Health Information By State

View the list below for answers about your state specific health insurance questions. If your state is not listed then visit our contact us page to get in touch with the right person.

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Health Info By State listing

Arizona

Arkansas

California

Colorado

Connecticut

Pursuant to Sec. 38a-477d, our company has provided to each of its insureds a plan booklet describing benefits under one of the following policy types: basic hospital expense coverage; basic medical-surgical expense coverage; and major medical expense coverage, authorized under Sec 38a-469, parts 1, 2 and 4. This booklet is in an easily readable, accessible and understandable format and provides the following information:

Any coverage exclusions;

Any restrictions on the use or quantity of a covered benefit, including on prescription drugs or drugs administered in a physician’s office or a clinic;

A specific description of how prescription drugs are included or excluded from any applicable deductible, including a description of other out-of-pocket expenses that apply to such drugs;

The specific dollar amount of any copayment and the percentage of any coinsurance imposed on each covered benefit, including each covered prescription drug; and

Information regarding any process available to consumers, and all documents necessary, to seek coverage of a noncovered outpatient prescription drug; and

Regarding explanations of benefits, each consumer who is a covered individual and legally capable of consenting to the provision of covered benefits under such policy may specify that the insurance carrier:

Not issue explanations of benefits concerning covered benefits provided to such consumer; or

Issue explanations of benefits concerning covered benefits provided to such consumer solely to such consumer; and use a method specified by such consumer to issue such explanations of benefits solely to such consumer, and provide sufficient space in the statement for such consumer to specify a mailing address or an electronic mail address for us to use to contact such consumer concerning covered benefits provided to such consumer.

Prescription coverage for plans issued pursuant to Sec 38a-469, parts 1, 2 and 4:

Do not have a drug formulary;

Does not require prior authorization and step therapy.

The coinsurance, copayment, deductible or other out-of-pocket expense applicable to such drug may be found in your plan booklet; as well as

Whether such drug is covered when dispensed by a physician or a clinic;

If you want to find out more about your health plan, including whether specific types of health care specialists are in-network; and whether a specific health care provider or hospital is in-network, give us a call toll-free at 800-899-6520.

Florida

Indiana

As a resident, what are my precertification requirements?

You can call Customer Service (see the number on your ID card) or check your plan booklet to determine whether your plan has a precertification requirement. If it does, the following applies:

All Inpatient Hospitalizations and procedures done at an Outpatient Surgery Facility must be pre-certified.
To comply with the pre-certification requirements, the Covered Person must:
1. Contact the professional review organization at the telephone number contained in the Insured's Certificate (1-866-344-6746) as soon as possible before the expense is to be incurred
2. Comply with the instructions of the professional review organization and submit any information or documents they require
3. Notify all Doctors, Hospitals and other providers that this insurance contains pre-certification requirements and ask them to fully cooperate with the professional review organization
If the Covered Person complies with the pre-certification requirements, and the expenses are pre-certified, the Company will pay Eligible Expenses subject to all terms, conditions, provisions and exclusions described in the plan booklet.
If the Covered Person does not comply with the pre-certification requirements, or if the expenses are not pre-certified, a penalty may apply, which may consist of a reduction of Eligible Expenses or a reduction of benefit. See your plan booklet for more detail.
Emergency pre-certification: In the event of an emergency Hospital admission, pre-certification must be made within 48 hours after the admission, or as soon as is reasonably possible.
Concurrent Review – For Inpatient stays of any kind, the professional review organization will pre-certify a limited number of days of confinement. Additional days of Inpatient confinement may later be pre-certified if a Covered Person receives prior approval.
Pre-certification Does Not Guarantee Benefits – The fact that expenses are pre-certified does not guarantee either payment of benefits or the amount of benefits. Eligibility for and payment of benefits are subject to all the terms, conditions, provisions and exclusions herein.

Kentucky

Louisiana

Maryland

What mental illness/substance abuse benefits am I provided in the state of Maryland?

