of the claim.


You can complete and submit the Claimant's Statement and Authorization Form in one of the following ways:


Via Online Submit Claim Request Form
  • Click to view instructions
    1. Download the Claimant’s Statement and Authorization Form here.
    2. Complete and sign the form.
    3. Visit https://service.hccmis.com and select “Submitting a Claim or an Appeal” under the “Contact Us” header.
    4. Click the “Submit Claim” button.
    5. Fill in the requested information on the Submit Claim Request Form and upload the form, along with additional documentation (medical records, receipts, etc.).
    6. Click "Submit."
By Email or Mail
  • Click to view instructions
    1. Download the Claimant’s Statement and Authorization Form here.
    2. Print, complete, and sign the form and

    a. Email to [email protected]

    OR

    b. Mail to:

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

    TM HCC – MIS Group is also happy to fax, e-mail, or mail the form to you upon request.

Electronically via Client Zone (DocuSign)
  • Click to view instructions

    You can complete, sign, and submit the Claimant’s Statement and Authorization Form online via Client Zone, our self-service portal for policyholders.


    To access Client Zone, you will first need to register an account. (Please refer to the "How to Register for a Client Zone / Student Zone Account" section of this document for registration instructions.)

    If you have already registered your account, visit the Client Zone login page to log into your account.


    1. Click "Log in" next to "Already registered with two-factor authentication?" You'll find this below the "Next" button.

    1. On the resulting "Sign In" page, enter the email address and password you used to create your account. Click "Sign In."

    1. After you log in, you will see the following screen. In the navigation bar, click on "Claims." Then select "Claim Information" in the drop-down menu.

    1. On the Claim Information page, click the "Select" button in the "Claims Forms" section.

    1. After clicking the "Select" button, the following page will appear:

    Follow the instructions on the page for filling out and submitting the form.

Electronically Via Student Zone (DocuSign)
  • Click to view instructions for student policyholders

    You can find the Claimant's Statement and Authorization Form online via Student Zone, our self-service portal for student policyholders.


    To access Student Zone, you will first need to register an account. (Please refer to the "How to Register for a Client Zone / Student Zone Account" section of this document for registration instructions.

    If you have already registered your account, visit the Student Zone login page to log into your account.


    1. Click "Log in" next to "Already registered with two-factor authentications?" You'll find this below the "Next" button.

    2. On the resulting "Sign In" page, enter the email address and password you used to create your account. Click "Sign In."

    3. After you log in, you will see the following screen. In the navigation bar, click on "Claims." Then select "Claim Information" in the drop-down menu.

    4. On the Claim Information page, click the "Select" button in the "Claim Forms" section.

    5. After clicking the "Select" button, the following page will appear:

    Follow the instructions on the page for filling out and submitting the form.

    Important Note for Students

    For eligibility purposes, you must submit the following along with a Claimant’s Statement and Authorization Form:

    • A copy of your education-related visa (F1, J1, OPT, etc.) or valid I-20/DS2019
    • Proof of full-time student status (not necessary if submitting a valid F1 visa including OPT, or J1 visa)

    If you have questions or need assistance, call global customer support at (800) 605-2282.


    Important Note for Upfront Payments

    If you paid for medical treatment upfront and wish to be reimbursed for an approved claim electronically, make sure you complete the section titled "Authorization Agreement Form - Wire Payments" on page 6 of the Claimant's Statement and Authorization Form. You'll find this section under "Supplement B - Payment Forms."

    If you do not complete this section, you will receive a paper check for reimbursement of any eligible expenses to the name and address listed on file.


Direct Billing and Claims Reimbursement Process


We encourage providers to bill us directly, rather than requiring immediate payment from you. While we are always willing to pay providers directly for eligible claims, we cannot guarantee that the provider will accept your proof of insurance at the time of service.


If Providers Are Willing to Bill Us Directly:
  • Click to view instructions

    You must authorize the payment of medical benefits to the provider by signing and dating the section of the Claimant's Statement and Authorization Form labeled "2C. Assignment of Benefits Authorization." You will find section "2C" under "Part C: Medical Record Authorization."



