FREQUENTLY ASKED QUESTIONS

1. What kind of company is Group Executive Insurance Marketing, Inc.? Is it an insurance company?

Group Executive Insurance Marketing, Inc. is a third party administration (TPA) firm. This means that Group Executive provides claims administration services for companies with self-funded (versus insured) group medical, dental and/or disability plans.

Group Executive Insurance Marketing, Inc. is not an insurance company, nor does any insurance company own it.

2. Where is Group Executive? How long has Group Executive Insurance Marketing, Inc. been in business?

Group Executive Insurance Marketing, Inc. was founded in 1990 and has become a specialty company for client-employers looking for customized health care administration programs. We administer claim programs for employers located all over the United States.

As an employee covered under Group Executive administered plan, a dedicated claim unit will handle all of your organization's claims. Whenever you have a question about the way a claim was paid, please call your benefits analyst and talk it over.

We are located in Phoenix, AZ.

3. Will I have a health plan identification card?

Yes. This card is important to you and your family because you will be able to use it when you need medical care.

You'll notice that this card has several unique features. First it identifies you by name and social security number; second it indicates if you have a spouse or family covered by the plan and it contains your company's name and logo.

This card is your company's way of telling you that you are their most valuable asset. They are providing a group health plan for the benefit of you and your family and they want to make sure you have medical care coverage when and where you need it.

4. How many cards will I receive?

If you enroll your spouse, you will receive two health plan identification cards. Contact your employee benefits department if you need an additional card for a dependent who lives away from home (for example, a college student) or for a dependent child who does not live with you.

5. What if I add or drop dependents and need a new card?

If your family status changes due to marriage, birth, divorce or any other reason, the change should be reported to your personnel or human resource office immediately. Your enrollment information can then be changed and, if a new card is required, it will be automatically produced.

6. What if I lose my I.D. card?

A lost I.D. card should be reported to your personnel or human resource office immediately. They will contact Group Executive and a new card will be issued.

7. Where can I get claim forms?

You don't need a form in order to file a medical claim with Group Executive Insurance Marketing, Inc. Just ask your doctor to submit an itemized bill to us and we utilize this information to process your claim. If your expenses are covered under the plan, and if you have met the plan's deductible and co-payment requirements, we will pay the doctor directly.

Whenever you submit a claim, we will always send you an explanation that describes how your claim was paid.

8. What if my doctor won't accept my Group Executive Insurance Marketing, Inc. identification card?

If your doctor refuses to bill Group Executive Insurance Marketing, Inc. directly, you will have to pay the bill and then send it to us. When you do this, be sure that the bill is stamped "paid" or include a payment receipt with your claim submission. If you do not include some indication that you have paid the bill yourself, we will issue payment directly to the doctor. Also, be sure that you send us the original bill; keep copies for your records.

9. How quickly can I expect claims payment?

Group Executive Insurance Marketing, Inc. usually pays clean claims within seven to ten business days after we receive them.

10. What is a "clean" claim?

A clean claim includes all of the information we need to process your claim. This information includes:

1. Your Name

2. Patient's Name

3. Date of Service

4. Diagnosis

5. Type of Service

6. Charge for service rendered

11. If Group Executive has the information, will the bill be paid?

Having an itemized bill allows Group Executive to begin claims processing. There are many other factors that Group Executive will look at before a bill is paid. Questions that a benefit analyst asks include:

· Is there any other group coverage?

· was the claim related to an accident; if so, how, when and where did the accident happen?

· Are the charges reasonable and customary for the services provided?

12. What do you do when you don't have enough information to process my claim?

When a claim is incomplete, your benefits analyst will write to you or your doctor and ask for the missing information. Follow-up requests are issued; however, if either you or your doctor does not respond after our 'last request', your claim will be closed.

13. Is there anything I can do to help get my claim paid?

When you make sure an itemized bill is provided, you've taken the first step in helping Group Executive to do their job. Other things you can do to help:

· if you send a bill, make sure it's an original. Group Executive cannot accept a photocopy for primary payment.

· if you've paid a bill, make sure it is marked paid or send a receipt. (Payment is issued to the provider of services if the bill does not indicate that payment has been made).

· if there is other coverage, inform Group Executive of that coverage information. If the other plan must pay the bill first, send a copy of the bill and the Explanation of Benefits Form from the other company.

· if the service was due to an accidental injury, tells Group Executive how, when and where the accident happened.

14. What do I do if I do not agree with the way my claim was processed?

Your claim appeal must be made in writing, usually within a specified time frame. Your appeal letter should specifically state why you think the claim decision is wrong. If you have additional information that you think is important to your claim, you should include it with your appeal letter. A unit manager in the Group Executive Insurance Marketing, Inc. claims department will review your claim appeal. If the unit manager decides that you are right, your claim will be sent to the benefits analyst for re-processing. If the supervisor decides that the claim was processed correctly, you will receive a letter explaining this. If you want to appeal the claim further, your next appeal should be directed to your company's employee benefits department.

15. Does Group Executive Insurance Marketing, Inc. have a toll-free telephone number? How can I contact my benefits analyst?

Yes, Group Executive Insurance Marketing, Inc. Inc. has a new toll-free number - 1(800) 756-4906. Your health plan identification card also includes the toll-free number available for claim inquiries.

16. How else can I contact Group Executive?

You can also call Group Executive at (602) 468-0284 during normal working hours. You can call anytime you have questions about the plan, the status of a bill or a question about payment.

You can also write Group Executive at the following address:

919 North 1st Street
Phoenix AZ 85004


Fax 602-468-0294
Email gem@gemtpa.com