Claims Resource Center


Frequently Asked Questions


Using Your Insurance

You are always free to use the medical providers of your choice. When seeking treatment within the U.S., however, you may reduce your out-of-pocket costs by visiting a provider within your preferred provider organization (PPO).

A PPO is an organized network of hundreds of thousands of qualified medical practitioners and well-recognized hospitals in the U.S.

Refer to the "Schedule of Benefits and Limits" in the Description of Coverage for your plan to determine your coinsurance responsibility for in-network and out-of-network payments within the U.S., if applicable.

Then visit our "Find a Doctor or Hospital" page to find U.S.-based providers within your PPO.

Note that there is no PPO for those traveling outside the U.S.

Many providers are willing to bill us directly, and 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" form.

If the provider requires you to pay for medical treatment at the time of service, you will need to file a claim for reimbursement. At the time of service, ask your medical provider for an itemized bill with the following information:

  • Provider name and address
  • Provider tax ID (if U.S.-based)
  • Your name, date of birth, and certificate ID number
  • Itemized charges
  • DX (diagnosis) code and CPT (Current Procedural Terminology) code (these are the codes your physician's office uses to tell our claims examiners which procedures, diagnoses, and services you received during your visit)

Also request your receipt for the payment and your complete medical records from the visit.

You will send the itemized bill, medical records, and receipt directly to us, along with a completed "Claimant's Statement and Authorization" form.

NOTE: For plans that offer a coinsurance waiver for expenses incurred in-network, the provider must bill expenses directly to us.

See "How do I submit the 'Claimant's Statement and Authorization' form?" for submission options.

You can also learn more about the claims process by reading "How to Submit a Claim: A Step-by-Step Guide to the Claims Process for Members."

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

Our World Service Center offers emergency travel assistance services 24/7. Please contact us at 1-800-605-2282 and a representative will be available to assist you.

We also accept collect calls from anywhere in the world at 1-317-262-2132. Mention the country and area code you are calling from and a representative from the World Service Center at Tokio Marine HCC - MIS Group will assist you.



Completing & Submitting Claim-Related Forms

The "Claimant's Statement and Authorization" form is a document that we request when we receive a claim for a new medical condition or episode of care. Your submission of a thoroughly completed and signed "Claimant's Statement and Authorization" form provides us with information so that we can properly evaluate whether the claim is eligible under your policy.

This form also allows us to request medical records from your medical providers.

The "Claimant's Statement and Authorization" form is available to you in several places:

You can also contact us at 800-605-2282 to request a form by mail or fax.

You may submit this form to us in one of the following ways:

  • Electronically via Client Zone at zone.hccmis.com/clientzone or Student Zone at zone.hccmis.com/studentzone
  • By uploading it to the Submit Claim Request form via our Customer Service page at service.hccmis.com. Click "Submitting a Claim or an Appeal" under the "Contact Us" header. Then choose "Submit Claim." Fill out the form and upload the completed Claimant's Statement and Authorization form. Click "Submit."
  • By email to service@hccmis.com
  • By mail to:
  • Tokio Marine HCC - MIS Group
  • Claims Department
  • Box No. 2005
  • Farmington Hills, MI 48333-2005
  • U.S.A.

No. You should submit one “Claimant's Statement and Authorization” form to us for each different condition.

We require 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.

The "Authorization Form for Use and/or Disclosure of Protected Health Information" (HIPAA form) gives Tokio Marine HCC - MIS Group permission to disclose and release protected health information (PHI) to anyone specified on the form. If you wish for your PHI to be disclosed to a specific person, you must complete, sign, and submit this form.

If you are filing a claim on behalf of another person, you MUST submit this form - signed by the policyholder - in order to speak with us regarding any of the policyholder's PHI. Without this signed form, we may only disclose to you the status of the claim.

You may complete and submit the form to us in one of the following ways:

  • Electronically via Client Zone at zone.hccmis.com/clientzone or Student Zone at zone.hccmis.com/studentzone
  • By uploading it to the Submit Claim Request via our Customer Service page at service.hccmis.com. Click "Submitting a Claim or an Appeal" under the "Contact Us" header. Then choose "Submit Claim." Fill out the form and upload the completed Claimant's Statement and Authorization form. Click "Submit."
  • By email to service@hccmis.com
  • By mail to:
  • Tokio Marine HCC - MIS Group
  • Claims Department
  • Box No. 2005
  • Farmington Hills, MI 48333-2005
  • U.S.A.

You may submit all claim-related documents to us in one of the following ways:

  • Electronically via Client Zone at zone.hccmis.com/clientzone or Student Zone at zone.hccmis.com/studentzone
  • By uploading it to the Submit Claim Request via our Customer Service page at service.hccmis.com. Click "Submitting a Claim or an Appeal" under the "Contact Us" header. Then choose "Submit Claim." Fill out the form and upload the completed Claimant's Statement and Authorization form. Click "Submit."
  • By email to service@hccmis.com
  • By mail to:
  • Tokio Marine HCC - MIS Group
  • Claims Department
  • Box No. 2005
  • Farmington Hills, MI 48333-2005
  • U.S.A.