    Providers must mail itemized bills, including diagnosis, to:

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

     

If Providers Are Not Willing to Bill Us Directly:
  • Click to view instructions

    You must pay for medical treatment at the time of service and file a claim for reimbursement.

    To file a claim, you must submit a completed Claimant’s Statement and Authorization Form as well as all original itemized bills and paid receipts to Tokio Marine HCC – MIS Group.

    You can complete and submit the Claimant’s Statement and Authorization Form in one of four ways:

    • Complete and submit the form electronically via Client Zone / Student Zone
    • Download and complete the form and then upload it to the Submit Claim Request Form via the Customer Service page
    • Download and complete the form and then attach and send via email to [email protected]
    • Download, print, and complete the form and send by mail to:

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


    Click here to jump to the “How to Complete and Submit the Claimant’s Statement and Authorization Form and Supporting Documents” section to see detailed submission instructions.

    We encourage you to make copies of all documentation (Claimant’s Statement and Authorization Form, bills, receipts, etc.) you send to us for your own records.


    IMPORTANT NOTE

    It is common for the claims department to request copies of medical records related to a claim or to your medical history. If you sought treatment outside the U.S., our claims department may require you to obtain the medical records related to your claim and submit them to us.

    If we request additional information, further processing time may be necessary, depending on the response time of the parties from whom we requested the information.

    We are not able to pay a provider in advance of services rendered. While you may contact us at any given time to verify your benefits, this is not a guarantee that the charge is covered. We must have the ability to investigate a claim before determining whether it is eligible for payment.


Claims Review Process


A TM HCC - MIS Group claims examiner will review the claim to determine if it can be processed or if more information is needed.


If more information is needed, the examiner will send a "Request for More Information" letter by mail to you and/or the medical provider.


NOTE: You can see any letters you have on file in the "Letters" section of Client Zone / Student Zone under the "Claims" tab. (Click here to learn more about letters sent from Tokio Marine HCC - MIS Group.)


You may respond to the "Request(s) for More Information" by taking one of the following actions:

  • Upload the requested document(s) via Client Zone or Student Zone
  • Upload the requested document(s) to an existing claim via the Submit Claim Request Form. You can access the form by visiting the Customer Service page and selecting “Submitting a Claim or an Appeal” under the “Contact Us” header.
  • Email the requested document(s) to [email protected]
  • Mail the requested document(s) to:

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


Refer to the exhibit in Appendix 1 to reference the various types of letters sent out to members by TM HCC - MIS Group.


NOTE: If you or the medical provider do not respond within 45 days of the initial request for more information, the claim may be closed.


How to View Your Claim Status


Viewing Your Claim Status via Client Zone
  • Click to view instructions

    1. On the Client Zone login page, select "Log in" next to "Already registered with two-factor authentication?" You'll find this below the "Next" button.

    2. On the resulting "Sign In" page, enter the email address and password you used to create your account. Click "Sign In."

    3. Click "Claims" in the main navigation bar to see a dropdown menu of claim-related information.

    Dropdown menu items include:

    Claim Information: View and submit claim forms, search for medical referrals, or review frequently asked questions.

    Claims & Explanation of Benefits: View the status of an ongoing or completed claim (learn more below).

    Letters: See any letters you have on file (see Appendix 1 to view the types of letters sent by Tokio Marine HCC - MIS Group).

    4. Click "Claim Information" in the dropdown menu to view and submit claim forms, search for medical referrals, or review frequently asked questions.

