For UnitedHealthcare supplemental plans from Golden Rule Insurance Company: hospital, fixed indemnity, accident and critical illness plans. The steps are mostly the same for every plan. Pick yours below for what to collect, the deadline and anything to watch for.
Show your main health insurance card at the hospital or doctor. Your main plan (ACA, employer plan, Medicare) is what pays the hospital and doctors.
Your supplemental plan is separate. It pays you a set amount (or, on the accident expense plans, pays back what you owe), and the money goes directly to you unless you sign it over to the provider. Use it for the bill or anything else you need.
Keep every piece of paper. Ask for discharge papers before you leave, and keep the itemized bill and any Explanation of Benefits (EOB) your main insurance sends later. That's what the claim is built on.
Filing, step by step
Get the claim form
Sign in to uhcmemberhub.com and print the claim form for your plan. No account yet? Here's my two-minute setup guide. You can also get the form from member services or from me. Hospital and fixed indemnity plans use the general claim form; accident and critical illness plans have their own claim forms.
Fill it out and sign it
Fill out Parts 1 and 2 completely, with your policy number (it's on your approval email, welcome packet and Member Hub). Use a separate form for each person getting care. Sign the form and the Authorization to Obtain Medical Information that comes with it, so Golden Rule can get records from your doctor or hospital. Leaving something out can delay the claim.
Attach your paperwork
Send complete itemized bills, not just a balance-due statement. Your provider can give you one that shows the diagnosis code, procedure (CPT) code, amount charged, provider information and date of service. For an accident, add a copy of the police report if there was one (always for a car accident). Your plan's tab below lists anything else to include.
Mail or fax it
Send it to the address or fax number printed on the form. Golden Rule's current fixed indemnity claim form lists: Claims Department, PO Box 31344, Salt Lake City, UT 84131-9910, fax 1-801-207-1085. Always use the address on the form you're sending, and keep a copy of everything.
Don't miss the deadline
Let Golden Rule know about a claim within 30 days of the hospital stay, accident or diagnosis, or as soon as you reasonably can. Some states allow longer (see your plan's tab). Late is better than never, so file even if 30 days have passed.
Your plan
Pick your plan for what it pays for, what to collect, and what to watch for.
Hospital & fixed indemnity
Accident & critical illness
HospitalWise
Hospital indemnity
What you can claim
A hospital stay when you're admitted, including observation of 12 hours or more. It pays the daily amount you chose.
Your riders, if you have them: ER and urgent care, office visits, outpatient surgery, CT/MRI-type tests, ambulance and wellness.
What to collect
Discharge papers showing the admission and discharge dates.
The itemized bill from the hospital or facility.
For a rider claim (ER, surgery, test), the visit or procedure record with the date.
How to file
Print the claim form at uhcmemberhub.com, fill it out, attach the paperwork and send it the way the form says. The payment comes to you.
Deadline
Within 30 days of the stay or visit, or as soon as reasonably possible. Kentucky and Wyoming: 60 days. Montana: 6 months. Pennsylvania: written notice within 20 days.
Watch for
Pre-existing conditions: for the first 6 months the plan won't pay for a condition you were seen for, treated for, tested for or had symptoms of in the 6 months before your plan started.
The Wellness rider has a 30-day wait in most states.
Stays for the same or a related reason count as one stay unless they're at least 60 days apart.
AdvantageGuard
Hospital indemnity, ages 60 and up
What you can claim
A hospital stay when you're admitted. It pays the daily amount you chose, on top of what Medicare or your Medicare Advantage plan pays.
Your riders, if you have them: cancer, provider-administered drugs, ER and urgent care, skilled nursing, outpatient surgery and tests.
What to collect
Discharge papers with the admission and discharge dates, and the itemized bill.
For skilled nursing: the facility's records showing the stay began within 30 days of a hospital stay (the rider pays days 21 to 100).
For the cancer rider: the doctor's written diagnosis.
How to file
Print the claim form at uhcmemberhub.com, fill it out, attach the paperwork and send it the way the form says. The payment comes to you.
Deadline
Within 30 days, or as soon as reasonably possible. DC, Kentucky and Wyoming: 60 days. Montana: 6 months. Pennsylvania: written notice within 20 days.
Watch for
Pre-existing conditions: for the first 6 months the plan won't pay for a condition you had care, tests or symptoms for in the 6 months before your plan started.
The Cancer, provider-administered drug and Wellness riders have a 30-day wait in most states.
Hospital SafeGuard GI
Fixed indemnity, hospital + outpatient
What you can claim
Hospital days, ICU, a first admission, surgery and anesthesia, and the ER.
Office and urgent care visits, lab work, x-rays, imaging and ambulance.
Two ways to file
Let the provider file. Show your plan ID card and ask for an assignment of benefits form. The provider is paid directly. Providers in the MultiPlan network for limited benefit plans (multiplan.com/fixedindemnity) give a discount when they're paid this way.
File it yourself for care you've already paid for: send a claim form with your itemized receipt, and you're paid back directly.
If the plan pays less than the bill, you pay the rest. If it pays more, Golden Rule mails you a check for the difference.
Deadline
Within 30 days, or as soon as reasonably possible. Kentucky and Wyoming: 60 days.
Watch for
Pre-existing conditions: for the first 12 months the hospital benefits won't pay for a condition you had care or symptoms for in the 6 months before your plan started. Office visits, labs, x-rays, imaging and ambulance aren't affected.
Wellness/preventive care has a 30-day wait (none in Maryland).
