Claims FAQ

Common Employee Claim Questions

Q. How do I submit a claim?
A. Gather essential information before submitting your claim. You will need to provide important details, such as your policy number, the date and description of the event, and relevant supporting documents.

Submit a claim online by visiting USAbleLife.com/claims. Select the type of claim you have from the drop-down list under “What type of claim do you want to file?”

NOTE: If you have a Group/Voluntary Long Term Disability claim, call Customer Care at 800-370-5856, Monday through Friday, 8 a.m.-5 p.m. CT.
Q. What if I am not submitting a claim online?

A. Visit USAbleLife.com/claims to download the form you need, then:

• Email: claims@usablelife.com
• Fax: (501) 235-8417
• Mail: USAble Life, Attention: Claims Department, P.O. Box 1650, Little Rock, AR 72203

Q. Can I access my claim status online?
A. Currently, we do not offer this feature to individual employees. Your employer can check your claims status on your behalf, or you may contact USAble Life Customer Care directly at custserv@usablelife.com or by calling 800-370-5856, Monday through Friday, 8 a.m.-5 p.m. CT.

Q. Whom should I contact to check the status of my claim?
A. Our Customer Care team is happy to check your claim status for you. Call 800-370-5856 at your convenience, Monday through Friday, 8 a.m.-5 p.m. CST, or email custserv@usablelife.com. We’re standing by, ready to help!

Q. Is someone assigned to my claim?
A. Yes. All claims are reviewed for completeness and assigned to a dedicated claims examiner. Your claims professional will manage your claim from start to finish, coordinating efforts to resolve your claim quickly and efficiently.

Q. What is the average processing time for claims?
A. A decision to pay, pend,* or deny a claim is reached on 95% of all claims within five business days of receipt.

Q. What causes delays in the claims process?
A. If the claims examiner needs more information from you (the employee), your employer, or another resource, it may delay the claim. Factors that increase claims processing time:

• Medical record(s) request(s)
• Premium status
• Clarification of eligibility
• No beneficiary listed
• Minor beneficiary
• Manner/cause of death is pending
• Accident/toxicology report(s) pending

Q. Will my Short Term Disability, Long Term Disability, Temporary Disability Insurance, or Paid Medical Leave payment be taxable?
A. How Short Term Disability, Long Term Disability, Temporary Disability Insurance, or Paid Medical Leave payments are taxed depends on the premium funding for the policy. The key consideration is whether the premiums were paid with pre-tax or post-tax dollars, rather than who paid them. If the disability insurance premiums are paid on a pre-tax basis, that means that taxes have not been deducted yet and any disability payments made under the plan would be taxable. If disability insurance premiums are post-tax, that means taxes have already been deducted, and disability payments made under the plan would not be taxable.

Q. What taxes are deducted from taxable Short Term Disability, Long Term Disability, Temporary Disability Insurance, and Paid Medical Leave wage payments?
A. For taxable wage payments, we deduct the following taxes from the claimant’s check, but there are special tax situations to be aware of that may alter the taxes for benefit payments. Taxes are based on a percentage of the gross wages issued on each check. The employer may have additional tax liability for disability wages, such as matching the employer’s share of FICA taxes, FUTA (federal unemployment tax)/SUTA (state unemployment tax), and state and local taxes.

• Social Security tax — 6.2%
• Medicare tax — 1.45%
• Federal income tax (FIT) — For premium-based policies, FIT is voluntary and only withheld if requested by the claimant with a Form W-4S

Q. Are Paid Family Leave (PFL) benefits taxed?
A. USAble Life pays PFL benefits to employees for leave unrelated to their own illness or injury. PFL typically involves caregiving responsibilities for a family member. Common qualifying events include:

• Adoptions/foster care
• Bonding
• Care of a family member
• Military leave

PFL benefits payments are not taxed. PFL benefits payments are included in the employee’s gross income and reported on a Form 1099 if they are paid more than the required 1099 reporting threshold.

Common Employer Claim Questions

Q. Who prepares employee W-2s for Short Term Disability, Long Term Disability, Temporary Disability Insurance, and Paid Medical Leave benefits?
A. Employers prepare W-2s and provide them to their employees. If requested, USAble Life will prepare your employee W-2s at no additional cost. Employers will need to submit a W-2 Agreement designating USAble Life as the preparer (this agreement is included in your application or can be requested from USAble Life Policy Services). We recommend consulting with your payroll service to discuss W-2 responsibilities. Most payroll services require that employers prepare the forms.

