Eligibility & Definition of Primary Health Plan
To be eligible for this plan, you must be enrolled in a primary health plan.
Although this plan is a secondary policy, HTH pays contracted medical providers directly in 180 countries. See HTH Direct Claims Pay.
A Primary Plan is a Group Health Benefit Plan, an individual health benefit plan, or a governmental health plan designed to be the first payer of claims (such as Medicare) for an Insured Person prior to the responsibility of this Plan. Such plans must have coverage limits in excess of $50,000 per incident or per year to be considered a Primary Plan.
Group Health Benefit Plan means a group, blanket, or franchise insurance policy, a certificate issued under a group policy, a group hospital service contract, or a group subscriber contract or evidence of coverage issued by a health maintenance organization that provides benefits for health care services. The term does not include:
- accident-only, credit or disability insurance coverages;
- specified disease coverage or other limited benefit policies;
- long-term care, dental care, or vision care coverages;
- coverage provided by a single service health maintenance organization;
- insurance coverage issued as a supplement to liability insurance;
- insurance coverage arising out of a worker's compensation system or similar statutory system;
- automobile medical payment insurance coverage;
- jointly managed trusts authorized under 29 U.S.C. Section 141 et seq. that contain a plan of benefits for employees that is negotiated in a collective bargaining agreement governing wages, hours, and working conditions of the employees that is authorized under 29 U.S.C. Section 157;
- hospital confinement indemnity coverage; or
- reinsurance contracts issued on a stop-loss, quota share, or similar basis.
PLEASE NOTE: Medicaid and V.A. health plans do not constitute primary health insurance because they are not defined as the first payer of medical claims.