You can find information about your health plan benefits by logging on to My Colina portal at www.colina.com and accessing your Schedule of Benefits.  If you are an Individual Medical Policyowner, your Schedule of Benefits can also be found in your policy contract.

You can find this information by logging on to My Colina portal at www.colina.com.

You can find resources to help you understand your health plan by logging on to My Colina portal at www.colina.com and downloading the Understand Your Plan pdf document.

You can call 356-8400 to speak with a Customer Service Representative, or send an email to [email protected]. Our Customer Service Representatives are available weekdays from 9am to 5pm and will be more than happy to assist you in getting answers to your health plan questions.

Preventative healthcare is the care you receive such as annual check-ups, immunizations and screenings to prevent illnesses or diseases and help you stay healthy. Colina’s health plans cover preventive services at 100%, up to the Calendar Year maximum benefit in the Schedule of Benefits found in your Group Insurance Coverage Booklet. This means that no deductibles, co-payments or coinsurance applies.

A Lifetime Maximum is the total or maximum dollar amount that Colina will pay in medical benefits during the time a Covered Person is enrolled in a health plan. Each covered person (employee and dependents) has a lifetime Maximum.

An annual maximum is the yearly limit, or maximum dollar amount, Colina will pay in Medical benefits for a Covered Person (age 70 years and older) during any given calendar Year. This maximum amount restarts at the beginning of a new calendar year until the lifetime maximum has been reached. The portion of the annual maximum used in any calendar year is deducted from the lifetime maximum.

The dollar amount you pay towards certain covered services each calendar year before your insurance plan starts paying any of the cost, or before the co-insurance kicks in. Deductibles are not applicable to services requiring a co-payment (you do not have to satisfy your Deductible before making a co-payment). Co-payments and co-insurance amounts do not go towards your deductible. Refer to your health plan’s Schedule of Benefits to see what deductible you have and the benefits to which it applies.

A fixed amount you pay to a healthcare provider at the time of service which can vary depending on your health plan and the services you receive. Co-payments do not go towards your deductible nor your out-of-pocket maximum amount.

The shared cost between the covered person and the insurance company for specified covered services. Co-insurance percentages vary between plans and is usually expressed as a percentage split, where the covered person pays a certain percentage and the insurance company pays the rest. Co-insurance begins after your deductible is met and goes towards your out-of-Pocket Maximum amount. Once your Out-of-Pocket Maximum is reached in a Calendar Year, you will not be required to pay a co-insurance amount for the remainder of the Calendar Year.

The out-of-pocket maximum is the most that you will be required to pay out of pocket for in network expenses during a Calendar Year. Only your co-insurance payments go towards your Out-of-Pocket Maximum amount. Once you have paid the maximum Out-of-Pocket amount, your insurance should pay 100 percent of your covered services for the remainder of the calendar Year.

Choosing a In-Network or Participating Provider from our provider networks eliminates the need for you to submit a claim. However, if you choose to receive care from a “Non-Participating Provider”, you will have to pay the provider in full for services and subsequently submit a claim to us for reimbursement at a reduced percentage/amount. Individual Medical policyholders and Group Plan Members are required to register for My Colina portal at www.colina.com and submit claims using the “Submit a Claim” feature.

All claims must be submitted within six (6) months from the date of service. Claims submitted outside of this time frame will be denied for untimely filing.

Clean/routine claims are processed within 7 – 10 business days.  A clean claim is one with all the required documents (itemized bill, proof of payment and other supporting documents) attached to a completed claim form.

A claim can be denied for any number of reasons not limited to the following:

1. The service received was not a covered benefit under your policy;
2. Your claim was submitted past the claim filing period which is 6 months;
3. Colina did not pre-approve the service; or
4. Additional information is required from your physician in order to process the claim; or

Once you have registered for the My Colina portal, you can track the status of your claim by reviewing your claims history on the “My Claims” page.

An In-Network Provider should not bill an insured for outstanding balances after the insurance company has paid its portion of the bill.