Q. Whom do I contact if I cannot access all of my claim information?
A. Our USAble Life Customer Care team will be happy to help you access your claim information. Please email custserv@usablelife.com or call 800-370-5856 with your group number, Monday through Friday, 8 a.m.-5 p.m. CT.

Q. How do I submit a claim?
A. Gather essential information before submitting your claim. You will need to provide important details, such as your policy number, the date and description of the event, and relevant supporting documents.

Submit a claim online by visiting USAbleLife.com/claims. Select the type of claim you have from the drop-down list under “What type of claim do you want to file?”

NOTE: If you have a Group/Voluntary Long Term Disability claim, call Customer Care at 800-370-5856, Monday through Friday, 8 a.m.-5 p.m. CT.

Q. What if I am not submitting a claim online?
A. Visit USAbleLife.com/claims to download the form you need, then:

• Email: claims@usablelife.com
• Fax: (501) 235-8417
• Mail: USAble Life, Attention: Claims Department
• P.O. Box 1650, Little Rock, AR 72203

Benefit-Specific Claim Questions

Short Term Disability

Q. I’m pregnant. When should I submit my Short Term Disability claim?
A. You may submit your claim form up to one week before a scheduled cesarean section, but if you are planning a vaginal delivery, the form should be submitted after the baby is born so all information is accurate.

Q. How do I get a Short Term Disability claim form?
A. Short Term Disability claim forms can be found on our website at USAbleLife.com. To access the forms you need, go to the Individuals & Families tab on our website, choose Claim Forms under the Resources section, then select Short Term Disability from the drop‑down menu, choose Fax/Email/Mail, and select your state; from there, you can download all required forms. If you prefer, you may also request the forms from your employer or call USAble Life Customer Care at 800‑370‑5856 for assistance, Monday through Friday, 8 a.m.-5 p.m. CT.

Q. How do I submit Short Term Disability claims online?
A. To get started, navigate to USAbleLife.com/claims and select Short Term Disability from the drop-down list under “What type of claim do you want to file?” On the same screen, select Online from the drop-down list under “How would you like to file?”

Before you begin, you will need:

• Your group policy number, which can be obtained from your employer
• Your medical information
• Dependent’s medical information (if claim is for a dependent benefit)
• Name and contact information for health care provider(s) you have used in the past two years

Q. When should I file a Short Term Disability claim?
A. Short Term Disability claims should be submitted as soon as your disability begins so we can make a timely decision on your claim. If you have a planned surgery or other scheduled event, you may submit your claim no more than 30 days before the date of the procedure.

Q. What is an elimination period?
A. An elimination period is the number of days you must be disabled before benefits are payable. No benefits are payable during the elimination period.

Q. How long does it take for a decision to be made on a Short Term Disability claim?
A. USAble Life strives to make the initial decision on Short Term Disability claims within five business days of receiving all information needed. Each claim is different, and we may request additional information to make a decision on a claim.

Q. When does USAble Life consider an insured employee disabled?
A. An insured employee is considered disabled on the date they meet the definition of disability as outlined in the policy. Medical records and information from physician(s) may aid in determining the date of disability.

Q. How long can an insured employee receive Short Term Disability​​​​​​​ benefit payments?
A. Once the elimination period is satisfied, Short Term Disability benefits are payable up to the maximum benefit period, as long as the insured continues to be disabled under the terms of the policy. Periodic updates will be requested to support the insured’s continued disability status.

Q. Who should notify USAble Life of return to work?
A. The insured employee should notify USAble Life as soon as they plan to return to work. The employer should notify USAble Life as soon as the insured has returned to work.

Q. How much will my Short Term Disability benefits be?
A. Depending on the specific policy, the benefit may be either a percentage of pre-disability earnings, an elected amount, or a flat amount. In some cases, the benefit may be reduced by other income benefits the insured is entitled to receive. Please refer to the specific policy, and contact our Customer Care team at 800-370-5856 if you have questions.

Q. How are maternity claims handled?
A. Pregnancy is considered the same as any illness under the terms of the policy. As such, standard medical disability guidelines are considered when determining the duration of the disability. Unless there are any specific state guidelines, the standard medical disability guideline for a normal pregnancy, vaginal, or C-section delivery is six weeks postpartum. The actual duration can vary, resulting in either a shorter or a longer period based on the medical documentation provided. If the insured employee returns to work or is released to return to work before the six weeks postpartum date, the duration may be shorter. If disability is extended beyond six weeks postpartum, specific medical documentation supporting the medical need for the extension is required.

