Claims Resource Center

Frequently Asked Questions

For each claim received, Tokio Marine HCC will send you an acknowledgement letter notifying you of the receipt the claim. The acknowledgement letter will also notify you of any additional information that is needed or is still outstanding from a prior request. Additionally, each time Tokio Marine HCC requests information from you or your medical providers, Tokio Marine HCC will send you a letter to notify you of the request.

Tokio Marine HCC requires a completed Claimant’s Statement and Authorization Form for each different condition or episode of care. Therefore, if you have completed a Claimant’s Statement and Authorization Form for a particular episode of care, you do not need to resubmit. However, if you received treatment for a different condition or episode of care, you will need to complete a new Claimant’s Statement and Authorization Form.

While Tokio Marine HCC may have received a completed Claimant’s Statement and Authorization Form from you, Tokio Marine HCC may be waiting on medical records from your providers. Each time Tokio Marine HCC requests additional information, you will receive a letter notifying you of what is being requested. You may assist Tokio Marine HCC with these requests by contacting the medical provider to request that the medical records be expedited to Tokio Marine HCC.

Tokio Marine HCC’s policies are not subject to the Patient Protection Affordable Care Act. It does not contain many of the coverages required by PPACA and therefore may contain a pre-existing condition exclusion.

The Claimant’s Statement Authorization Form is a document that is requested upon receipt of a claim for a new medical condition or episode of care. The form provides Tokio Marine HCC with information so that we can properly evaluate claim eligibility under your policy. This form also allows Tokio Marine HCC to request medical records from your medical providers.

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You are always free to use the medical providers of your choice. Your provider selection does not affect your benefits. Tokio Marine HCC Medical Insurance Services uses the First Health National Network as its provider listing. You may search for providers here.

Please phone 317-262-2132 or 1-800-605-2282. We accept all collect calls. Our World Service Center representatives are available 24 hours a day, 7 days a week for benefit inquiries, pre-certifications, and general assistance.

If a medical provider is willing to bill Tokio Marine HCC directly, then we are happy to work directly with the provider. The provider should submit to us original itemized bills. You the patient will still need to submit to us a completed Claimant’s Statement and Authorization. If the provider requires you to pay up front, you may submit the original itemized bills and paid receipts to us along with a completed Claimant's Statement.

Note: For plans that offer a coinsurance waiver for expenses incurred within the PPO, expenses need to be billed by the provider directly to Tokio Marine HCC.

You may complete and submit a Claimant's Statement electronically by logging into ClientZone. If you do not have access to the internet, please feel free to contact our Tokio Marine HCC so that we may send a form to you by fax or by mail.

No, you should submit one Claimant's Statement to Tokio Marine HCC for each different condition or diagnosis only.

Yes. We can define the benefits that are available within your coverage; however, we cannot pre-approve any treatment or guarantee payment in advance.

Once you have signed and submitted your claim, it must be reviewed by our claims examiners. Once your claim has been submitted to Tokio Marine HCC, the initial review is typically conducted within 15 days of our receipt of the claim.

The initial review of your claim will decide whether it will be paid, denied, or if more information is needed to make a final decision. More often than not, more information will be requested of you or your medical providers before your claim is paid or denied.

The requesting of more information can be most time-consuming part of the claims process and is what typically causes delays in the claims process. To reduce the time frame, it is extremely important that you completely and accurately complete the Claimant’s Statement and Authorization Form. This form can be completed via the ClientZone. Throughout this process, you will receive multiple letters. You should receive an initial letter when your claim is first received as acknowledgement. This letter will also notify you of any additional information may be required. For each claim received by Tokio Marine HCC, you will receive this acknowledgement letter. You will also receive a letter each time more information is requested of your medical providers, explaining where your claim is in the process.

Final processing time of your claim is dependent upon multiple factors; however, ensuring that all requested information is received timely and quickly will greatly assist Tokio Marine HCC in reducing claim pending time.

To check claim status please visit our benefit and claim center at, email your inquiry to, or contact us 24 hours a day at 800-605-2282.

The EOB is not a bill. Rather, it is an explanation of how your claim has been processed.

You may ask for Tokio Marine HCC to reconsider the denial by submitting a request for an appeal in writing within 90 days. In order for the claims department to review the appeal, you must supply additional documentation to support a reversal of the denial. You may locate the appeal form here.

See Fewer Questions

Understanding the Claims Process

How to File a Claim Outside the United States

Follow Michelle’s journey through the claims process to understand what happens if you receive medical care outside the United States.

How the Claims Process Works in the United States

If you received medical care within the United States, watch the video and follow along with Will to learn how the claims process works.

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  • Copayments (Copays) — the fixed amount the insured person must pay out of pocket for specific medical services. Generally co-pays pertain to general health care services, such as general office visits. Some plans require that the insured pay the full amount for all medical services, including general doctor’s visits, until the deductible has been met.
  • Claimant — a person or entity making a claim under a policy.
  • Claimant Statement — an authorization form completed by the claimant, then submitted to the insurer.
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  • Deductibles — an amount that must be met, usually over the course a certificate period, in order for the insurance plan to cover specific medical expenses.
  • Date of Service — the date that a medical service was received. This date may differ from the date that the medical claim is filed with the insurance company.
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  • In Network — refers to physicians and medical facilities who are under contract with First Health Network (US) or Equian International Provider Network (outside US) and provide medical services at a discounted rate.
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  • Out of Pocket — an amount determined in the medical insurance plan as the amount the insured must pay, in addition to premiums, for health care services.

    A maximum amount is usually assigned per policy. Once the maximum is met, the insurer will pay a percentage – sometimes up to 100 percent – of the insured’s eligible health care costs.

  • Out of Network — Physicians and medical facilities who are under contract with First Health Network (US) or Equian International Provider Network (outside US) and thus charge the full rate for their services.
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