Frequently Asked Questions

What is Accident Insurance?
Accident Insurance is supplemental to your primary health plan that helps you pay for out-of-pocket medical and non-medical costs from an accident or injury. Your plan provides lump-sum cash benefits that are paid directly to you, and not the doctors and hospitals.

What is Critical Illness Insurance?
Critical Illness Insurance is supplemental to your primary health plan that helps you pay for out-of-pocket medical and non-medical costs from lifechanging illnesses. Your plan provides lump-sum cash benefits that are paid directly to you, and not the doctors and hospitals.

What is Hospital Insurance?
Hospital Insurance pays you benefits when you are confined to a hospital, whether for planned or unplanned reasons, or for other medical services, depending on the policy. The plan provides payment for each day spent in the hospital, and for some other qualified expenses as well. That’s money you can use however you choose whether for hospital bills or those other costs that come up while you’re recovering.

How are EssentialCare Group Accident, Critical Illness, and Hospital Insurance different from major medical insurance?
Major medical insurance pays for doctors and hospitals. Our coverage is designed to provide you with cash benefits, unless otherwise assigned, that you can use to help with daily expenses when you’re injured—cash to be used as you wish to help you and your family with unexpected expenses.

Can I enroll in Accident, Critical Illness, or Hospital Insurance without having to take a medical exam?
Yes. EssentialCare Group Accident, Critical Illness, and Hospital Insurance are guaranteed issue, which means your acceptance is guaranteed, regardless of your health. You just need to be actively at work for your coverage to be effective. There are no medical exams to take and no health questions to answer.

Is there a waiting period before my Accident, Critical Illness, or Hospital Insurance coverage begins?
No. This coverage will be effective at the beginning of your benefit period as long as you are actively at work. There are no waiting periods to satisfy. Pre-existing conditions are excluded.

Can I increase my Accident, Critical Illness, or Hospital Insurance coverage at any time if I continue my coverage on an individual basis?
No. The option to change your coverage is only available during open enrollment.

What if I want to cancel my Accident, Critical Illness, or Hospital Insurance coverage?
You can cancel at any time. Call our Customer Service Center at (877) 563-2367 for cancellation procedures.

Will my Accident, Critical Illness, or Hospital Insurance benefit checks be payable to me?
Benefits will be paid directly to you, the insured, unless otherwise required by law or assigned. You can also choose to direct a hospital, physician, or other health care provider to receive your benefits. This is called assigning benefits, and you can do so by signing the appropriate section on the claim form or by signing an assignment of benefits at the health care provider’s office.

Are my Accident, Critical Illness, or Hospital Insurance benefits taxable?
If you pay premiums under a flexible benefits plan with pre-tax dollars, or if your employer pays part or all of your premiums, some of the benefits you receive may be taxable. Therefore, you may receive a W2 form from your employer that will include the taxable benefit amounts you received. In addition, a 1099 form will be sent to the insured if a benefit of more than $10,000 is provided. If you have questions about taxability of benefits, discuss them with your employer or tax advisor.

What happens if my employment status changes? Can I take my Accident, Critical Illness, or Hospital Insurance with me?
If you terminate your employment with your employer, you may opt to continue your current coverage on an individual pay basis, as long as your employer’s plan has the Portability Coverage option available. Please see your certificate for plan details.

What is Limited Benefit Fixed Indemnity Medical plan and how do benefits pay?
A fixed indemnity plan is known as a fee-for-service plan and provides cash payout benefits for specific covered services.

Is there a pre-existing condition limitation on Limited Benefit Fixed Indemnity Medical plan?
No, there is not a pre-existing condition limitation for the fixed indemnity medical plan which means if you have been previously diagnosed with a medical condition, you can receive coverage for related services as soon as your coverage is effective.

When can I enroll in Limited Benefit Fixed Indemnity Medical plan?
Once eligible, you can enroll in coverage during the open enrollment period or if there is a qualifying life event due to marriage, divorce, legal separation, loss or gain of insurance coverage, death of a spouse, and birth or adoption of an eligible dependent.

Who can I cover under Limited Benefit Fixed Indemnity Medical plan?
You can cover eligible family members in the fixed indemnity medical, vision, dental and/or term life plan. Your eligible family members (dependents) are:
Your spouse
Your domestic partner*
Your children under age 26*
*State laws may vary. Call the BCS Customer Support Center at (877) 563-2367 for details.

When does my Limited Benefit Fixed Indemnity Medical coverage begin and end?
Coverage begins the first of the following month after you enroll. Coverage ends when a payroll deduction is not taken. Note once coverage ends, you will not be able to re-enroll until the next open enrollment period or until you have a qualifying life event.

Do I have to enroll in all benefits?
No, you may select to enroll in the fixed indemnity medical, dental, vision, term life or short-term disability.

Can I enroll in different tiers for the fixed indemnity medical, dental, vision or term life?
No, the tier you select for one coverage will be the same for all.

What happens after I enroll in Limited Benefit Fixed Indemnity Medical plan?
Within 2 weeks after your coverage begins in EssentialCare you will receive the following information:
• A copy of your ID Card with your name on it.
• Confirmation of Coverage Letter.
• Some other helpful information about your benefits.

Are maternity benefits covered on Limited Benefit Fixed Indemnity Medical plan?
Yes, maternity benefits are covered under this plan as any other condition.

Whom do I call with questions about my coverage?
If you have questions, please contact the BCS Customer Support Center toll-free at (877) 563-2367. Representatives (including bilingual representatives) are available Monday – Friday from 8am – 6pm Eastern Time.

How do I know what benefits I have?
Benefits information can be found on the BCS Gateway portal (bcsgateway.com) under “Plan Summary” on the left side of your screen.

How do I register for the portal?
A BCS portal registration letter should have been mailed to your address on file. If you need assistance, please call BCS Customer Support Center at (877) 563-2367.

How do I file a claim?
To file a claim, download the Combined Claim form from bcsgateway.com or call BCS Customer Support Center at (877) 563-2367 to request a form.

Where can I get a claim form?
Claim forms can be obtained by logging onto bcsgateway.com.

What information do I need for filing a claim?
Claimants will need to complete the claim form and provide supporting documentation.

How long do I have to file a claim?
There is a one-year timely filing provision in your certificate. Please review the provision and call BCS Customer Support Center at (877) 563-2367 with any questions.

Where do I send my claim information to get processed?
Claim information can be faxed to BCS Customer Support Center at (630) 869-0655, uploaded in the Message Center of bcsgateway.com or mailed to the following address:
BCS Customer Support Center
P.O. Box 458022
Westlake, OH 44145

How long does the claim process take?
Once all necessary information is received, claims can be processed within 2–5 business days.