Q. How will an insured employee receive benefits?
A. Benefit checks are payable to the insured employee and are typically mailed to the employee’s mailing address listed on the claim form.

Q. How often do I need to complete an update form on my Short Term Disability claim?
A. Update forms are usually mailed to the employee four to six weeks after the beginning of the disability date. This may vary based on the individual claim.

Temporary Disability Insurance

Q. What is Hawaii’s Temporary Disability Insurance (TDI)?
A. TDI, like workers’ compensation and unemployment insurance, is a wage replacement program. This means that if you are unable to work due to an off-the-job sickness or injury, and you meet the qualifying conditions of the law, you will be paid disability or sick leave benefits to partially replace the wages you lost. TDI does not include medical care.

To learn more about TDI benefits, please reach out to your employer or visit labor.hawaii.gov/dcd/.

Q. Who provides TDI benefits?
A. Your employer must provide TDI (or sick leave) benefits when you are unable to work due to a disability. The State of Hawaii does not pay TDI benefits; it ensures that every employer subject to the law provides benefits for the employer’s employees. If your employer does not provide these benefits, report this immediately to the nearest Disability Compensation Division (DCD) office.

Q. Who pays for the cost of TDI benefits?
A. Your employer may pay the entire cost or may require you to share in the cost. If you share in the cost, your employer may deduct one-half the premium, but not more than 0.5% of your weekly wages up to the maximum set annually by DCD. If your employer deducts more than the law prescribes, notify DCD immediately. No contributions can be withheld from an employee who does not meet the law’s eligibility requirement.

Q. Who is covered by TDI?
A. Any employee who meets the eligibility requirements, whether hired on a full-time or part-time basis, must be provided TDI coverage by their employer.

Q. What are the eligibility requirements?
A. You must have been employed in Hawaii for at least 14 weeks, during each of which you were paid for 20 hours or more in the 52 weeks preceding the first day of disability and earned at least $400. The 14 weeks need not be consecutive or with only one employer.

Q. What other requirements must be met?
A. You must meet the following conditions in addition to meeting the eligibility requirements:

• Your injury or illness is not work-related (not caused by your job)
• Your injury or illness prevents you from performing your regular work
• Your disability is certified by a licensed physician, surgeon, dentist, chiropractor, osteopath, naturopath, or accredited practitioner of a faith-healing group
• You were employed immediately before the date you suffered your injury or illness, or if you were separated from your job, your disability occurred within two weeks from your separation date

Q. How much benefit am I entitled to?
A. Your employer has a statutory plan that provides benefits according to minimum benefit standards.

• Cash benefits of 58% of your average weekly wages rounded to the next higher dollar, but not more than the maximum weekly benefit amount annually set by DCD
• Benefits from the eighth day of disability; in other words, there is a seven-day consecutive waiting period
• A maximum of 26 weeks of payments during a benefit year
• Payment will be made by USAble Life within 10 business days of receipt of a valid claim

Q. What do I do if I suffer a disability and need to file a TDI claim?
A. If you suffer a disabling nonoccupational injury or sickness, notify your employer immediately and ask for Form TDI-45, Claim for Disability Benefits.

1. Complete Part A of the claim form, Claimant’s Statement.
2. Take the form to your doctor to complete Part C, Doctor’s Statement.
3. Have your employer complete Part B, Employer’s Statement.
4. Submit completed forms to USAble Life.

Q. How soon should I file a TDI claim?
A. The law requires that you file your claim within 90 days from the date you were disabled. If you file your claim after 90 days, you may lose part of your benefits, unless good cause can be shown. If you file your claim 26 or more weeks after your disability, you will not be entitled to any benefits. To avoid partial or complete loss of benefits, file your claim within 90 days.

Q. What if I am denied TDI benefits or disagree with my weekly benefit amount?
A. USAble Life is required to send you written notices (three copies) if your claim is denied. If you disagree with the denial, you may appeal by explaining why you disagree on the notice and sending two copies to DCD. You have 20 days to appeal. DCD will notify you of the time and place of the appeal hearing. An impartial referee will hear your case. Although it is not required, you may have an attorney represent you at the hearing. If you do not agree with the referee’s decision, you may further appeal to the circuit court. You may appeal to DCD if you disagree with the amount of benefits paid to you by USAble Life. Bring evidence such as pay slips or check stubs to prove that you are entitled to more benefits.

