Frequently Asked Questions
For specific questions, call 1-800-775-3766 to speak with a ZaneAMC Licensed Benefits Consultant or email Info@ZaneAMC.com.
- Questions About Zane Benefits
- General Accident Medical Coverage Plan Information
- Coverage and Benefits Available
- Health Insurance Definitions
Questions About Zane Benefits
Who is Zane Benefits?
Zane Benefit is a full-service health benefits company offering health benefits solutions for individual, families and employers.
How do I contact a representative of Zane Benefits?
How do I contact a Licensed Benefits Consultant to help me with questions I have about Accident Medical Coverage?
I am having problems with my Accident Medical Coverage, who can I call for help?
Zane Benefits has Licensed Benefits Consultants available to speak with you and help with questions regarding Accident Medical Coverage and all your health insurance requirements.
Hours are Monday thru Friday 8:00am to 5:00pm MST. Please call 1-800-775-3766 for further assistance from a personal representative or email info@ZaneBenefits.com.
General Accident Medical Coverage Plan Information
What is Accident Medical Coverage?
Accident Medical Coverage pays only medical expenses not covered by your health insurance policy when you have an accident. Covered expenses include traditional health expenses not paid because you have not met your Annual Deductible, Coinsurance requirements and Dental, Ambulance, Crutches and hundreds of other items not covered by most health insurance policies.
How does it work?
When you have an accident, you use your primary health insurance carrier to pay your medical expenses. Accident Medical Coverage then pays for covered medical items not paid by your insurance carrier—either because you have not yet met your Annual Deductible, Coinsurance, or because your health insurance does not fully cover specific items covered by AMC like Dental.
For example, let's say you have health insurance from your employer with a $500 Annual Deductible and a 20% Coinsurance requirement to $10,000. While running, you tear a ligament in your knee and fall on the pavement breaking your front tooth. Your medical expenses are as follows:
| Ambulance | $ 600 |
| Emergency Room Visit | $ 1,500 |
| MRI and Tests | $ 2,200 |
| Surgeon and other MD Fees | $ 4,500 |
| Rehabilitation | $ 3,000 |
| Dental Expense | $ 1,500 |
| Total | $13,300 |
Your employer health insurance policy requires you to pay 100% of the first $500 until you meet your Annual Deductible, then 20% of the next $10,000 as Coinsurance ($2,000), and all of the Dental expenses.
| Annual Deductible | $ 500 |
| Coinsurance | $ 2,000 |
| Dental Expense | $ 1,500 |
| Total | $ 4,000 |
In this case, Accident Medical Coverage, which has a $100 per accident deductible, would pay $3,900 of the $4,000 in medical expenses not paid by your health insurance. Payment is made either to you as reimbursement for these expenses or directly to your health care providers.
Is Accident Medical Coverage available in all states?
Yes, Accident Medical Coverage is available to residents of all 50 states, plus D.C.
How do I apply for Accident Medical Coverage?
Accident Medical Coverage can be obtained several ways including:
- Contacting Zane Benefits to obtain a health insurance policy or plan offering protection against accidents;
- Contacting Zane Benefits to purchase a standalone Accident Medical Coverage policy;
- Lowering the Annual Deductible and/or coinsurance requirement of an existing employer-sponsored or other health policy; or
- Joining an association that provides multiple benefits of membership, one of which is accident medical coverage--similar to the way some people join AAA for a package of benefits (maps, discounts) along with roadside assistance coverage at a better price than roadside assistance coverage might cost alone.
If I apply to join an association, when will I receive confirmation or acceptance of the application?
Applications submitted online will receive confirmation and/or acceptance by email shortly thereafter to the email address you provided on you application. Applications submitted via fax or mail take several days, but you can always confirm membership online or by calling your association.
When does my coverage begin if I join an association?
Coverage begins on the effective date of your membership assigned to you during your application process, typically 7 days from your application date. Upon request, coverage can begin immediately if you have a legitimate reason (e.g. vacation, sports event) and are willing to certify that an accident has not already occurred.
How is payment made and what if I miss a payment?
Payment is made via Visa or MasterCard on a monthly basis, 7 days before your monthly association fee is due.
If your credit card payment is rejected (e.g. you changed cards and did not notify your association), then the association may attempt to contact you via email and/or telephone to obtain correct payment information before your monthly membership fee is due. If such corrected information is not obtained, and your monthly membership fee is not paid, your policy will typically be cancelled.
Once your membership is cancelled, you will no longer receive benefits. You will have to pay a new Application Fee to reinstate your membership.
What if I want to cancel?
You can generally cancel your membership in an association at anytime with no cancellation fee, penalty, or further obligation.
How is my personal health information protected?
No personal health information is collected during your application except information regarding your existing health insurance in order to verify your eligibility.
When you submit a claim, your personal health information will be known to the Insurance Carrier and their claims administrator but not shared with anyone else. All health providers and insurers are bound by HIPAA government regulations in order to cover the privacy of your personal policy information.