    5. Click "Claims & Explanation of Benefits" in the dropdown menu to view the status of a claim.

     

    Here's an example of what you will see in the "Claims & Explanation of Benefits" section:

    Claims &; Explanation of Benefits page in Client Zone

    This section is populated with the following information:

    Label/Heading

    Purpose

    Certificate Number

    Policy/certificate number issued by TM HCC - MIS Group

    Patient

    Patient name of record

    Claim Number and Link to Explanation of Benefits (EOB)

    Claim number generated by TM HCC - MIS Group (a link to the EOB will be provided when the claim has been finalized)

    Provider

    Provider name (includes total charges and payment amounts to provider)

    Status/Reason

    Indicates if a claim is in a "pending" or "completed status" (includes reason codes)

    Date(s)

    Dates:

    Incurred - Actual date of service that you received treatment

    Received- Date TM HCC - MIS Group received the claim

    Processed - Date the claim was finalized

    When finalized, each claim will have an Explanation of Benefits (EOB) associated with it.

    1. To view the EOB, click on "EOB" under the "Claim #" section.

    How to view an EOB

    2. After click on the "EOB" icon, a message will appear notifying you that the EOB is downloading.

    EOB downloading message in Client Zone

    You can open the downloaded PDF document on your computer or mobile phone to view the EOB. You may also save the EOB document to a device or print it.

    An example EOB is shown below. It displays the various data elements contained within a standard EOB from TM HCC - MIS Group.

    Explanation of Benefits example


Viewing Your Claim Status via Student Zone
  • Click to view instructions for student policyholders

    1. On the Student Zone login page, select "Log in" next to "Already registered with two-factor authentication?" You'll find this below the "Next" button.

    2. On the resulting "Sign In" page, enter the email address and password you used to create your account. Click "Sign In."

    3. Click "Claims" in the main navigation bar to see a dropdown menu of claim-related information.

    Dropdown menu items include:

    Claim Information: View and submit claim forms, search for medical referrals, or review frequently asked questions.

    Claims & Explanation of Benefits: View the status of an ongoing or completed claim (learn more below).

    Letters: See any letters you have on file (see Appendix 1 to view the types of letters sent by Tokio Marine HCC - MIS Group).

    4. Click "Claim Information" in the dropdown menu to view and submit claim forms, search for medical referrals, or review frequently asked questions.

    5. Click "Claims & Explanation of Benefits" in the dropdown menu to view the status of a claim.

    Here's an example of what you will see in the "Claims & Explanation of Benefits" section:

    Claims &; Explanation of Benefits page in Client Zone

    This section is populated with the following information:

    Label/Heading

    Purpose

    Certificate Number

    Policy/certificate number issued by TM HCC - MIS Group

    Patient

     

    Patient name of record

    Claim Number and Link to Explanation of Benefits (EOB)

    Claim number generated by TM HCC - MIS Group (a link to the EOB will be provided when the claim has been finalized)

    Provider

    Provider name (includes total charges and payment amounts to provider)

    Status/Reason

    Indicates if a claim is in a "pending" or "completed status" (includes reason codes)

    Date(s)

    Dates:

    Incurred - Actual date of service that you received treatment

    Received - Date TM HCC - MIS Group received the claim

    Processed - Date the claim was finalized

    When finalized, each claim will have an Explanation of Benefits (EOB) associated with it.

    a. To view the EOB, click on "EOB" under the "Claim #" section.

    How to view an EOB

    b. After clicking on the "EOB" icon, a message will appear notifying you that the EOB is downloading.

    EOB downloading message in Client Zone

    You can open the downloaded PDF document on your computer or mobile phone to view the EOB. You may also save the EOB document to a device or print it.

    An example EOB is shown below. It displays the various data elements contained within a standard EOB from TM HCC - MIS Group.

    Explanation of Benefits example


How to Appeal a Claim


There may be situations when you choose to appeal how a claim was processed. You may appeal your claim decision using one of the following methods:


Online Form Submission
  • Click to view instructions
    1. Visit https://service.hccmis.com.
    2. Select “Submitting a Claim or an Appeal” under the “Contact Us” header.
    3. Click “Submit Appeal.”
    4. Fill in the requested information on the Claimant Appeal Request Form and upload additional documentation that supports your reasoning and position (medical records, receipts, etc.).
    5. Click "Submit."
Appeal Form Submitted via Email or Mail
  • Click to view instructions
    1. Download the Claimant Appeal Request Form here.
    2. Fill out the form and email it, along with additional documentation that supports your reasoning and position (medical records, receipts, etc.), to [email protected].