Q. How does USAble Life determine if someone is ineligible for TDI benefits?
A. You are ineligible for TDI benefits if:

• You performed work for pay during your period of disability
• You were denied unemployment insurance benefits because of a work stoppage due to a labor dispute
• Your injury was willfully and intentionally self-inflicted or received while committing a criminal offense
• You received or will receive unemployment insurance, workers’ compensation, or federal disability benefits

Q. What is the Special Disability Fund, and who may file for benefits?
A. The Special Disability Fund was established through assessments imposed on all employers subject to the TDI law. According to the law, this fund can only be used to pay benefits to:

• Employees whose employers have failed to provide TDI coverage or who have gone bankrupt
• Unemployed claimants who, while receiving unemployment insurance benefits, became disabled and were held ineligible for further benefits solely due to the disability

If you fall into either of the above categories at the time you become disabled, notify the nearest DCD office immediately. DCD will advise you on how to file a claim against the Special Disability Fund and the amount and direction of your weekly benefit amount.

Q. What is notice of insurance?
A. Your employer should have a “Notice to Employees” poster visible around their place of business that informs all employees that they are being provided TDI coverage in accordance with TDI law. If the poster does not contain information on the benefit entitlement, ask your employer for details. If no poster is visible, call this to your employer’s attention or notify the nearest DCD Office.

Q. What happens if I am paid or receive cash benefits from other sources?
A. If you were paid or expect to be paid cash benefits from other sources (except your private income protection plan) for a disability for which your employer or the insurance carrier has already paid you TDI benefits, USAble Life has the right to claim or subrogate the amount paid to you. Subrogation may also extend to workers’ compensation benefits if such benefits are awarded subsequently and cover the same disability period.

Q. Can I suffer any penalties?
A. You will be ineligible for benefits for an indefinite period if you knowingly make false statements, misrepresent a fact, or fail to disclose a material fact in order to obtain unentitled benefits. You will be required to repay all improperly received benefits.

Q. How do I submit a TDI claim?
A. To get started, navigate to USAbleLife.com/claims and select Temporary Disability Insurance (Hawaii Only) from the drop-down list under “What type of claim do you want to file?” On the same screen, select Online from the drop-down list under “How would you like to file?”

Before you begin, you will need:

• Your group policy number, which can be obtained from your employer
• Your medical information
• Dependent’s medical information (if claim is for a dependent benefit)
• Name and contact information for health care provider(s) you have used in the past two years

To process your disability claim, please submit the following documents, which you can find on the website:

• Employee statement (Part A)
• Authorization to release
• Fraud notice

If you are not submitting your claims online, you can ** ** visit USAbleLife.com/claims to download the form(s) you need and submit information and any attachments to:

• Email: tdicustomerservice@usablelife.com
• Fax: (808) 538-8930
• Mail: USAble Life, Attention: Claims Department
• P.O. Box 840, Honolulu, HI 96808-0840

For assistance or support, contact our Customer Care team at 800-370-5856, Monday through Friday, 8 a.m.-5 p.m. CT.

Life and Accidental Death & Dismemberment

Q. How do I get a Life claim form?
A. Life claim forms can be found on our website at USAbleLife.com. Choose the Individual & Families tab, select Claim Forms under Resources, and select the claim type from the drop-down list. There you will be able to download any forms you need. You can also contact your employer or call USAble Life Customer Care at 800-370-5856, Monday through Friday, 8 a.m.-5 p.m. CT.

Q. How do I submit a Life claim online?
A. To get started, navigate to USAbleLife.com/claims and select the type of claim you are looking to file. On the same screen, select Online from the drop-down list under “How would you like to file?”

Before you begin, you will need:

• Your group policy number, which can be obtained from your employer
• Your medical information
• Dependent’s medical information (if claim is for a dependent benefit)
• Name and contact information for health care provider(s) you have used in the past two years
• Claim form
• Fraud notice
• Benefit application
• Death certificate (Note: Death certificate must contain original seal for claims exceeding $100,000, and must therefore be mailed to USAble Life directly after online claim is filed.)

This can also be done by logging into your AccessAble^SM account.

Q. How long do I have to file a claim?
A. File a claim within 60-180 days after the date of loss.

Q. When determining primary beneficiary percentage, what should I keep in mind?
A. Primary beneficiary amounts should total 100%.

