| Explanation of Benefits | ||
| To help you understand the claim settlement, here is a brief explanation of some of the headings: | ||
| Insurance coverages are underwritten by National Union Fire Insurance Company of Pittsburg, PA ("NUFIC") with offices in New York, NY. Policy numbers 9026884 and 9026885. Please see the policy for complete details of coverages, limitations, and exclusions. | ||
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| Medical Claims | Baggage Claims | |
| Provider | The name of each billing party (doctor, hospital, radiography, office, etc.) | The items on your claims list. |
| Service | The start and end dates of any treatment. | The date of loss. |
| # of SVC | The number of treatments provided. | Numbers of each item claimed. |
| Total Charged |
Total amount billed by each provider in US dollars. |
The value you are claiming for each item. |
| Non-Covered The amount in US dollars that NUFIC will NOT be reimbursing. |
Any amount the provider has billed that is more than is "Reasonable and Customary" (your policy only covers Reasonable & Customary charges). | The assessed depreciation of the item listed. |
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| Other Headings | ||
| Amount Considered The net amount in US dollars being considered by NUFIC. |
% Normally 100% unless you have exceeded the policy limit, or unless some is excluded because it is not Reasonable or Customary. |
Amount Paid The amount in US dollars that NUFIC will actually be paying out. |
| Cheques Issued - Payee Name Person or provider to whom reimbursement cheque is actually made. If this is not you, your provider is being paid directly by NUFIC. |
Remark Code A numerical code which is explained in English under Description of Remark Codes. |
Reasonable & Customary Standard industry statistics showing the prevailing charge in the same geographic area for a given procedure. |
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| If you have any questions concerning your
claim, please contact our office in writing. American International Companies, A&H Claims, 501 Carr Road, Suite 200, Wilmington, DE 19809 |
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