Student Insurance Excess Provision
An Excess Provision is similar to a Coordination of Benefits provision in that it establishes an order in which insurance plans pay their claims so that the combined benefits of all plans does not exceed the total medical expenses. An Excess Provision means that benefits will be paid on the unpaid balances after the other health insurance has paid. In essence, a policy containing this provision is secondary or an "excess" policy to any other health insurance policy that you may have and is often referred to as secondary insurance.
The College-sponsored Student Insurance Plan contains an Excess Provision, so it requires the UnitedHealthcare StudentResources (UHCSR) claims department to gather details on other health insurance in force. Typically, this information gathering occurs once we receive a claim and may result in delayed claims processing while we wait for a response from the insured student. After UHCSR receives a claim, insured students may be mailed a form letter requesting information about whether or not you have other insurance coverage. Failure to response to these requests for additional information in a timely manner may result in your current and subsequent claims being denied as being incomplete, so it is imperative that you respond to these requests within 30 days from the date of the letter. This information may be requested each policy year.
The delay in claims processing can be eliminated by providing this information up front, PRIOR to the submission of a claim. Insured students can provide this information in a number of ways, either online, by phone or by mail. You can log into MyAccount and select the "Additional Coverage Information" link on the landing page. Then, complete the required fields and click "Submit." Or you can contact Customer Service at (800) 767-0700 Monday-Friday, 7AM-7PM Central time to provide this information to one of our Representatives. And finally, you can complete the information on the form letter, should you receive one in the mail, and return it to UHCSR in a timely manner.
If you are insured under another health insurance plan, the W&M Plan is secondary and your other health insurance is primary. Students insured by more than one health plan must present both insurance cards to any medical providers or facilities that you use and notify them of the order in which the insurance plans will pay so that the provider can submit the insurance claims accordingly. Additionally, it is the insured student's responsibility to provide UnitedHealthcare StudentResources with a copy of the other insurance Explanation of Benefit so that UHCSR can determine to which unpaid balance(s) benefits will be paid. The Student Insurance Plan may cover unpaid balances, deductibles and eligible medical expenses not covered by the other insurance. However, the Plan excludes coverage for amounts not covered by the primary carrier due to penalities imposed as a result of the insured's students failure to comply with policy provisions or requirements.
Important: The Excess Provision has no practical application if you do not have other medical insurance or if your other group insurance does not cover the loss.