Frequently Asked Questions About Insurance

Question: What does "in-network" or "out of network" mean?

Answer: In-network refers to the medical facilities, such as doctors, hospitals and other health care providers who have arranged with claims administrator GMMI to provide specific medical care under this insurance policy at negotiated rates. Out-of-network refers to medical facilities that are not part of this contracted arrangement.

The WISE insurance program allows you to receive care from any doctor or hospital. However, your cost, such as your deductible, will be lower whenever you use an in-network medical facility. Claims administrator GMMI can help you find in-network providers by telephone or over the web. You should choose in-network providers whenever possible, and go to out-of-network providers only when there is not a suitable in-network option in your area. When an out-of-network provider is used, the insurance company will not pay more than "reasonable and customary" charges for the geographic area, which may be less than the medical bill presented. You may be held responsible for the difference in cost.


for more information, visit the Insurance FAQ page.

Question: What do I do in case of an emergency?

Answer:If you have a true, life-threatening emergency, get to the nearest available form of appropriate medical care, which is generally the local Emergency Room. You can dial 911 to get an ambulance. Then contact both WISE and GMMI as soon as possible.

If you have the option to make a phone call first, contact GMMI at 1-855-209-8027 (toll-free) or at 1-954-308-3934. They are your medical care resource on a 24-hour basis. They can help you to determine the next best steps, often in your own language.

GMMI encourages you to call them with medical care questions anytime, even in cases of minor emergency or medical concern.


for more information, visit the Insurance FAQ page.

Question: What if my injury is not life-threatening?

Answer: For less serious accidents or illnesses, you should go either to a minor emergency clinic or make an appointment with a doctor at his or her office. Hospital emergency rooms treat the most serious cases first. Because of this, people with minor emergencies sometimes experience long waits for attention. Hospital emergency rooms are also more expensive than other places to receive treatment.


for more information, visit the Insurance FAQ page.

Question: Does the insurance cover prescription drug charges?

Answer:The insurance covers prescriptions made by a medical professional in connection with a covered accident or illness. The policy does not pay for over-the-counter medications, vitamins, or prescription drugs not prescribed in response to an accident or illness, such as birth control pills, weight loss medication or stop-smoking aids or prescription medications to treat pre-existing conditions. If you want to make a claim for reimbursement of prescription drug costs, download the claim form from www.wisefoundation.com. The insurance company requires the date, name of drug, person for whom prescribed, and the charge. This information is often attached to the bag by the pharmacist but may come in other forms. Make sure your pharmacy receipt includes all requested information. Cashier receipts are not accepted.

More Frequently Asked Questions about insurance are available here.

 


Medical Insurance

WISE® participants are covered by insurance during their program dates.

Starting in January 2015, your medical coverage has been updated. The medical benefits have been increased to $200,000 and your deductibles have decreased. In making these changes, we have also changed insurance providers.

For current participants that have received their DS-2019 packages in 2014, we are currently in the process of sending out your replacement insurance card via e-mail and also sending an original to you by mail.

For participants receiving their DS-2019 packages in January 2015 or later, you will receive your insurance information with your DS-2019 form.

Please be sure to carry this card with you at all times, along with the insurance booklet that contains information about your policy and a copy of a claim form. If you do not have your card with you in the US, please contact WISEŽ immediately for a replacement.

If you need medical attention while on your program, this page provides you with helpful information to ensure you are reimbursed for any costs above & beyond your deductible. Please read all information carefully, and if you have any questions, do not hesitate to contact WISE® or your insurance claims administrator (GMMI).

2015 Policy - AXIS GLOBAL INSURANCE COMPANY
Policy #SRPO-50931-1099
Claims Administrator
 To file a claim or to confirm benefits
or for approval of surgery or hospitalization contact:

Global Medical Management (GMMI Inc.)
1300 Terrace, Suite 300
Sunrise, FL 33323 USA

Available 24 hours / 7 days a week
Toll Free Tel: 1-855-209-8027
or Local Tel: 1-954-308-3934
Email: CustomerService@gmmi.com

Travel Assistance Provider
For 24-hour emergency medical assistance worldwide
Europ Assistance
Tel: 866-690-5111 inside the USA
Tel: 202-659-7776 collect outside the USA


How to find a Medical Provider
Claims administrator GMMI maintains a database of medical providers with whom they have network arrangements all around the United States. If you confer with GMMI by telephone or email for help in finding a medical provider, you will pay the lowest deductible of $50. GMMI personnel are multi-lingual and can likely speak with you about your medical condition and choices for medical care in your native language if needed. Don't hesitate to call them at 1-855-209-8027 (toll-free) or at 1 954-308-3934, whether the medical concern is big or small.

You may also contact GMMI on-line at www.gmmi.com to find an in-network medical facility. When you use a medical facility on this list, you will pay the lowest deductible of $50. GMMI provides details on your health insurance card about how to locate in-network doctors, hospitals, and medical facilities.


Call GMMI at the beginning of your program to find an in-network general practice physician and to locate an in-network urgent-care facility in your city or zip code. Keep this information available in your wallet and on your smartphone should you need it later.


General Insurance Information
Information about your insurance coverage, benefits, and how to file a claim can be found in the Policy and Insurance Handbook provided to you with your DS-2019 form and insurance card. To view a copy of this handbook, please click below:

Axis Global Accident & Health Insurance Booklet - 2015


Claim Procedure
If you need medical attention, you will need to pay a $50-$75 deductible (depending on your policy) at the time you receive treatment. In some cases, you may be required to pay for services up front and then file a claim form in order to receive reimbursement. A copy of this claim form can be found in the packet sent to you along with your DS-2019 form and insurance card and handbook. Below is a link to a copy of the insurance claim forms.

GMMI Inc. Insurance Claim Form 2015

One claim form must be completed for each accident or illness. The claim form should then be filled out completely and returned to the address indicated on the form, along with an itemized bill that you received at the doctor’s office.Be sure to make a copy of your claim form and itemized bill for your personal records before you send it to the insurance company. All claims for should be filed as promptly as possible and returned no later than 90 days from the date of service.

If possible, a claim form should be brought along with you to all medical visits. The provider can then submit all bills and claim form together. A claim form should also be submitted with any prescription receipts or medical bills you are submitting. In this case, a doctor's signature is not necessary if the provider has already submitted a claim form. Indicate to whom the payment should be made. If you have paid the provider, then make sure you have noted this on the claim form. In this case, it will be your responsibility to send in the claim form and bills/receipts.

Helpful Hint: When you are at the doctor's office, request a super-bill or standard health insurance bill. When in the hospital, request a form UB-92 or its equivalent. For prescription drugs, the company requires the date, name of drug, person for whom prescribed, and the charge. This information is often attached to the bag by the pharmacist but may come in other forms. Make sure your pharmacy receipt includes all requested information. Cashier receipts are not accepted.

All bills must be original, no photocopies, with diagnosis, date of service, provider's name and amount. If you or someone else other than the provider submits the claim form, verify that all this information is on the bill before mailing it to the processing center. The claim will not be paid until bills with all required information are submitted.

KEEP A PHOTOCOPY FOR YOUR RECORDS OF THE INFORMATION YOU SEND TO PROCESS A CLAIM INCLUDING THE COMPLETED CLAIM FORM AND ALL RECEIPTS.

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