Q. What about contingent beneficiary percentage?
A. Contingent beneficiary amounts should also total 100%.

Q. How does a contingent beneficiary become eligible to receive a benefit?
A. A contingent beneficiary will only be paid if there is no surviving primary beneficiary.

Q. What if one or more beneficiaries pass away?
A. The percentage designation would change and be evenly distributed to your remaining primary beneficiaries.

Q. What occurs if the beneficiary or beneficiaries are minors?
A. If a minor beneficiary is listed, we can only pay the benefit through the Uniform Transfer to Minors Act (UTMA) or legal conservatorship. The UTMA requires the guardian of the minor to complete an affidavit and can only be used on claims under the state threshold, generally $10,000. Legal conservatorship requires the assistance of an attorney, and the courts must appoint a conservator of the minor’s estate; this is a separate legal status from that of a natural parent or custodian.

Q. What if my beneficiary is not a U.S. citizen?
A. A member can list someone who is not a U.S. citizen and does not have a Social Security number. It is recommended that USAble Life have as much information as possible on the beneficiary (full name, address, phone number, etc.) so that we will be able to locate and identify the beneficiary in the event of a claim. Other information will need to be validated before payment can be made.

Q. What happens if there is no beneficiary on file?
A. If there is no beneficiary listed at the time of loss, USAble Life will pay according to the policy provisions. Most policies will list a class of survivors, such as spouse, children, parents, siblings, or the estate. Some policies only allow for payment to the estate. If we are paying by the policy provisions, we will need to obtain affidavits of survivorship, and if needed, these will be initiated by the claims examiner.

Q. Can a trust be considered a beneficiary?
A. Trusts can only be paid if the trust is the listed beneficiary. At the time of the claim, we would need copies of the trust documents listing the trustee and the beneficiary’s statement of claim completed by the trustee.

Q. Can an estate be eligible to receive Life proceeds?
A. Estates can be paid as the listed beneficiary based on policy provisions if there is no listed beneficiary or other class of survivor. At the time of the claim, USAble Life will need copies of the estate documents listing the executor and the beneficiary’s statement of claim completed by the executor. Small estate affidavits can be used based on the amounts and specific state laws.

Q. Can a portion of the benefit proceeds be assigned to a funeral home or comparable entity to help with funeral arrangements?
A. Yes. Funeral home assignments can be completed by the listed beneficiaries. Minors cannot enter into a legal contract and cannot sign an assignment. If there is more than one beneficiary, all beneficiaries will need to sign the assignment; otherwise, the entire assignment will be paid by the beneficiaries who did sign.

Life Waiver of Premium

Q. Are there age requirements for the Life Waiver of Premium (LWOP)?
A. Yes. The policy will list all eligibility requirements, including age requirements. Most policies indicate the disability must begin before the employee reaches the age of 60 or 65. Please refer to your specific policy for eligibility requirements.

Q. Does the LWOP have an elimination period?
A. Yes. The disability must continue without interruption ranging from 90 days to 180 days. Please refer to your specific policy for the waiting period. Premiums should be continued until a decision is made on the Life Waiver. Once the Life Waiver is approved, no additional premiums are due for that employee.

Q. What happens if the group has a 12-month continuation period for disability?
A. The group can choose to keep the member under the group’s coverage, regardless of age, for up to 12 months if premiums are paid. Once the 12-month continuation period expires, the member would need to apply for a Life Waiver to keep the group coverage. If the member does not meet the waiver eligibility requirements, the member should be offered conversion at the end of the 12-month continuation period.

Q. If I have Short Term Disability or Long Term Disability with USAble Life, do I need to complete an LWOP claim form?
A. If a member is receiving Short Term Disability or Long Term Disability benefits with USAble Life, the disability examiner will send the disability information to the Life Waiver team to review without a separate Life Waiver claim being submitted.

Q. Will the employee and employer be notified when a decision is made on the LWOP claim?A. Yes. When a claim decision is made on the Life Waiver, a letter is mailed out to the employer and the employee. The letter will indicate the decision, the effective date of the Life Waiver, and the amount of coverage. If the Life Waiver is denied, the member should be notified to convert the coverage.

Q. What happens if the Life Waiver claim terminates?
A. If a Life Waiver claim terminates for any reason, the employee should be offered conversion for the coverage that was enforced under the waiver claim.