Claim Processing

Once you have signed and submitted your "Claimant's Statement and Authorization" form, our claims examiners will review your information.

The initial review of your claim will determine whether it will be paid, denied, or if more information is needed to make a final decision. We may request more information from you or your medical providers before your claim is paid or denied.

Final processing time of your claim depends on multiple factors. However, you can assist us in reducing your claim pending time by ensuring that we receive all requested information quickly.

To check the status of a claim, please sign into your Client Zone account at zone.hccmis.com/clientzone or your Student Zone account at zone.hccmis.com/studentzone.

Click "Claims" in the navigation menu across the top of the page. Then choose "Claims & Explanation of Benefits" from the dropdown menu. Find the relevant certificate number or claim number and review the "Status/Reason" column to see the status of your claim.

You may also email your inquiry to service@hccmis.com or contact us at 800-605-2282

While we may have received a completed “Claimant’s Statement and Authorization” form from you, we may be waiting on medical records from your providers. Each time we request additional information, you will receive a letter notifying you of what is being requested.

You may assist us with these requests by contacting the medical provider to request that the medical records be expedited to us.

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

Learn more about the EOB here.

For each claim we receive, we will send you an acknowledgement letter notifying you that we have received your claim. The acknowledgement letter will also notify you of any additional information that we need or information that is still outstanding from a prior request.

Additionally, each time we request information from you or your medical providers, we will send you a letter to notify you of the request.


Claim Denials & Appeals

There may be situations when you choose to appeal how a claim was processed. You may appeal your claim decision using one of the following methods:

  • Fill out and submit the Claimant Appeal Request form online - Visit service.hccmis.com and select "Submitting a Claim or an Appeal" under the "Contact Us" header. Click "Submit Appeal." Fill in the requested information on the Claimant Appeal Request form and upload additional documentation that supports your reasoning and position (medical records, receipts, etc.). Click "Submit."

  • Download the Claimant Appeal Request form, complete it, and submit it via email or mail - Download the Claimant Appeal Request form here. Fill out the form and email it, along with additional documentation that supports your reasoning and position (medical records, receipts, etc.) to service@hccmis.com.

  • Or mail the form and supporting documents to:

  • Tokio Marine HCC - MIS Group
  • Claims Department
  • Box No. 2005
  • Farmington Hills, MI 48333-2005
  • U.S.A.

  • Write a letter of appeal and submit it via email or mail - Write a letter of appeal following the appeal procedure instructions outlined in your certificate of coverage. Email this written letter of appeal, along with additional documentation that supports your reasoning and position (medical records, receipts, etc.), to service@hccmis.com.

  • Or mail the letter and supporting documents to:

  • Tokio Marine HCC - MIS Group
  • Claims Department
  • Box No. 2005
  • Farmington Hills, MI 48333-2005
  • U.S.A.

In order for our claims department to review the appeal, you must provide additional documentation or information to support a reversal of the denial.

Please note that submission of the appeal will lead to re-evaluation of your claim but does not guarantee that the initial benefit determination will be altered.

Our policies are not subject to the Patient Protection Affordable Care Act. They do not contain many of the coverages required by PPACA and may contain a pre-existing condition exclusion.




Educational Videos: Navigating the Claims Process


video iconHow 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.

Print Version



video iconHow 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.

Print Version



Glossary Terms


  • Authorization Form for Use and/or Disclosure of Protected Health Information - an authorization form that gives the insurer permission to disclose and release protected health information to anyone specified on the form. Tokio Marine HCC - MIS Group requires that this form be signed and thoroughly completed if the member wishes for their protected health information to be disclosed and/or released to a specified person.
  • Certificate Period - this is the period of time beginning on the date and time your insurance becomes effective and ending on the date and time your coverage is terminated.
  • Coinsurance - specifies the percentage amount the insurer pays for eligible expenses and the percentage amount the insured pays for eligible expenses once the insured has met their deductible.
  • Copayments (Copays) - the fixed amount the insured person must pay out of pocket for specific medical services, such as use of an emergency room for an illness.
  • Claimant - a person or entity making a claim under a policy.
  • Claimant's Statement and Authorization Form - an authorization form that asks for claimant information, medical information, and authorization for the release of medical records. It is completed by the claimant and submitted to the insurer. Tokio Marine HCC - MIS Group requires Claimant's Statement and Authorization form for each incident.
  • Deductibles - the dollar amount of eligible expenses the insured must pay per certificate period before eligible expenses are paid.
  • Date of Service - the date that a medical service was received. This date may differ from the date the medical claim is filed with the insurance company.
  • In Network - refers to physicians and medical facilities who have a contract with the insurer. If you visit an in-network provider, you may receive medical services at a discounted rate.
  • Member - an individual who is covered under an insurance policy.
  • Out of Network - refers to physicians and medical facilities who do not have a contract with the insurer and therefore charge the full rate for their services.

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