Each time Colina process a claim submitted by you or your healthcare provider, we explain how we processed it in the form of an Explanation of Benefits (EOB).  The EOB is not a bill.  It simply explains how your benefits were applied to that particular claim.  Each time you receive an EOB, review it carefully to make sure you received the service(s) being billed.  If you observe any discrepancies between your EOB and the services your received from your healthcare provider, contact us immediately at 356-8400.

You can call 356-8400 to speak with a Customer Service Representative, or send an email to [email protected]. Our Customer Service Representatives are available weekdays from 9am to 5pm and will be more than happy to assist you in getting answers to your health plan questions.

You can submit a completed claim form to [email protected]

Yes, you will have to satisfy co-payments, deductibles and co-insurance according to the provisions of your policy.

Choosing a “Participating Provider” from our provider networks eliminates the need for you to file a claim. However, if you choose to receive care from a “Non-Participating Provider”, you will have to pay the provider in full for services and subsequently file a claim with us for reimbursement. We aim to settle claims within 7-10 business days.

You can send an email to [email protected] or call 396-5140/396-5146/396-5142

You can send an email to [email protected] or call 396-5140/396-5146/396-5142

All claims must be submitted within six (6) months from the date of service. Claims submitted outside of this time frame will be denied for untimely filing.

Please answer all the questions on the employee section of the form, and remember to sign your form as well. If the claim is for a dependent, that person also needs to sign the form, unless the dependent is a minor.

Your Plan Administrator needs to complete the Employer’s Section of the form, and needs to sign and date the form as well.

Your health care provider should indicate the patient’s diagnosis using an ICD-10 code, the patient’s name, date of service, what service or services was/were provided using a CPT code, and the charge for each of these services. Charges for lab tests that were performed, and the fee for each of these tests. If a surgical procedure is performed, we require the surgeon to submit an operative report.

For additional information regarding claims:

Individual medical claims – [email protected] or call 396-5140/396-5146/396-5142

Group Medical claims – [email protected] or 396-5140/396-5146

Life claims – [email protected]

Our Customer Service Representatives are available weekdays from 9am to 5pm and will be more than happy to assist you in getting answers to your health plan questions.

In order for us to consider your claim, you would need to submit copies of all the bills along with a copy of your other insurance carrier’s explanation of benefits (EOB) statement.

We accept only original receipts (except in a coordination of benefits situation with another carrier) that includes the provider’s name, the amount paid, the balance owing, and the date. We do not accept cash register receipts, canceled cheques, credit card receipts or statements, or balance due statements.

A Pre-existing Condition is an illness or injury (including pregnancy, complications of pregnancy, or pregnancy-related conditions) for which symptoms have been present or for which an insured has received medical care, treatment or advice at any time during the 12 months before coverage begins under the policy. A Pre-existing Condition is not covered within the first twelve (12) months of coverage.

Exclusions are services that are not covered under a health plan.  The insured is required to pay the full cost of non-covered services out of their own pocket.

Pre-Certification is the approval in advance by the Company for a medically necessary and covered medical procedure or service, or an elective admission to a Hospital for care.

A Referral is a written recommendation by an insured’s primary care physician or a specialist that the insured see another physician or specialist.

Preventative care is the care you receive such as annual check-ups, immunizations and screenings to prevent illnesses or diseases and help you stay healthy. Colina’s group and individual health plans cover preventive services at 100%, up to the Calendar Year maximum benefit found in your Schedule of Benefits.  This means that no deductibles, co-payments or coinsurance applies.

A Lifetime Maximum is the total or maximum dollar amount that Colina will pay in medical benefits during the time a Covered Person is enrolled in a health plan. Each covered person – has a Lifetime Maximum which can be found in your Schedule of Benefits.

An Annual Maximum is the yearly limit, or maximum dollar amount, Colina will pay in Medical benefits for a Covered Person during any given Calendar Year. This maximum amount restarts at the beginning of a new Calendar Year until the Lifetime Maximum has been reached. The portion of the Annual Maximum used in any Calendar Year is deducted from the Lifetime Maximum. The Annual Maximum can be found in your Schedule of Benefits.