Q. Can an employee retire while they are on the LWOP?
A. Yes. The policies are set up to allow members to retire and keep the life coverage.

Q. During the initial claim review, is there any interaction with the group?
A. A member of the LWOP team may reach out to the employer to gather and confirm eligibility information before a claim decision.

Q. How is the claim managed once it is approved?
A. After a claim has been approved, the LWOP team will establish periodic follow-ups for information to help validate if an employee continues to meet the definition of disability. If the LWOP requests coincide with the annual Long Term Disability review, the LWOP can accept a copy of those forms.

Supplemental (Wellness, Accident, Critical Illness, Hospital Indemnity)

Q. Do I have to wait until I have all of the bills before I can file a claim?
A. No. You may file the claim and send the bills as they are received. Always include your policy number and claim number on each bill submission. Please refer to the specific policy for questions about the following items:

• Pre-existing provisions
• Elimination period
• Other income offsets
• Termination of coverage and/or benefits

Integrated Claims

Integrated Claim Process

Q. What is the integrated claim process?
A. USAble Life receives medical insurance claim data from your insurance provider to initiate applicable claims.

Q. How does the integrated process work?
A. When a covered employee or dependent, with medical coverage through the employer, goes to the doctor, the medical claim information is transmitted via a secure file to USAble Life once the medical claim is processed. Claims that may be eligible for benefits are reviewed to determine if additional information is needed or if the claim is eligible for benefits.

Q. With the integrated process, will I need to complete a claim form?
A. You will not need to complete a claim form unless you choose to file a claim on your own or if your spouse or dependent is not covered under your medical plan. However, at times it may be necessary for us to request additional pieces of information from you or your medical provider before a decision can be rendered on your claim.

Q. What is the processing time for an integrated claim?
A. A payment or correspondence is issued within 24 hours of USAble Life receiving the medical data.

Wellness Benefits

Q. Are wellness benefits available under the integrated products?
A. The integrated products offer a preventative care rider.

Q. How many wellness benefits are available under the preventative care rider? How much is the benefit?
A. This benefit is limited to one per covered member per calendar year. The payable amount corresponds to the preventative care benefit listed in your policy. Please refer to the policy provided by your employer for complete details.

Q. What benefits are covered under the preventative care rider?
A. The following are covered under the preventative care rider:

• Biopsy for skin cancer
• Blood test for triglycerides
• Bone marrow testing
• Sampling of blood or tissue to test for genetic susceptibility for the risk of cancer
• CA15-3 (cancer antigen 15-3 — blood test for breast cancer)
• CA125 (cancer antigen 125 — blood test for ovarian cancer)
• CEA (carcinoembryonic antigen — blood test for colon cancer)
• Chest X-ray
• Colonoscopy
• Doppler screening for carotids
• Doppler screening for peripheral vascular disease
• Echocardiogram
• Electrocardiogram (EKG)
• Flexible sigmoidoscopy
• Hemoccult stool analysis
• Human papillomavirus (HPV) vaccination
• Lipid panel (total cholesterol count)
• Mammography, including breast ultrasound
• Pap smear, including ThinPrep Pap test
• PSA (prostate specific antigen — blood test for prostate cancer)
• Serum protein electrophoresis (test for myeloma)
• Stress test on bike or treadmill
• Thermography
• Ultrasound screening of the abdominal aorta for abdominal aortic aneurysms

Q. Will I need to file a wellness claim under the preventative care rider?
A. You will not need to file a claim unless you choose to file a claim on your own or if your spouse or dependent is not covered under your medical plan.

Q. How do I file a wellness claim in the event that I choose or need to?
A. To get started, navigate to USAbleLife.com/claims and select Wellness/Preventative Care from the drop-down list under “What type of claim do you want to file?” On the same screen, select Online from the drop-down list under “How would you like to file?”

Before you begin, you will need:

• Your group policy number, which can be obtained from your employer
• Information regarding the wellness service provided
• Dependent’s wellness service information (if claim is for a dependent benefit)
• Name and contact information for health care provider(s)

If you prefer not to file online, you may choose from the following options:

• Email: claims@usablelife.com
• Fax: (501) 235-8400
• Mail: USAble Life, Attention: Claims Department, P.O. Box 1650, Little Rock, AR 72203

For assistance or support, contact our Customer Care team at 800-370-5856, Monday through Friday, 8 a.m.-5 p.m. CT.

