TransAmerica Employee Voluntary Benefits Claim Process

Submitting a TransAmerica Self-Administered Accident, Critical Illness, Hospital Indemnity Claim Process

This Health Claim Package consists of multiple parts. When filling out each package section, please remember to provide complete and accurate information. If you make a claim on your dependent who is over the age of 18, the claimant (patient) needs to sign and date the HIPAA Authorization for the Release of Health-Related Information (“HIPAA Authorization”) – you cannot sign for the dependent. It’s important to note that each claim type’s list of forms and information is generic. Please call the Contact Center at (855) 244-8318 for a copy of your certificate of benefits to help determine what else you need to submit for consideration.

HOW IT WORKS:

• Pays benefits directly to you.
• Spouse and dependent benefits available.
• Payroll-deducted premiums.
• Easy enrollment process.

⏭️CLAIMS PROCESS:

All Forms must be physically signed, with the name printed and the date, and include the Policy Number. Please reference the following specific product number for the type of claim being processed. Fill out the claim form packet and send it back, along with the required documents, to National Account / Self Admin

📌Click to access the Claim Form Packet

This number must be included on the claim form.

• CANCER SELECT PLUS PRODUCT NUMBER: CN00084529 
• TRANSAMERICA UNIVERSAL LIFE PRODUCT NUMBER: FP00084436
• TRANSAMERICA 10-YEAR TERM LIFE PRODUCT NUMBER: T100084434
• TRANSAMERICA 20-YEAR TERM LIFE PRODUCT NUMBER: T200084435

Every box must be filled out, and if it doesn’t apply, put N/A – Not Applicable.

• Claimant Statement -2 pages
• Attending Physician’s Statement – 1 Page
• Medical History Form – 2 Pages 
• HIPAA Authorization – 2 Pages
• Claim Fraud Warning – 1 Page

Accident* Claimant’s HIPAA Authorization showing actual charges/expenses for medical treatment or diagnosis. (Accident Wellness Benefit is only applicable to adults)
Critical Illness* Claimant’s Statement, Attending Physician’s Statement, HIPAA Authorization, diagnostic reports (pathology report if cancer-related), discharge summary, or other medical records indicating the condition and date of diagnosis.
Hospital Indemnity* Claimant’s Statement, Attending Physician’s Statement, HIPAA Authorization, and an itemized hospital or UB04 statement.
Wellness Screening Benefit* You must only submit statements or medical records from the physician or hospital showing the date and procedure performed. No additional documents are necessary; remember to include the product number. 

Itemized Statement of Medical Charges for each Date of Service –

The UB04/CMS-1500 form is required from the billing department at the hospital/Facility Where he/she was. It includes the Diagnosis Codes, the Number of units, and Prices, and requires the Explanation of Benefits Statement from Medicare, Medicaid, or another insurance carrier.

• Hospital Indemnity
• Major Diagnostic Exam (MRI)
• Ambulance
• Surgery Benefit
• Anesthesia Benefit
• Chemotherapy / Radiation 
• Blood / Plasma / Platelets / Bone Marrow and Stem Cell Transplant

When admitted to the hospital, the UB-04/CMS-1500 (Sample of UB-04 Form) must indicate that you were a Resident Bed Patient or Room and Board for the claim to be paid. Don’t let the hospital tell you that they don’t know what that is.That’s how they bill the insurance company for services rendered. You get it from the Billing Department.

What is proof of loss?  Proof of Loss, usually it means that we need the Explanation of Benefits Statement for Medicare, Medicaid or whomever their Insurance Carrier is. The Benefits Payable amount is based on the Actual Charges owed to and accepted by the provider as payment in full for covered services. This amount is determined based on the information that you submitted as part of your proof of loss.

🎯Please make sure to put the Policy Number on all pages of the Claim Form as well in the Subject line of the Email or on the Fax Cover Sheet.

Self Admin Email: [email protected]

Mail to: Transamerica — Claims PO Box 219 Cedar Rapids, IA 52406-021

Via Contact Info:

Self Admin PH # 855-244-8318

Self Admin Fax # 855-604-5205

⏭️ Instructions for Submitting a TransAmerica Cancer Select Plus / Universal Life and Term Life Claims

All Forms must be physically signed, with the name printed and the date, and include the Policy Number. Please reference the following specific product number for the type of claim being processed. 

Transamerica Universal Life Insurance: provides a cash benefit upon death that can help cover final expenses, dependents’ care, living expenses, or college tuition. You had the choice between two types of life insurance coverage: a 10- or 20-year term life plan and a new Program, a Permanent Life policy with Long Term Care benefits. These options give the flexibility to select the coverage that aligns with your individual needs and circumstances.

Please note—Universal Life and Term Life (10/20 years) claims: The beneficiary or employer should contact customer service at 888-763-7474. Once the death notification is received, the claims team will mail the claim packet to the beneficiary. This packet has instructions for submitting a claim. The policy number must be listed on the claim form.

This number must be included on the claim form:

• CANCER SELECT PLUS PRODUCT NUMBER: CN00084529 
• TRANSAMERICA UNIVERSAL LIFE PRODUCT NUMBER: FP00084436
• TRANSAMERICA 10-YEAR TERM LIFE PRODUCT NUMBER: T100084434
• TRANSAMERICA 20-YEAR TERM LIFE PRODUCT NUMBER: T200084435

Every box must be filled out; if it doesn’t apply, enter N/A (Not Applicable).

• Claimant Statement -2 pages
• Attending Physician’s Statement – 1 Page
• Medical History Form – 2 Pages 
• HIPAA Authorization – 2 Pages
• Claim Fraud Warning – 1 Page
• Pathology Report for the First Positive Diagnosis of Cancer
• Pathology Report for each Date of Service
• Date of Diagnosis
• Statement for Surgery / Biopsy – The Patient Identifying Information, the Date of Service, the CPT Procedure Codes and Charges
• Operative Report for each Date of Service

Cancer Select Plus – Annual Cancer Screening: Pays per calendar year for the following cancer screening tests (This benefit only applies to adults):

• Mammogram
• Pap smear
• Flexible sigmoidoscopy
• Prostate-specific antigen
• Test
• Chest x-ray
• Hemocult stool specimen
• Ultrasound
• CEA
• CA125
• Biopsy
• Thermography
• Colonoscopy
• Serum protein
• Electrophoresis
• Bone marrow testing
• Blood screening

When filing a Cancer Claim*, include the Claimant’s Statement, Attending Physician’s Statement, HIPAA Authorization, and pathology report diagnosing cancer. Itemized provider statements with actual charges/expenses (**) incurred for the treatment.