Health ProtectorGuard & Guard
Fixed indemnity, underwritten
What you can claim
Hospital admissions and stays, surgery, the ER, office visits and, depending on your plan, tests and prescriptions.
How to file
In network (UnitedHealthcare Choice Plus, find one at uhone.com under Find A Doctor): show your plan ID card. The provider files the claim and is paid directly at the discounted price. If the benefit is more than that price, Golden Rule mails you a check for the difference.
Out of network: you submit the claim yourself through uhcmemberhub.com, with the itemized bill.
Deadline
Within 30 days, or as soon as reasonably possible. Kentucky and Wyoming: 60 days.
Watch for
Pre-existing conditions: for the first 12 months the plan won't pay for a condition you had care, a diagnosis or symptoms for in the 12 months before your plan started (6 months in Nevada and Wyoming).
Hospital stays that start on a Friday or Saturday aren't covered unless it's an emergency or surgery is scheduled for the next day (some states differ).
AccidentWise
Accident only
What you can claim
Cash amounts after an accidental injury: a hospital admission, the ER or urgent care, CT/MRI-type tests, follow-up visits or physical therapy, outpatient surgery, and loss of life, limb or sight.
It doesn't pay for sickness.
What to collect
The date and a short description of how the accident happened.
ER, urgent care or hospital records showing the dates you were treated, and the itemized bill.
Records for any test, surgery, follow-up visit or therapy session.
How to file
Use the accident claim form (not the general one) from uhcmemberhub.com, member services or me. Fill it out, sign it, and mail or fax it with your records and any police report, the way the form says.
Deadlines
Let Golden Rule know within 30 days of the accident, or as soon as reasonably possible (Kentucky and Wyoming: 60 days; Montana: 6 months).
Send the claim form and records (proof of loss) within 90 days.
Watch for: care has to be on time
ER or urgent care within 72 hours of the accident.
Hospital admission, CT/MRI-type tests and outpatient surgery within 30 days.
Follow-up visits and physical therapy within 30 days, and only after an ER or urgent care visit.
A hospital admission means at least 24 hours in a row.
Accident ProGuard & ProGap
Accident expense + critical illness
What you can claim
After an accident: what you still owe after your main insurance pays, after a $250 deductible per year.
Critical illness: a lump sum for a covered diagnosis.
ProGap only: a lump sum once a year for a hospital admission due to sickness (at least 24 hours).
What to collect
Accident claims: the Explanation of Benefits (EOB) your main insurance sends after it processes the bill. It shows what you still owe, and that's what the plan pays back. Wait for it before you file.
Critical illness: the doctor's written diagnosis.
ProGap hospital admission: discharge papers with the admission and discharge dates.
How to file
Use the accident or critical illness claim form from uhcmemberhub.com, member services or me. Mail or fax it with the EOB (accident) or the diagnosis or discharge papers, the way the form says. If you have other medical insurance, fill in that part of the accident form too. The payment comes to you.
Deadline
Within 30 days, or as soon as reasonably possible (longer where your state requires). For an accident, tell Golden Rule within 30 days even if your EOB hasn't arrived yet, then send it when it does.
Watch for
Burns, cuts, concussions, the ER and urgent care must be treated within 48 hours of the accident; other care within 30 days.
Critical illness (and ProGap's hospital admission) has a 30-day wait in most states, and a 12-month pre-existing condition limit.
Critical illness diagnoses must be at least 180 days apart.
CriticalGuard
Critical illness
What you can claim
A lump sum on the first diagnosis of a covered illness: the first time in your life you're diagnosed with it, after the 30-day wait, while you're covered.
Which illnesses depends on your plan: cancer, heart attack or stroke, both, or the full critical illness list.
What to collect
The doctor's written diagnosis with the date (for cancer, the pathology or biopsy report).
Records showing the treating doctor and where you were diagnosed.
How to file
Print the critical illness claim form at uhcmemberhub.com, fill it out, sign the medical authorization that comes with it, attach the diagnosis paperwork and mail or fax it the way the form says. The payment comes to you.
Deadline
Within 30 days of the diagnosis, or as soon as reasonably possible. Kentucky and Wyoming: 60 days. Montana: 6 months.
Watch for
Nothing diagnosed in the first 30 days is covered.
Pre-existing conditions: for the first 12 months the plan won't pay for a condition you had care, a test or symptoms for in the 12 months before your plan started (6 months in some states).
A diagnosis made by you or a family member, or outside the U.S., doesn't qualify.
After you file
Golden Rule processes the claim based on your plan's benefits. Your signed authorization lets them ask your doctor or hospital for more records if they need them. Answer any letter from them quickly.
Any benefit that's payable is paid directly to you, unless you signed it over to the provider.
Questions about a claim or how to fill out the form: member services at 1-800-657-8205.
Haven't heard back, or the claim was denied or paid less than you expected? Call me. I'll look at it with you and call Golden Rule if needed.
Have a DentalWise, DentalWise Max or VisionWise plan? Those work differently. In network there's usually no claim to file: the dentist or eye doctor handles it. See the dental & vision plan guide, or call me.
Who to call
Member services Golden Rule policies
1-800-657-8205, Monday through Friday, 8:00 a.m. to 6:00 p.m. ET. Claim forms, claim status and coverage questions. Have your policy number ready.
Your agent
Always welcome, especially before you file or if a claim is held up. If you're not sure who to call, call me first.
Hamon R. Burkhardt
Licensed Health & Life Insurance Agent · NPN #16713594