If your plan meets the definition of a “Health Benefit Plan” as defined by Code of Maryland §15–1301 or §15–1401 (click here for definitions), the plan will provide at least the following benefits for the diagnosis and treatment of a mental illness, emotional disorder, drug use disorder, or alcohol use disorder:

Inpatient benefits for services provided in a licensed or certified facility, including hospital inpatient and residential treatment center benefits
Partial hospitalization benefits
Outpatient and intensive outpatient benefits, including all office visits, diagnostic evaluations, opioid treatment services, medication evaluation and management and psychological and neuropsychological testing for diagnostic purposes

The benefits under this section are required only for expenses arising from the treatment of mental illnesses, emotional disorders, or drug or alcohol misuse if, in the professional judgment of health care providers the condition is treatable and that treatment is medically necessary.

The benefits required under this section:

Shall be provided as one set of benefits covering mental illnesses, emotional disorders, drug misuse and alcohol misuse
Shall comply with 45 C.F.R. § 146.136(a) through (d) and 29 C.F.R. § 2590.712(a) through (d)
May be delivered under a managed care system
May not be less than 60 days for partial hospitalization

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.

MHPAEA originally applied to group health plans and group health insurance coverage and was amended by the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the "Affordable Care Act") to also apply to individual health insurance coverage.

You can find more information about this protection at: https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet.html

You may also contact the Maryland Insurance Administration about the benefits at:

200 St. Paul Place
Suite 2700
Baltimore, MD 21202
410-468-2000 | 1-800-492-6116 (toll free) | 1-800-735-2258 (TTY)

www.mdinsurance.state.md.us/

If you have a precertification requirement, but fail to precertify, a penalty may be applied. Again, check your Schedule of Benefits or Certificate Schedule for the potential penalty.

Massachusetts

Mississippi

As a resident wanting to learn more about the PPO process, do I need referrals to see a doctor and what happens if I can't find a PPO doctor?

Our company has established a product that utilizes a Preferred Provider Organization (PPO) network to offer professional health care as needed. The principle of a PPO is to bring savings to you, the consumer, by providing a higher level of coverage (coinsurance) and reduced premiums, while directing business to providers. This benefits physicians and facilities in the PPO because they get potential patients, rather than needing to advertise to draw in business. For the insurance company, our expenses reduce, allowing us to reduce the member premiums.

Ultimately, the coverage is yours to utilize as you please. You are in the "driver's seat", steering the course of your medical care. You have the freedom to choose any medical provider in the network that is accepting new patients. You also have the ability to change medical providers to fit your need at any time. You only need go to the PPO's website address on your ID card or call them for a list of providers. Their toll-free number is also on your ID card.

When it is an Emergency or a PPO Provider is not Available

We know that sometimes no matter how hard you try, a PPO provider is not available and you will need to see an out-of-network, or nonpreferred provider. In these situations, you are still covered. In the following situations, we allow services as if performed by a PPO provider:

Due to the emergency nature of the care
When no preferred provider is reasonably available within the designated service area for which the policy was issued; and when a nonpreferred provider's services were pre authorized based upon the unavailability of a preferred provider
When the insured utilizes an in-network facility and the facility-related providers are not in-network (this applies to pathologist, radiologist, anesthesiologist, physical therapist, occupational therapist, respiratory therapist, or other physical medicine provider)
When the insured has no choice in an assistant surgeon, if the surgeon is an in-network PPO provider.

In these situations, our company will pay a claim by a nonpreferred provider at the usual or customary charge for the service at the higher, preferred benefit coinsurance level, less any patient responsibility. Furthermore, when the insured provides documentation of payments made above and beyond the allowed amount, we will apply this amount to the insured's deductible and annual out-of-pocket maximum applicable to in-network services.

Our company utilizes Fair Health, a nationally recognized vendor, to determine usual, reasonable or customary charges. Fair Health employs generally accepted industry standards and practices for determining the customary billed charge for a service that fairly and accurately reflects market rates, including geographic differences in costs. Allowances are based on sufficient claim data to constitute a representative and statistically valid sample. Such data is updated twice per year and is no more than three years old. The methodology is consistent with nationally recognized and generally accepted bundling edits and logic.