      OR

    Mail the form and supporting documents to:

    Tokio Marine HCC Appeals
    Box No. 2058
    Farmington Hills, MI 48333-2005
    U.S.A

Written Letter Submitted via Email or Mail
  • Click to view instructions
    1. Write a letter of appeal following the appeal procedure instructions outlined in your policy documents/certificate of coverage.
    2. Email this written letter of appeal, along with additional documentation that supports your reasoning and position (medical records, receipts, etc.), to [email protected].

      OR

      Mail the form and supporting documents to:

    Tokio Marine HCC Appeals
    Box No. 2058
    Farmington Hills, MI 48333-2005
    U.S.A

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.


How to Register for a Client Zone / Student Zone Account


Client Zone and Student Zone allow you to view and track your claim status as well as update your personal information. In order to access this functionality, you must first register for an account.


Not sure whether to register for a Client Zone or Student Zone account? If you're not sure which type of policy you have, visit Client Zone and continue following the instructions below. You will be redirected to Student Zone if the email address or policy/certificate number you enter is associated with a student travel medical insurance policy.


Registering for a New Client Zone Account
  • Click to view instructions

    1. Go to zone.hccmis.com/clientzone.

    2. Enter the email address you used to purchase your policy or another valid email address. Then hit "Next."

    3. Enter the policy/certificate number located on your fulfillment documents or member ID card.

    Click the calendar icon to enter your date of birth. Choose the decade in which you were born. Then choose the year. Then choose the month, followed by the day.

    Click "Next."

    4. Enter your email address.

    Enter a password that has at least:

    • 8 characters
    • A lowercase letter
    • An uppercase letter
    • A number

    No part of your password may include your username.

    Enter your password again to confirm.

    Read through the terms and conditions and select the checkbox if you agree.

    Click "Register."

    Step 2 of registering a new Client Zone account

    You will receive an email welcoming you to Client Zone at the email account you used to register,

    5. Return to Client Zone and enter the email address you used to create your Client Zone account.

    Enter the password you created.

    Click "Sign In."

    6. To add an additional later of security when signing into your account, choose your preferred multifactor authentication method.

    Options Include:

    a. Okta Verify - Click "Setup" if you wish to enter a single-use code from the mobile app

    b. SMS Authentication - Click "Setup" if you wish to enter a single-use code that is sent to your mobile phone

    c. Voice Call Authentication - Click "Setup" if you wish to follow voice instructions via phone

    d. Security Question - Click "Setup" if you wish to answer a security question

    7. Follow the setup instructions of your chosen multifactor authentication method.

    Set up multifactor authentication in Client Zone

    Once you've set up multifactor authentication, you will receive an email notifying you that you have successfully enrolled.

    8. On the resulting page, choose a "Forgot Password" question. Make sure you select a question with only one correct answer that is easy to remember.

    Type the answer into the blank box below "Answer." You will need this answer to access your account if you ever forget your password and need to change it.

    Click "Create My Account."

    Choosing a &;quot;Forgot Password&;quot; question in Client Zone

    Once you have created a new account, you may enter your credentials and log into Client Zone.

Registering for a new Student Zone account
  • Click to view instructions

    1. Go to zone.hccmis.com/studentzone.

    2. Enter the email address you used to purchase your policy or another valid email address. Then hit "Next."

    3. Enter the policy/certificate number located on your fulfillment documents or member ID card.

    Click the calendar icon to enter your date of birth. Choose the decade in which you were born. Then choose the year. Then choose the month, followed by the day.

    Click "Next."

    4. Enter your email address.

    Enter a password that has at least:

    • 8 characters
    • A lowercase letter
    • An uppercase letter
    • A number

    No part of your password may include your username.

    Enter your password again to confirm.

    Read through the terms and conditions and select the checkbox if you agree.