The dollar amount you pay towards certain covered services each Calendar Year before your insurance plan starts paying any of the cost, or before the Co-insurance kicks in. Deductibles are not applicable to services requiring a Co-payment (you do not have to satisfy your Deductible before making a Co-payment). Co-payments and Co-insurance amounts do not go towards your Deductible. Refer to your health plan’s Schedule of Benefits to see what Deductible you have and the benefits to which it applies.

A fixed amount you pay to a healthcare provider at the time of service which can vary depending on your health plan and the services you receive. Co-payments do not go towards your Deductible nor your Out-of-Pocket Maximum amount, if applicable to your health plan.

The shared cost between the covered person and the insurance company for specified covered services. Co-insurance percentages vary between plans and is usually expressed as a percentage split, where the covered person pays a certain percentage and the insurance company pays the rest. Co-insurance begins after your Deductible is met and goes towards your Out-of-Pocket Maximum amount, if applicable to your health plan. Once your Out-of-Pocket Maximum is reached in a Calendar Year, you will not be required to pay a Co-insurance amount for the remainder of the Calendar Year.

The Out-of-Pocket maximum is the most that you will be required to pay out of pocket for in network expenses during a Calendar Year. Only your Co-insurance payments go towards your Out-of-Pocket Maximum amount. Once you have paid the  Out-of-Pocket Maximum amount, your insurance should pay 100 percent of your covered services for the remainder of the Calendar Year.  Out-of-Pocket Maximum is not applicable to individual medical plans. Who can I contact regarding my health plan benefits?

A Calendar Year is from the 1^st day of January to the 31^st day of December (both days included).

Co-ordination of Benefits is the practice of ensuring that total paid claims do not exceed 100% of covered charges, when an insured is covered by two (2) or more health plans.  This process determines which plan pays first (the primary plan) and which plan pays second (the secondary plan).

A Schedule of Benefits is a list of various benefits and services covered under a health plan and which outlines the responsibility of the insured and the Company.

A Dependent is an individual, other than the policyholder, or employee, who is eligible for coverage under a health plan.  Generally, a Dependent is limited to a spouse and unmarried child, including a legally adopted, step-child or legal ward.

Usual, Customary and Reasonable Charges are charges of healthcare providers that are consistent with charges from similar providers for identical or similar services in a given geographical area.

An In-Network or Participating Provider is an approved provider who has a contract with an insurance company or their representative.

An Out-of-Network or Non-Participating Provider is a provider who does not have a contract with an insurance company or their representative.

In the case of group insurance, a Covered Person is an Employee or a Dependent in respect of whom insurance is provided under the Policy. In the case of individual medical insurance, a Covered Person is the Policyholder or a Dependent in respect of whom insurance is provided under the policy.

To speak with a Customer Service Representative, dial 356-8400.

You can designate your spouse, and biological, legally adopted or step-children as dependents on your benefits plan.

We would need a letter from the University confirming that your child is a student there, their status as a student and the active period of enrollment for your child. This letter needs to be resubmitted every new active period of enrollment (i.e. every semester or upon request of Colina to verify or pre-cert benefits).

Emergency care for life threatening or severe medical conditions are covered 24 hours a day, seven days a week, worldwide.

In the event of a medical emergency, call 911 or go to the nearest private hospital emergency room. You will be required to make payment as stipulated in your Schedule of Benefits and according to the classification of the care administered. A Referral is not required for emergency care. Should you require emergency care while travelling, please access the nearest medical facility and/or contact Sanus Health Corporation, using the number on the back of your ID card. The Pre-Certification Program requires that a Covered Person, or someone on his behalf, contact Colina as soon as possible, but no later than 48 hours after the date and time of Admission, or as soon as reasonably possible thereafter.

