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Frequently Asked Questions and Responses are intended for general information purposes only. A complete description of the plan including limitations and exclusions is contained in the Brochure, and in the Plan Description, which is mailed after enrollment. Questions can also be directed to Customer Service at 800-282-4495 or 202-367-5097 between 9 a.m. and 5 p.m. EST.
How long does it take to process an Application?
Assuming that the Application is complete, is approved, and correct premium is received, this process generally takes 1-2 business days.
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Can a third party or sponsor complete an Application for insurance for someone else?
A responsible third party or sponsor can complete and submit an Application for insurance on behalf of other individual(s).
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What is provided for proof of coverage?
A package containing a Declaration of Coverage, Plan Description, Identification Card, and Claim Form is mailed to the mailing address provided on the Application after enrollment.
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Can coverage be extended?
Yes, Gateway Premier and Gateway Global (Annual Plan) plans can be renewed. Gateway USA can be renewed only if initial enrollment in the plan is for 3 months or more. Prior to the date the insurance ends, a notice of expiration of insurance and option to renew coverage is mailed to the Insured Person at the mailing address on file.
Gateway International and Gateway Visit America do not contain a renewal provision. Gateway USA cannot be renewed when initial enrollment in the plan is for less than 3 months. No expiration notice is sent. However, a new Term of Insurance may be issued provided a new Application and premium is received, and eligibility requirements continue to be met. Each subsequent Application represents a separate Term of Insurance subject to plan provisions including limitations and exclusions.
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Can premium be billed?
No. Payment of full premium for the requested Term of Insurance is due at the time Application is submitted.
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What is covered?
A list of covered expenses, limitations and exclusions is located in the plan brochures. This list is provided in the Plan Description once enrolled.
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Is there a requirement to select a hospital or physician from a specific list?
No. The plan allows an Insured Person to select a physician or hospital of choice.
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Who pays medical providers?
When a physician or hospital agrees to submit charges for services to the Plan Administrator, eligible benefit payments can be paid directly to providers. When payment is required at the time the service is rendered, the Insured Person is reimbursed for eligible expenses. Eligible benefits are determined during claim review.
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What is a Deductible? How does the medical insurance work?
A Deductible is the amount of eligible medical expense which is the responsibility of each Insured Person. Refer to specific plan brochure(s) for details about how the Deductible is applied during a Term of Insurance.
After the Deductible, the plans pay for Covered Medical Expenses according to a specified ratio - 80/20% as an example. This ratio, if any, applies to the reasonable and customary charges for Covered Medical Expenses after the Deductible is satisfied. Eligible medical expenses are reduced by the Deductible before benefits are calculated. The example below assumes illustrated expenses are considered eligible.
Example:
Deductible $150 - Plan pays 80% of first $5,000, thereafter 100%
| Out-patient hospital bill |
$3,000 |
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| Surgery |
$2,500 |
|
| Physician Follow-up Visit |
$360 |
|
| Rx |
$120 |
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| Total Medical Expense |
$5,980 |
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| Deductible |
($150) |
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| Eligible for Benefits |
$5,830 |
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| @80% |
$4,000 |
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| @100% |
$830 |
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| Benefits payable |
$4,830 |
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| Insured Expense |
$1,000 |
+ $150 = $1,150 |
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What are eligible expenses?
Eligible expenses are those that are specifically listed, subject to plan limitations and exclusions. Details are provided in the brochure(s).
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How is a claim filed?
Complete a Gateway Claim Form and send to address on claim form. Attach itemized bills for charges paid for services. A Gateway claim form must be completed and on file for claim processing, regardless of whether a hospital or physician has sent bills directly to us, or if the Insured Person is seeking reimbursement for charges already paid. Only one claim form is required for each separate illness or injury. Refer to Gateway claim form instructions.
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