    Click "Register."

    Step 2 of registering a new Client Zone account

    You will receive an email at the email account you used to register welcoming you to Student Zone.

    5. Return to Student Zone and enter the email address you used to create your Student Zone account.

    Enter the password you created.

    Click "Sign In."

    6. To add an additional layer of security when signing into your account, choose your preferred multifactor authentication method.

    Options Include:

    a. Okta Verify - Click "Setup" if you wish to enter a single-use code from the mobile app

    b. SMS Authentication - Click "Setup" if you wish to enter a single-use code that is sent to your mobile phone.

    c. Voice Call Authentication - Click "Setup" if you wish to follow voice instructions via phone

    d. Security Question - Click "Setup" if you wish to answer a security question

    7. Follow the setup instructions of your chosen multifactor authentication method.

    Set up multifactor authentication in Client Zone

    Once you've set up multifactor authentication, you will receive an email notifying you that you have successfully enrolled.

    8. On the resulting page, choose a "Forgot Password" question. Make sure you select a question with only one correct answer that is easy to remember.

    Type the answer into the blank box below "Answer." You will need this answer to access your account if you ever forget your password and need to change it.

    Click "Create My Account."

    Choosing a &;quot;Forgot Password&;quot; question in Client Zone

    Once you have created a new account, you may enter your credentials and log into Student Zone.


Appendix 1: Most Common Types of Letters


Review the chart below to see the most common types of letters sent by Tokio Marine HCC - MIS Group. For each letter, you'll see the:

  • Type of letter
  • Purpose of the letter
  • Required actions you must take

Please note that this is not an exhaustive list. If you have questions about a specific letter, please contact our customer service department.


Type of Letter

Why Am I Receiving This Letter from Tokio Marine HCC - MIS Group?

Do I Need to Take Action as the Insured After Receiving This Letter?

Claimant's Statement and Authorization Form - Member Request

This letter asks you to submit the Claimant's Statement and Authorization Form for a specific incident of care.

The letter also contains instructions on how to submit the form.

Yes. Please complete the Claimant's Statement and Authorization Form and submit it to Tokio Marine HCC - MIS Group via one of the methods outlined in the letter.

If you are a StudentSecure policyholder, please also submit the required student documentation as requested within the letter.

Additional Information - Member Request

This letter asks you to submit additional information. The requested information could be several different items, but some common requests include:

  • A copy of your passport
  • Medical records from your doctor in your home country
  • Receipt of payment for a submitted claim (if requesting reimbursement)

Yes. Please submit all information requested within the letter to Tokio Marine HCC - MIS Group.

Medical Records - Provider Request

This letter notifies you that we have requested medical records and other supporting documentation from specific providers for certain incidents of care.

The requested medical records and supporting documentation are necessary so we can determine benefits for the associated claims.

No. You are not responsible for submitting the information we requested from specific providers.

This letter serves only to notify you of our request.

Medical Records - Provider Request for UHC-Priced Claims

This letter is relevant for claims priced using the UnitedHealthcare Network.

It notifies you that we have asked UnitedHealthcare to request medical records from specific providers for certain incidents of care so that we can determine benefits for the associated claims.

No. You are not responsible for submitting the information UnitedHealthcare will request from specific providers.

This letter serves only to notify you of our request.

Overpayment Return - Provider Request

This letter notifies providers when we have overpaid on a claim. The letter requests a refund from the provider to eliminate the overpayment.

No. You are not responsible for submitting the overpayment refund.

The provider will send the overpayment refund to us directly.

KHE2FFFYH6SP-152-1715

Tokio Marine HCC - MIS Group international insurance products are underwritten by Lloyd's. Tokio Marine HCC - Medical Insurance Services Group (MIS Group) is a service company and a member of the Tokio Marine HCC group of companies. Tokio Marine HCC - MIS Group has authority to enter into contracts of insurance on behalf of the Lloyd's underwriting members of Lloyd's Syndicate 4141, which is managed by HCC Underwriting Agency Ltd.