Typically, if you visit a physician or other healthcare provider within Colina’s network, the amount you will be responsible for paying will be less than what you will pay to a Non-Participating or Out-of-Network Provider. This is because Colina have agreements in place with these providers.

Colina has an extensive local provider network which can be found on our website at www.colina.com under the Individual Health Insurance or Group Health Insurance page. 

Covered persons have access to the highest quality care overseas with the best outcomes. We have an extensive overseas provider network through partnership with our overseas Third Party Administrator (TPA) Sanus Health Corporation which contracts services with healthcare providers directly or through major provider networks including United Healthcare, one of the largest provider networks in the U.S.  To find out more about our overseas network, visit our website at www.colina.com and click on the Individual Health Insurance or Group Health Insurance page.  You can also visit  Sanus Health Corporation at www.sanushealth.com to locate a healthcare provider.

Pre-Certification is the approval in advance by the Company for a medically necessary and covered medical procedure or service, or an elective admission to a Hospital for care. For certain procedures or services, your healthcare provider must receive prior approval from Colina. Procedures or services requiring Pre-certification or Pre-authorization from the Company, prior to services being rendered, are outlined in your Schedule of Benefits.  Your provider office will typically obtain the required Pre-certification, however, it is ultimately the Covered Person’s responsibility to ensure that the Pre-certification requirements have been met. We appreciate that there will be times when it will not be practical or possible for a Covered Person to contact us for prior approval, like in the case of emergency hospital admission. In circumstances like these, we require you to obtain Precertification within 48 hours after the date and time of admission, or as soon as reasonably possible thereafter. If you fail to obtain Pre-certification, Colina will only pay 50% of Usual, Customary, and Reasonable Charges (URC), after you have paid your applicable out-of-pocket expenses, and you will be responsible for the balance.

A Referral is a written recommendation by an insured’s primary care physician or a specialist that the insured see another physician or specialist. Colina must coordinate and approve all non-emergency overseas medical services. It is your responsibility to provide a Letter of Medical Necessity and Referral from a Specialist in The Bahamas to a Specialist overseas for a second opinion or for treatment not available locally. If you fail to obtain a referral, and Colina’s approval of the same, prior to obtaining non-emergency medical services overseas, Colina will only pay 50% of Usual, Customary, and Reasonable Charges (URC), after you have paid your applicable out-of-pocket expenses, and you will be responsible for the balance.

Your Health Insurance ID Card is your proof of insurance which allows healthcare providers to verify coverage. Covered Persons are required to present this card when visiting a doctor, hospital or other Colina healthcare providers to receive medical services. Review your ID card as soon as you receive it and contact us at 356-8400 to report any discrepancies in your personal information appearing on your card. In the event you misplace your Insurance ID Card, register for My Colina portal at www.colina.com where you can view or print an electronic version of your card.

Group Insurance provides coverage to a defined group of people (typically employees of an organization) under a single master policy which is a contract between the Policyholder or Plan Sponsor (normally an Employer) and the insurance company.

Colina Insurance Limited offers the following products to groups under our Stellar Care Suite of products:

a) Health Insurance: Medical, Vision and Dental
b) Life Insurance: Life and Accidental Death & Dismemberment
c) Disability Insurance: Long-term disability and Short-term disability
d) Critical Illness Insurance

No. Only the policyholder (your employer) can upgrade benefits to the plan.

Premium payments are due on the 1^st of the month.

Yes. Our health policies have a 30-day grace period for payment of premiums which starts from the 1^st day of each month.

Premiums can be paid via:

• Pre-authorized Cheque (PAC)
• Debit/credit card payments (via our website, www.colinapayments.com)
• CIBC FirstCaribbean International Bank online
• Commonwealth Bank online
• Royal Bank of Canada online
• Bank of The Bahamas (over-the-counter: BOB customers only)
• Cheque drop box (21 Collins)
• In-person at any one of our convenient locations

Who can I email if I need assistance with the payment process? Email [email protected] for direct assistance with the payment process.

