How to process a claim?
To make a claim for benefits from the OneCare program, first download and complete the form below, and read in detail the procedure guide to follow,
DOWNLOAD: EL Formulario de Reclamos de Beneficios Programa OneCare y Beneficios Opcionales
This form and all relevant documents and invoices, as specified in the form, must be sent to the Company within ninety (90) days of the date of occurrence of the event. Please verify that the form is duly completed in all its parts (as applicable) and signed by both the main insured and the treating physician in the corresponding parts. Remember that any lack of information or signature may delay the payment process of the claim. Attach all the necessary documents and send them to:
P.O. Box 144490,
Coral Gables, FL 33114, EE.UU.
You must send the originals of all invoices. The Company can not accept a copy or photocopy of them. The invoices must clearly indicate the date, the concept and the amount, the credit card vouchers or photocopies do not substitute the original invoices. "ALL DOCUMENTS MUST BE LEGIBLE".
Verify with the following list of documents as appropriate:
All reports or medical records with date of admission and date of discharge.
In case of hospitalization or surgery, the detailed bill of expenses incurred in the institution, progress notes, anesthesia notes and surgery report.
Readings of prevention tests carried out.
Hospital bill with time incarcerated in Intensive Care Unit (if applicable).
Report of Report of Alta and Notes of Progress.
Results of laboratory tests
It is essential to present a pathology report with its corresponding diagnosis.
Invoices from the treating physician (s) clearly indicating:
Name of patient
Date of invoice
Diagnosis, Procedure and date of services
Signature of the doctor and specialty
Results and invoices of laboratory tests performed.
Invoice with pints of blood used (if applicable).
Radiologist's report on radiographs, etc. and including invoices and payment receipts.
In case of accident, description of the accident and include the Police Report.
If the insured is a dependent between 18 and 23 years of age, it is required to send proof of current studies at a higher education institute.
Death certificate (if applicable).
Please refer to Formulario de Reclamos de Beneficios Programa OneCare y Beneficios Opcionales for additional details regarding the specific documents required according to the type of claim that is going to be submitted. The Claims Department reserves the right to request additional documents in order to evaluate and determine the eligibility and / or payment disposition of the submitted claim.
To have access to telephones to communicate with your Insurance Company and the Call Center for Customer Service.