If a Zane Benefits Associate assists you in obtaining Accident Medical Coverage, they will know that you have joined an association with benefits including accident medical coverage but will not know the name of your health insurance carrier unless they are a licensed health insurance agent.
Coverage and Benefits
How do I file a claim?
Contact your association, usually by phone, and they will walk you through the claims process.
What are the typical benefits of membership?
Depending on your membership you could receive: car rental discounts, tradesman referrals, floral discounts, magazine subscription savings, moving and storage discounts, hotel savings, amusement park savings, movie ticket discounts, E-Wellness, medical records software, auto maintenance discounts, and roadside assistance emergency access. See the Summary of Benefits for your membership.
What is typically covered under the Accident Medical Coverage benefit of an association membership?
The information contained in this FAQ is for summary purposes only. Consult the Summary of Benefits for your membership for a complete description of benefits
The insurance carrier will pay Accident Medical Expense Benefits for Covered Expenses that result directly, and from no other cause, from a Covered Accident. These benefits are subject to the Deductibles, Benefit Periods, Benefit Maximums and other terms or limits shown in the Summary of Benefits.
Accident Medical Expense Benefits are only payable:
- for Usual and Customary Charges incurred after the Deductible (typically $100) has been met;
- for those Medically Necessary Covered Expenses incurred by or on behalf of the Covered Person; and
- for charges first incurred within a specified time (typically 60 days) after the date of the Covered Accident.
What is not typically covered by accident medical coverage?
Consult your Summary of Benefits for exclusions and limitations.
Health Insurance Definitions
What is the deductible?
The deductible is the annual amount you must pay out-of-pocket before the carrier, will begin to cover medical expenses. Typical Accident Medical Coverage has a $100 deductible.
How often does the deductible start over?
The deductible may apply annually or to each covered accident.
What is the maximum benefit?
The maximum benefit is the highest amount the Insurance Carrier will pay in the event of a covered accident. Example maximum benefits are $1,000, $2,500, $5,000, $7,500 and $10,000
What is a "Covered Accident?"
An accident that occurs while coverage is in force for a Covered Person and results directly and independently of all other causes in a loss or Injury covered by the Policy for which benefits are payable.
What is a "Covered Expense?"
An expense actually incurred by or on behalf of a Covered Person for treatment, services and supplies covered by the Policy that covers either the insured or the members of an association. Coverage under the Policyholder's (or Member's) Policy must remain continuously in force from the date of the Covered Accident until the date treatment, services or supplies are received for them to be a Covered Expense. A Covered Expense is deemed to be incurred on the date such treatment, service or supply, that gave rise to the expense or the charge, was rendered or obtained.
What is a "Covered Loss?"
An accidental death, dismemberment or other loss resulting from Injury covered under the Policy.
Who is a "Covered Person?"
Is any eligible person, including Dependents if eligible for coverage under the Policy, who applies for coverage or for membership in an association providing coverage and for whom the required fees are paid. If the cost for this insurance is paid for by the Policyholder, individual applications are not required for an eligible person to be a Covered Person.
Who is a "Dependent?"
An Insured's lawful spouse under age 70; or an Insured's unmarried child, from the moment of birth to age 19, 25 if a full-time student, who is chiefly dependent on the Insured for support. A child, for eligibility purposes, includes an Insured's natural child; adopted child, beginning with any waiting period pending finalization of the child's adoption; or a stepchild who resides with the Insured or depends on the Insured for financial support.
Also, Dependent includes a newborn child of any Covered Person. Insurance will continue for any Dependent child who reaches the age limit and is unable to engage in any substantial gainful activity because of a mental or physical handicap that is expected to result in death or continued disability for at least 12 months. The Insured must send the insurance carrier satisfactory proof of the handicap within 31 days of the child reaching the maximum age for insurance to continue. If the Insured has elected coverage for a Dependent child, any newly born child of the Insured will be covered from the moment of birth for 31 days. Coverage may be continued beyond this time period if the Insured notifies the insurance carrier within 31 days of the child's birth and pays any required premium.
Accident Medical Coverage provides benefits for medical expenses that result from an accident or injury—it does not provide benefits for medical expenses due to an illness.
Information on this page does not refer to a specific product, policy, or membership—all examples are only for purposes of education. Accident Medical Coverage described on this page can be obtained several ways including: (1) Contacting Zane Benefits to obtain a health insurance policy or plan offering protection against accidents; (2) Contacting Zane Benefits to purchase a standalone Accident Medical Coverage policy; (3) Lowering the Annual Deductible and/or coinsurance requirement of an existing employer-sponsored or other health policy; or (4) Joining an association that provides multiple benefits of membership, one of which is accident medical coverage—similar to the way some people join AAA for a package of benefits (maps, discounts) along with roadside assistance coverage at a better price than roadside assistance coverage might cost alone.