CAIC

Continental American Insurance Company

Frequently Asked Questions

Is the coverage that is offered Major Medical?

No. This coverage is designed to supplement any other coverage that you may have.

How do I file a claim?

A completed claim form will need to be submitted to our Claims Department for processing. Please complete the claim form in its entirety. Detailed instructions are included along with the claim form. A claim form and instructions may be obtained by calling our Customer Service Center at 1-800-433-3036, downloading the form from our website (located under the Claims tab) or in your certificate package that you received.

Once the pre-processing of my claim is complete, how long will it take to process my claim?

Total processing of the claim, including pre-processing is 7-10 business days.

If I send my claim form in overnight or by Federal Express will this help to expedite my claim?

Claims delivered in this manner will expedited the delivery of mail time but will not expedite the processing of the claim. Claims are processed in received date order, not by method of delivery.

If I am eligible to keep my coverage on an individual basis, what payment options do I have?

There are 4 payment options: monthly electronic draft from your banking account, paying your premiums quarterly, semi-annually or annually. Paying your premiums other than monthly cannot be set up electronically. A premium due notice will be generated when the premium is due.

Who do I call regarding questions about my coverage?

You can call our Customer Service Center at 1-800-433-3036 between the hours of 8:00 a.m. to 5:00 p.m. Eastern Standard Time or you can email our Customer Service Center at CSC@caicworksite.com

How do I change my beneficiary on my life insurance plan?

A Service Request form can be downloaded from the website (located under the Customer Service tab) or you can call our Customer Service Department at 1-800-433-3036 for this form. When changing a beneficiary, someone must witness the form other than the beneficiary or the owner of the certificate.

Will I receive an annual statement on my life insurance?

You will receive an annual statement on the anniversary date of your Universal Life plan. Annual statements are not generated on Whole Life plans.

What is a HIPAA authorization and why is it needed?

This is an authorization form that is completed by the insured for the purpose of evaluating your eligibility for insurance and eligibility for benefits under your existing certificate. This authorization form completed by you authorizes your medical providers to disclose any medical documentation needed to complete the processing of your claim. Congress passed the Health Insurance Portability and Accountability Act (HIPAA) in 1996. The part of HIPAA that deals with privacy provisions is called the Privacy Rule. It lays out requirements for protecting individuals' medical records and other personal health information, referred to as protected health information (PHI). Generally, the Privacy Rule requires health care providers, health plans and health care clearinghouses to:

  • Limit the use and disclosure of protected health information.
  • Obtain a written authorization for some uses and disclosures of protected health information.
  • Notify individuals about their privacy rights and respond when individuals invoke their rights.
  • Require their business associates, including sales representatives, to agree to safeguard the privacy of protected health information.
  • Adopt and implement privacy policies and procedures.
  • Train their workforce on privacy policies and procedures.
  • Secure protected health information so it's not available to those who don't need it.

How do I make changes to my personal information such as name changes or address changes?

You can download a Service Request form from the website (located under the Customer Service tab) or call our Customer Service department at 1-800- 433-3036 for a Service Request form to be mailed out to you. Any changes must be accompanied to a dated signature.

Can I keep my certificate on an individual basis if I should terminated my employment?

You would have to refer to the verbiage of your certificate. If your certificate carries a portability clause then you would need to make a written statement within 31 days of your termination date. There may be other stipulations regarding the portability privilege under your plan that you would need to refer to. In the event that your plan is portable and your previous employer terminates the plan, your plan would also terminate.

How do I pay my premium while on leave of absence?

You can call our Customer Service Department and you will be advised of the proper procedure. Typically under the Family Medical Leave Act, which is 3 months or less, you would need to send the amount that would have been deducted from your paycheck for the pay periods you will miss.

What if I want to cancel my coverage?

Call our Customer Service Center at 1-800-433-3036 and you will be advised on the cancellation procedures.

Does my Life Insurance coverage accumulate cash value?

Yes, Whole Life and Universal Life accumulates cash value. However, it normally takes about 3 - 5 years before the cash value begins to accumulate.

How is the cash value accumulated?

Cash values are accumulated by crediting premium payments and interest to a fund from which deductions are made for expenses and cost of insurance. The rates at which the interest is credited are declared by the company or may be specified in the certificate. The initial surrender charge is determined at the beginning of each certificate year. The fund value (not to be confused with the surrender value) is accrued based on the premium deposited. Once the fund value exceeds the surrender charge is when the cash value begins to grow.

Customer Service

How long do I have to file a claim?

There is a one-year timely filing provision in your certificate.

Will my benefit check be payable to me?

If not otherwise required by law, benefits will be paid directly to you, the insured, unless you authorize a hospital, physician or other health care provider to receive your benefits. This is called "assigning benefits." You can assign your benefits by signing the appropriate section on the claim form or by signing an assignment of benefits at the provider's office in the event that the provider files the claim for you.

Are my benefits taxable?

If you pay your premiums under a flexible benefits plan with pretax dollars, or if your employer pays part or all of your premiums, some of the benefits you receive may be taxable. You may receive a W-2 form from your employer that will include the benefit amount you received that may be taxable. If you have questions about taxability of benefits, discuss them with your employer or contact your tax advisor.

Can I fax my claim in?

No. The original claim form is required to process your claim. Please also make a copy for your records.

What information will I find in the annual statement?

This statement shows the current certificate values, premiums paid and deductions made since the last report and any outstanding certificate loans.

Can I continue my Universal Life or Whole Life insurance on an individual basis?

Yes. With the Universal Life and Whole Life plans, if the Group Master Policy terminates, the insured will continue to have coverage as long as the premiums are paid.

What if I stop paying my premiums but do not cash surrender my Universal Life plan?

If payment of premiums discontinues and the certificate is not surrendered, monthly deductions will continue as long as there is sufficient accumulated value. The certificate will remain inforce until the earlier of the following dates: 1.) The maturity date (if there is sufficient accumulated value to make monthly deduction to that date), or 2.) The end of the grace period. 3.) The date of the insured's death.