A drop box is available at our 21 Collins Avenue location

Premiums can be paid via:

• Pre-authorized Cheque (PAC)
• Debit/credit card payments (via our website, colinapayments.com)
• CIBC FirstCaribbean International Bank online
• Commonwealth Bank online
• Royal Bank of Canada online
• Bank of The Bahamas (over-the-counter: BOB customers only)
• Cheque drop box (21 Collins)
• In-person at any one of our convenient locations

Online Banking

Payments made via our online platform at First Caribbean Bank and Commonwealth Bank are received and processed the following business day after payments are made. Your online bank account statement can be used as proof.

Colina Website

Payments made on business days by 5:00 p.m. are processed the same day. Payments made after 5:00 p.m. are processed the following business day. You will receive an email receipt from [email protected] to confirm your payment.

Yes. You or your physician should contact Colina to pre-certify your hospital admission. This will maximize the percentage of expenses covered under your plan.

For certain procedures or services, your healthcare provider must receive prior approval from Colina. Procedures or services requiring pre-certification or pre-authorization from the company, prior to services being rendered, are outlined in detail in your Group Insurance Coverage Booklet.

Colina Insurance Limited offers the following comprehensive products to groups under our Stellar Care Suite of products:

a) Health Insurance: Medical, Vision and Dental
b) Life Insurance: Life and Accidental Death & Dismemberment
c) Disability Insurance: Long-term disability and Short-term disability
d) Critical Illness Insurance

To learn more about our group insurance products, visit the Group Health Insurance page on our website to see our product offerings.

A minimum of 5 eligible employees, working a minimum of 30 hours per week, can be covered under a group plan. Coverage for part-time employees may be considered on a case by case basis, as requested by the employer. Part-time employees are not eligible for group Long-term Disability coverage.

The employer must, at all times, make a meaning contribution (i.e. a minimum of 50%) towards the cost of insurance to ensure a high level of participation. Group insurance plans can be contributory or non-contributory for the employee. This means that the employer can contribute 100% of the cost.

At least 70% of eligible employees, who do not have an existing coverage, must enroll in the plan, both initially and at renewal.

Yes. Colina’s Individual Medical (Shape) plans are managed care major medical plans which provide all essential health benefits like emergency services, primary & specialist care, surgical services, hospitalization, overseas care, organ transplants, preventive care, prescription medication, maternity and newborn care and much more, subject to the terms, conditions, limitations and exclusions of your policy contract. We have Individual Medical plan options with varying levels of benefits to suit your needs and budget. To learn more about our individual health plans, visit the Individual Health Insurance page on our website to see our product offerings.

Yes. One of the benefits of our major medical plans is that you have access to the Colina network locally, and to the Sanus Health Network oversees. Both offer an extensive range of high quality health care providers.

Typically, if you visit a physician or other provider within Colina’s network, the amount you will be responsible for paying will be less than what you will pay to a Non-Participating or Out-of-Network Provider. This is because Colina contracts with many doctors, hospitals, labs, pharmacies and other facilities who have agreed to accept a negotiated discount rate for their services.

Information about the network, as well as provider information is available on our website (www.colina.com), on the Sanus Health Network website (www.sanushealth.com) or from your group plan administrator (HR Dept.).

Dental coverage is available as a part of our group insurance plans. If your employer has chosen dental insurance coverage for you and your dependent(s), Colina will only pay benefits for covered dental expenses in accordance with the Schedule of Benefits found in your Group Insurance Coverage Booklet and other applicable provisions of your Employer’s group insurance policy.

Vision coverage is available as a part of our group insurance plans. If your employer has chosen vision insurance coverage for you and your Dependent(s), Colina will only pay benefits for covered vision expenses in accordance with the Schedule of Benefits found in your Group Insurance Coverage Booklet and other applicable provisions of your Employer’s group insurance policy.

Vision insurance coverage covers 100% of covered vision services up to the calendar year maximum benefit in your Schedule of Benefits. No deductibles, co-payments or co-insurance apply.