Q. Will I need to include the policy number?
A. Your policy number is required when calling in your wellness claim or filing your wellness claim online. If you would like to file your claim by phone, please contact our Customer Care team at 800-370-5856.

General Information

Q. How do I obtain a copy of my policy?
A. Please contact your employer; these are employer-owned policies. The policy will have the policy number, describe the benefits you qualify for and what is covered under the integrated products, and benefit amounts.

Q. How do I file a claim?
A. In the event you must file a claim, please visit USAbleLife.com/claims to download a claim form and submit in one of the following ways, or file online:

• Email: claims@usablelife.com
• Fax: (501) 235-8417
• Mail: Use the address on the form

Q. What documents are required for processing my claim?
A. The documents required are dependent upon the benefit claimed.

Q. What if my spouse or dependent is not covered under my medical plan?
A. If your spouse or dependent is not covered under your medical plan, the claim will need to be submitted manually. Refer to the claim form to identify what should be included in the claim.

Q. What happens if the claim is on my dependent child who is 18 or older?
A. Correspondence is addressed to your dependent child; however, any payments issued are made to you. Any phone communication may be with the dependent or the primary insured. However, the dependent’s medical information will not be discussed with the primary insured.

Decisions

Q. May I appeal a claim decision?
A. If an adverse claim decision is made, you will receive correspondence advising you on how to file an appeal. Appeals must be submitted within 180 days of the claim decision. Appeals and inquiries about appeals can be sent in writing via mail, fax, or email, as noted below:

• Email: appealscoordinator@usablelife.com
• Fax: (501) 235-8484
• Mail: USAble Life, Attention: Appeals Coordinator, P.O. Box 1650, Little Rock, AR 72203-1650

Payments

Q. Who are payments issued to?
A. Payments are issued to the primary insured.

Q. How are payments issued?
A. Payments are issued by check.

Q. Do you offer direct deposit?
A. No, not at this time.

Q. How much was paid on my claim?
A. Please refer to the check stub explanation of benefits.

Questions

Q. Whom do I contact for questions?
A. Please contact USAble Life’s Customer Care team at 800-370-5856, Monday through Friday, 8 a.m.-5 p.m. CT, or email custserv@usablelife.com.

Q. When will I know a decision has been made on my claim?
A. Correspondence is sent to you by email or mail, or you may contact our Customer Care team at 800-370-5856, Monday through Friday, 8 a.m.-5 p.m. CT.

Q. What is the status of my claim or my dependent child or my spouse’s claim?
A. Correspondence is sent to you by email or mail, or you may contact our Customer Care team at 800-370-5856, Monday through Friday, 8 a.m.-5 p.m. CT.

Q. Have you received my claim?
A. Correspondence is sent to you by email or mail, or you may contact our Customer Care team at 800-370-5856, Monday through Friday, 8 a.m.-5 p.m. CT.

Q. What is still outstanding for processing my claim?
A. Correspondence is sent to you by email or mail. You may contact our Customer Care team or view status updates in AccessAble.

Continuing Coverage

Q. If I leave the employer, may I keep the coverage?
A. Dependent upon the reason for leaving the employer, you may have the option to apply for a ported policy, which would continue the amount of insurance you had at the time your employment terminates.

Q. What is the process to continue the coverage once I leave the employer?
A. You must apply for portability in writing to USAble Life within 31 days after the date employment ends. You must pay the required premium monthly directly to USAble Life via AutoPay. There are various frequencies of payment available. USAble Life will determine the premium rate. The first premium payment is due no later than 31 days after the date the insurance would otherwise terminate under the policy.

Q. Why do I need to apply to keep my own policy?
A. Your employer owns the policy. You are not the owner; therefore, in order to port or keep the policy, you must apply for coverage.

If you have other general questions, please contact USAble Life Customer Care at 800-370-5856. Please be aware that we cannot answer hypothetical claim questions.

*Pended claim: If the examiner needs information from an outside source (e.g., medical provider, employer), the information will be requested, and the claim will be put in a pended status for up to 45 days until the information is received. The response time for medical record(s) requests varies and may require an extension of the pended status.

Policy benefits may vary by state. Please view your policies to get the best and accurate information regarding your coverage.

The information contained in this FAQ does not alter or modify the insurance contract. Claims will be administered according to the applicable policy terms and condition.

AccessAble^SM is used with the consent of USAble Mutual Insurance Company.