TEXMED Group Insurance

health insurace

The plan is designed to give valuable financial assistance in meeting medical costs as a result of a covered accident or sickness. It is very important that you know the scope of the benefits, since you are responsible for any amount charged for medical care in excess of the benefits payable.

Here are some frequently asked questions about the plan.  We have also placed links below to brochures for more information.  Feel free to contact the credit union office for more information.

View Leaflets here: 
Under 60 yrs Leaflet
Over 60 yrs Leaflet

Frequently Asked Questions:

  1. I am healthy now, why do I need health insurance?
    Health Insurance provides financial assistance against medical contingencies. If you apply for medical coverage after you get sick you are unlikely to get coverage. Regularly paying a set premium for health coverage assures that money will be available to defray the cost of everything from routine checkups to catastrophic medical bills. 

  2. What do I need to present to join the plan?
    A valid form of picture ID along with a copy of a recent utility bill is required if you sign up before April 1, 2017. If a Member signs up for coverage after the open enrollment period which ends March 31, 2017 they will also be required to submit completed Evidence of Insurability and Dental & Vision Forms.

  3. Who is eligible for coverage?
    Active members of TEXTEL  Credit Union.

  4. If I come on the plan and then discontinue paying premiums during the year, can I continue later on when I need the plan?
    This is not advisable and you may be required to submit Evidence of Insurability before you are considered to rejoin the plan. 

  5. Is there any refund of premiums, if I don’t claim?
    No, health insurance does not allow for refund of premiums or attract a no-claim bonus.

  6. How long does it take to get reimbursement?
    2 – 3 weeks from the time the claim forms reach our office.

  7. What's the difference between a deductible and coinsurance?  
    Your deductible is the initial amount you must pay each year for covered health services before your insurer will start to reimburse. Your plans has an individual deductible ($300.00) and a maximum of 3 family deductibles.

    Covered charges incurred in the last three months of a calendar year, which were used to satisfy the Deductible, either in full or in part, may be carried over into the following year to assist in satisfying the Deductible.

    Co-insurance is a fixed percentage that you pay toward each service. Your plan carries an 80% - 20% co-insurance factor.

  8. What is a waiting period?
    A stated period after the beginning of coverage during which no benefits are paid. Your plan carries waiting periods for Dental (6 months), Vision (6 months), Preventative Care (3 months) and Maternity (10 months). This is applicable to both Members and Dependents.

  9. What are pre-existing conditions and how do they impact coverage?
    A pre-existing condition is a health condition (other than a pregnancy) or medical problem that was diagnosed or treated during a specified timeframe prior to the commencement of coverage. Your plan allows for a maximum of TT$1,000 for pre-existing conditions for the 1st 24 months.

  10. What is Co-ordination of Benefits and how does it work?
    Even if you are insured under another Group Health Plan you are still eligible to enroll in this plan. Your claims would be handled under the Co-ordination of Benefits provision of the policy.  The Primary Insurer would make the initial claim payment and the balance considered by the other insurer up to their plan limits.  The order of payment is agreed among insurers.
    - Claims for the member should be submitted to their existing Group Health Insurer first. It will then be forwarded to TATIL.
    - Claims for the spouse should be submitted to his/her Insurer first.
    - Claims for dependent children should be submitted to the father’s Insurer first.

  11. Who can be considered my dependents vs. a beneficiary?
    A dependent is considered the spouse (married or common-law) and / or unmarried, unemployed children (inclusive of step-children or legally adopted children and / or foster children) up to 19 years of age or 23 years of age if they are attending school on a full time basis. Parents, siblings and/or extended family members are not considered dependents.

    A beneficiary is the person or entity entitled to receive any claim amounts and other benefits upon the death of the member. It is advised that this person be 18 years and older and can include siblings, aunts, uncles and parents.

  12. How is Overseas Medical Treatment handled?
    Medical expenses incurred for treatment abroad will be payable at the reasonable and customary levels prevailing in Trinidad and Tobago, unless it is proved to the satisfaction of the Company that such medical treatment is not available locally.   This must be certified by two physicians, one of whom must be a specialist in the field of medicine to which the illness applies.  Tatil’s Medical Adviser must give approval of treatment prior to departure abroad.

  13. How are claims handled?
    Settlement of claims under this Plan is on a reimbursement basis, i.e. expenses will be initially borne by the Member and TATIL will reimburse the insured Member up to the amounts recoverable under the plan when a properly documented claim is submitted on the prescribed claim form. Be sure to attach all related bills. Benefits may be assigned by the member for various services (hospital, surgeons, MRI, Dental & Vision), in which case TATIL will pay direct to the provider the amount to which the Member may be entitled in respect of hospital and surgical expenses.