Sarah’s Claims 360 Story
Last summer, Sarah* slipped and fractured both her rib and leg
This accidental fall put her in the hospital, so she filed a Hospital Indemnity Insurance claim. This type of claim does not require information about the cause of hospitalization, just that an individual was hospitalized, and Sarah’s claim was paid based on the provisions of her coverage.
Though Sarah also had Accident Insurance, she did not file a claim at that time. She did, however, file a Short-Term Disability Income Insurance claim — which included information about her accidental injury.
As the claims examiner, Anna*, reviewed her case, this missed benefit opportunity became clear. Without any additional paperwork, Anna opened and paid a $17,940 benefit for the covered events Sarah had experienced.
Sarah received an unexpected $17,940 benefit payment for her covered accident
“When I called Sarah to let her know, she was absolutely stunned,” said Anna. “She said, ‘You have no idea how much this is going to help us right now.’”
“Sarah was excited, I was excited. Even her dogs were barking due to her reaction,” Anna continued. “I think one of the key things that stands out to me with calls like this is that, regardless of the amount of the paid benefit, this is money they didn’t know they were eligible to get, even though they had the coverage.”
“Being able to deliver the news that I’m going to, based on their coverage, send a check is gratifying,” Anna said. “I love it. Our whole team looks out for situations like this, and it makes me feel amazing about my job.”
Sarah’s integrated claim process included three Voya-offered products:
*Names changed.
**Medical claims integration is available for Accident Insurance, Critical Illness/Specified Disease Insurance, or Hospital Confinement Indemnity Insurance offered by Voya Employee Benefits. These are not coordinated benefits and medical coverage is not offered by Voya Employee Benefits.
***Formless submissions are currently available for Wellness benefit, Accident Insurance and Hospital Indemnity Insurance claims.
This example is based on an actual 2020 claim that utilized product-to-product claims integration. It is provided for illustrative purposes only. The average Accident Insurance benefit amount paid in 2020 was $1,100. The average Hospital Confinement Indemnity Insurance benefit amount paid in 2020 was $1,500. Filing a claim may require any necessary medical records or proof of claim as determined during the review process.
A complete description of benefits, limitations, exclusions and termination of coverage will be provided in the certificate of insurance and riders. All coverage is subject to the terms and conditions of the group policy. If there is any discrepancy between this document and the group policy documents, the policy documents will govern.
Insurance products are issued by ReliaStar Life Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Woodbury, NY). Within the State of New York, only ReliaStar Life Insurance Company of New York is admitted, and its products issued. Both are members of the Voya® family of companies. Voya Employee Benefits is a division of both companies. Product availability and specific provisions may vary by state and employer’s plan.