Referrals, Discharge Planning and Continuity of Care

Your plan is not an HMO, where either a designated Primary Care Provider (PCP) carefully coordinates care, or you have no coverage. You have the freedom to use whichever provider you choose. Likewise, you have more responsibility for your care. Your plan does not require referrals from one provider to another; you are free to choose from any of the providers in your PPO network.

Your PPO ("preferred") provider has a responsibility to work with you through the following necessary changes:

Referrals to another provider, such as specialists, for second opinions, etc.
Discharging from a hospital, setting up rehabilitation services or home health care.
It may be that a PPO provider will separate from a PPO network, whether because of retirement, relocation, or other reason.

When that happens, the provider has a contractual responsibility to help you transition to your next provider. In addition to these protections, we are only a toll-free number away.

Nebraska

New Jersey

New Mexico

Rhode Island

Tennessee

Texas

What is the company's practice in handling telemedicine?

Our company's telemedicine practices follow Texas statute 1455.004:

COVERAGE FOR TELEMEDICINE MEDICAL SERVICES AND TELEHEALTH SERVICES.

(a) A health benefit plan may not exclude from coverage a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service or a telehealth service solely because the covered health care service or procedure is not provided through an in-person consultation.

(b) A health benefit plan may require a deductible, a copayment, or coinsurance for a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service or a telehealth service. The amount of the deductible, copayment, or coinsurance may not exceed the amount of the deductible, copayment, or coinsurance required for the covered health care service or procedure provided through an in-person consultation.

(c) Notwithstanding Subsection (a), a health benefit plan is not required to provide coverage for a telemedicine medical service or a telehealth service provided by only synchronous or asynchronous audio interaction, including:

An audio-only telephone consultation

A text-only email message

A facsimile transmission.

I have a health plan with a utilization review requirement. Where can I locate the federal external review forms?

The federal external review forms can be downloaded from these links:

Where can I locate the Texas Prior Authorization Request Form for Prescription Drug Benefits?

You can download the form by clicking here. Please note that the patient must be eligible and your plan must have prescription coverage to qualify for benefits.

Is there a resource that describes my PPO network? Is there an Access Plan that applies to my coverage?

Pursuant to Title 28 Texas Administrative Code § 3.3705(b), the PPO network disclosure can be accessed by selecting the link corresponding with the company with whom you are insured. Next to the company name is a second link that will provide you the company's Access Plan, as required by the state of Texas.

You can search for a provider that is a member of the network at www.multiplan.com/ProviderSearch

Texas requires that we display the following notice in our provider listings:
A facility-based physician or facility-based health care practitioner, such as an anesthesiologist or radiologist, may not be included in the network. Non-participating facility-based physicians and non-participating facility-based health care practitioners may balance bill the enrollee for amounts not paid by the enrollee's health benefit plan. For more information, please refer to the 1-800 number located on your ID card.

This document link contains a listing of in-network facilities and their facility-based physicians participating in our network(s), to include radiologists, anesthesiologists, pathologists, emergency department physicians, neonatologists, and assistant surgeons. This list is updated monthly and therefore may have changed since posting to the website. Please contact the facility to confirm any facility-based physicians that may provide services to you are participating in the network(s) and accept your benefit plan prior to services being rendered. Please see the online directory search for full details regarding a facility’s demographic data, including address and contact information.

Does my plan have a preauthorization requirement?

The company is waiving all precertification requirements for residents of Texas. Services remain subject to all other plan policies and provisions. If you would like more information, please call our Customer Service department toll-free at 800-899-6520.

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American National is a group of companies writing a broad array of insurance products and services and operating in all 50 states. American National Insurance Company was founded in 1905 and is headquartered in Galveston, Texas. Life insurance, annuities, health insurance, credit insurance, pension products, and other products and services are written through multiple companies. Property and casualty insurance is written through American National Property And Casualty Company, Springfield, Missouri, and affiliates. In New York, business is written through Farm Family Casualty Insurance Company, United Farm Family Insurance Company, and American National Life Insurance Company of New York, Glenmont, New York. Not all products and services are available in all states. Not all companies are licensed in all states. Each company has financial responsibility only for the products and services it issues.

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