Underwriting and exclusions for all other insurances

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Pre-Authorization Requirements Worldwide (excluding the United States)

For many of the benefits provided under our insurance products, you are required to seek Pre-Authorization from WellAway®. Pre-Authorization is a process by which an insured person obtains approval for: (i) certain non-emergency medical procedures prior to the commencement of the proposed procedure and prior to incurring costs or undertaking any medical treatment; or (ii) before being admitted to a hospital (except in an emergency situation, in which event WellAway® must be informed within 48 hours). Please refer to your policy for a list of services that require Pre-Authorization.

Pre-Authorization may be undertaken by an insured person, the medical practitioner, or the hospital administrator, subject to all information being available and verifiable and must be obtained at least 5 business days prior to the scheduled procedure date. Some procedures may require longer than 5 business days for Pre-Authorization to be provided.

Your policy wording contains important terms, conditions and instructions on Pre-Authorization. Please ensure you carefully adhere to these requirements. Failure to follow Pre-Authorization procedures will result in the assessment of a 50% penalty on the entire episode of care, may invalidate your claim or, in certain circumstances, result in a loss or reduction of cover.

Underwriting Guidelines

Cover for Pre-Existing Medical Conditions

Our individual international products allow for either Full Medical Underwriting or Moratorium Underwriting evaluations, which determines what type of coverage will be available for pre-existing medical conditions. Your application is reviewed by WellAway’s Underwriting Team and coverage may be subject to exclusions, waiting periods or rate up on certain medical conditions. Please note that Health Insurance Instantly is not responsible for underwriting, which is WellAway’s sole responsibility. If you have any questions regarding the underwriting process, we do provide assistance and you are welcome to contact us.

Full Medical Underwriting

With respect to Full Medical Underwriting, you must complete the application form which includes a full medical questionnaire. Upon review of your responses and any additional information WellAway may require from you or your physician, WellAway’s Underwriting Team will make a determination to approve you for cover, as well as apply any limitations, exclusion(s) or rate up on certain medical conditions.

Moratorium Underwriting

Moratorium Underwriting enables you to apply for cover and any pre-existing condition will be automatically excluded for 12 consecutive months. After 12 months of continuous cover under the policy, you must demonstrate that you were symptom free, and did not seek treatment, consultation, advice, or medications during this period for such pre-existing condition or related conditions. Should you then need subsequent treatment for that condition, you may have cover, subject to the policy’s terms and conditions. In the event that you have symptoms, receive treatment, consultation, advice, or medications during this period, a new waiting period will automatically trigger for the next 12 consecutive months.  

Under the Moratorium Underwriting option, many pre-existing medical conditions, where you need regular or periodic treatment, medication, or check-ups, which existed prior to the purchase of your plan, may never be covered. Please be aware that undisclosed pre-existing conditions will not be covered.

Network Provider Search and Claim Filing in the United States

WellAway® maintains a provider network both inside and outside the United States. In the United States, your out-of-pocket costs and coverage will be determined by whether you use of an in-network provider, preferred provider, or out-of-network provider.

In-network provider means any health care provider who, at the time services are rendered to you, is under contract with WellAway® to participate as an in-network provider.

Out-of-network provider means a provider who, at the time services are rendered to you, does not have a contract with WellAway® to participate in-network.

Preferred provider means a provider that has been recognized and designated by WellAway® as a preferred provider.

On WellAway’s website @ https://www.wellaway.com under the Provider Search tab, you may access a list of facilities, providers and physicians. This provides a complete listing of providers by specialty and geographic location, as well as conditions and procedures.

Certain conditions require medical services from a Preferred Provider. You may contact a WellAway® ConciergeCare Counselor at the contact information listed below for a list of the Preferred Providers in your area.

In the United States, you must provide your identification card to all health care providers. This allows the provider to verify your benefits with WellAway®. After services have been rendered, the health care provider will file your claim with WellAway® for you. WellAway® encourages you to obtain services from an in-network provider in order to reduce your out-of-pocket costs. If you receive medical services from an in-network provider who requests payment at the time of service, please immediately report this to WellAway®.

How to File a Claim Worldwide (excluding the United States)

Please follow these instructions prior to filing a claim, when applicable. Assistance is available from us or WellAway® at the contact information set forth below:

HII: Click here to contact us

WellAway® ConciergeCare Counselor:

Telephone: +1 855 773 7810

E-mail: Conciergecare@wellaway.com.

You must submit a complete claim directly to the Plan Administrator (PayerFusion Holdings, LLC) within the time period specified in your chosen policy. The claim form is available on WellAway’s member portal at www.wellaway.com or you may request the claim form by contacting a WellAway® ConciergeCare Counselor. All claim forms must be accompanied with the following:

  • Patient’s name
  • Physician’s specialty
  • Detailed description of the service rendered (office visits, surgery, etc.)
  • Original itemized invoices with fees on physician/hospital letterhead. Invoice must include patient’s full name, date of birth, diagnosis (type of Illness), date of the visit, treatment type, physician’s charges and acceptable proof of payment (credit card receipt)
  • Prescription medications must clearly provide the name of the patient, the price of the drug, and prescription quantity. Copy of the physician’s script is required
  • In the case of hospitalization, you must attach the hospital medical notes or reports, and our Pre-Authorization provided to you. Please ensure that your invoice details the cost of private or semi-private room
  • Type of currency

Claims may be submitted via e-mail to conciergecare@wellaway.com, courier, or by postal service. Mail your completed claim documents to:

WellAway® Limited c/o PayerFusion Holdings, LLC

5200 Blue Lagoon Drive, Suite 100

Miami FL 33126

Copies of claims are accepted; however, WellAway® reserves the right to request original documents at its discretion. WellAway® encourages its members to keep copies of the invoices for their records.

WellAway® will reimburse the member in accordance with the terms and conditions of the member’s Policy. Please refer to your Policy for the specific time frames required to submit a claim. If WellAway® does not receive your completed claim within the time frame stated in your Policy, your claim may be denied.

How do I get help with filing my claim? We’re here to help!  Please contact us at any time before, during or after the claims process using the contact details above.  

How long will it take to process my claim? Once all of the requested information is received by the Plan Administrator, claims are processed within 15-20 days.

How will you pay my eligible claim?

We can pay by:

  1. international wire transfer* – please complete the banking information section on your Claim Form; or
  2. Cash Passport™ Prepaid MasterCard®

In certain regions, WellAway® will pay the claim in the currency incurred.

*WellAway® will pay the initiation fee