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Group Health Insurance

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FAQ

Frequently Asked Questions

Who is the Insurer?

The Insurer is Trinidad and Tobago Insurance Limited (Tatil) with broker services provided by CIC Insurance Brokers Limited (CIC).

How do I join the plan?

You will need to complete the relevant enrollment forms which are available online or at our office.

Is there an age limit?

The maximum age limit for new applicants is 64 years old.

What payment options are available?

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

Will CCU have use of a provider network?

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

How does the provider network work?

Use your issued Health Card and ID at any of the providers on the listing and pay less out of pocket with immediate claim settlement.

Who can I list as a dependent?
  •  You can include the following persons: 
  1. Spouse (common-law included)
  2.  Children (up to 25 years of age). Children between the ages of 21-25 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. 
How to Claim?
  • Completed Health Claim Form including: 
  1. Date of Service
  2. Diagnosis 
  3. Provider Signature and Stamp 
  4. Primary Insured’s signature (and spouse, if applicable) 
  5. Co-ordination of Benefits Section (required if covered by another Health Insurance plan) 
  6. Assignment of Benefits section (where necessary) 
  7. Detailed bills/invoices outlining breakdown of services provided and cost of each service 
  8. Receipts confirming payment of bills 
  9. Referrals/Prescriptions (where necessary) 
  10. Dates of service on receipts and claim form must correspond.  

    Claims can be submitted at the Credit Union or online via Tatil’s portal. 

     

What is a Pre-Existing Condition?

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.

What is a Deductible?

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

What is Co-ordination of Benefits (COB)?
  • 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 following determines which plan pays first: 
  1. The plan covering the insured as an employee. 
  2. The plan covering the insured as a Dependent of a Male employee. 
  3. If neither, the plan which has covered the insured for the longer period of time. 
What is Pre-Certification?

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, Tatil 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.

What is required to attain Pre-Certification?

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.

What are Exclusions and Limitations?

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.

What is Usual, Customary & Reasonable (UCR)?

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 considers factors such as complexity, skill needed, type of specialist, and range of services. For example, if a doctor charges $3,000 but the usual fee is $2,000, the plan reimburses based on the $2,000 charge.

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