Helping you protect what matters most.

Genmed – Health Plan

CUNA Mutual – Critical Illness and Family Indemnity Plan

COLFIRE General Insurance – Residential, Motor, Liability, Commercial

You will need to complete the Enrolment, ACH and Medical Questionnaire forms which are available online or at our office.

Premiums must be paid in full for the period from the date of approval or members can apply for premium financing through our loan facility option and pay monthly installments.

CCU members will have the use of Tatil’s Total Benefits Specialists Limited Network (TBSL) of qualified, registered professionals in their respective fields across Trinidad and Tobago.

Coverage is only applicable to your spouse (common-law included) and children (step, legally adopted + incapacitated over the age of 25 years included). Children are covered without exception up to age 19. Between the ages of 19 and 25 children can continue coverage; however, they must be in school full-time as evidenced by a letter from the respective institution at the start of each academic year.

Step 1
At the end of each visit, the Physician should be requested complete their relevant section on the claim form.

Step 2
On Completion of treatment or services the member should complete Section 1 (Insured’s
statement)

Attach all supporting original itemized bills and receipts
• Date of Service
• Name of Patient
• Cost of each Service
• Hospital Bills must include: number of days spent, cost per day and other hospital services
• Drug Bills must include: Patient, name of prescribing doctor, RX#, name and quantity per drug
• X-rays/Labs must include cost and type of services

A pre-existing condition is a condition resulting from illness or injury for which a Covered
Insured has received a diagnosis , consultation , medical treatment , or drug prescription prior
to the effective date of the policy or date cover was effective; OR for which a symptom and/or
sign of illness, if presented to a physician prior to the effective date of the policy would have
resulted in the diagnosis of an illness or medical condition whether or not the patient was
aware of the condition.

This is the annual dollar amount of covered expenses for which the Insured is responsible
before benefits can be payable under the Policy

When an individual is covered under more than one health plan and is able to claim for the
expenses incurred from both plans, the benefits under this policy will be reduced to an amount
which when added to the benefit of the other plan will equal 100% of medical expenses
incurred.

The plan covering the insured as an employee.

The plan covering the insured as a Dependent of a Male employee; and If the above do not establish an order of priority, the plan which has covered the insured for the longer period of time pays the benefits first.

Pre-certification is a notification of anticipated or scheduled medical services that is required in
advance of the actual medical treatment. Before you actually receive treatment or incur the
medical expenses, BEACON upon request by the Provider, issues a pre-approval letter stating
whether the anticipated service is eligible for coverage and the level of charges that would be
reimbursed from the health plan.

A letter from the treating Physician or Medical facility with an itemization of the charges and the
type of treatment/procedure recommended or scheduled must be sent to your CCU plan administrator.

Exclusions and Limitations refer to services, equipment, procedures and types of treatment that are not covered under the plan. These are listed in the policy contract.

UCR means the charge or fee determined by the Company to be the general rate charged by
others who render or furnish such treatments, services or supplies to persons whose injuries or
illnesses are comparable in nature and severity.

The Company will consider such factors as; complexity; degree of skill needed, type of specialist required, and the range of services or supplies provided by the facility. For example, if a doctor charges $3,000 for a surgical procedure and the usual fee for the procedure is $2000 then the plan will reimburse you based on the charge of $2000 and applicable co-insurance will apply