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Medical Information for Personal Injury Protection (PIP) and Medical Payments Coverage (MedPay)*

Medical Information for Personal Injury Protection (PIP) and Medical Payments Coverage (MedPay)*

 

What Is PIP
Personal Injury Protection coverage is typically referred to as PIP or no-fault coverage. In the unfortunate event you are injured in an automobile accident, PIP provides coverage for payment of your medical bills (and some other medical-related expenses) that you incur as the result of an auto-related injury.

What Is MedPay?
MedPay helps pay for medical and funeral expenses after a car accident, no matter who is at fault. This coverage is an optional form of auto insurance, and when purchased, typically covers the policyholder, family members driving the car and any passengers.

If you are a Connecticut resident who has filed a claim with Plymouth Rock, you may need to provide additional information to resolve your claim as quickly as possible. For a list of Claim Forms, click here.  

Your claim representative will let you know exactly what you need to provide, assist you with questions about the forms and provide you with instructions on how and where to submit them.

Auto coverage is primary for the first $8,000 in medical expenses. Once $2,000 has been paid, we will coordinate benefits with the health insurance up to the purchased limit.

Coordination of Benefits
Some people have a policy of health (“health plan”). If so, we will pay up to $2,000 of medical expenses for any injured person. We will also pay medical expenses in excess of $2,000 for such injured person, which will not be paid by a health plan (co-payments, deductibles, co-insurance). Medical expenses must be submitted to the health plan to determine what the health plan will pay before we pay benefits in excess of $2,000 under this Part. We will not pay for medical expenses in excess of $2,000 that the health plan would have paid had the injured person sought treatment in accordance with the requirements of the health plan.

Medical Payments
Medical Payments, or MedPay, helps pay for reasonable expenses for necessary medical and funeral costs after a car accident, no matter who is at fault. This coverage is an optional form of auto insurance, and applies only after PIP coverage has been paid in full. This does not apply to motorcycle claims. Massachusetts residents who have filed a claim with Plymouth Rock may need to provide additional information to resolve your claim as quickly as possible. Click here for a list of Claim Forms.

What Is MedPay?
MedPay helps pay for medical and funeral expenses after a car accident, no matter who is at fault. This coverage is required for all private passenger auto policies in New Hampshire. It typically covers the policyholder, family members driving the car and any passengers.

To download a Medical Authorization Form, click here.  

For additional MedPay information, read this Accidents and Financial Responsibility Bulletin from the New Hampshire Insurance Department.

Forms
Access many of the important PIP forms online. If you are a medical provider, you can access our Decision Point Review Plan and Attending Provider Treatment Plan Form in this section.

Health Care Primary: Lower Your Premium and Maintain Protection
Health Care Primary is a coverage option available to personal auto insurance policyholders in New Jersey who currently have health insurance. By selecting this option, you can immediately lower your auto insurance Personal Injury Protection (PIP) premium on each insured automobile by designating your health insurance as your source of primary health care services for auto accidents. As long as you provide us with the name and policy number of your health insurer, we will waive the additional $750 deductible that would have previously applied under the old option if your health carrier would not accept the primary position. If an accident occurs, your health insurer would serve as your primary health care provider and Plymouth Rock would provide secondary coverage through PIP. Please review the frequently asked questions below or ask your agent to determine if Health Care Primary is an appropriate option for you. To learn more about Health Care Primary read our FAQs.

Who is eligible for these savings?
You are eligible to save money by selecting Health Care Primary if you have health insurance coverage in effect at the time you make the selection and your health insurance is not provided through Medicare, Medicaid, or a New Jersey Family Care Plan (provided by Aetna Better Health, AmeriGroup Community Care, Horizon NJ Health, UnitedHealthcare Community Plan or WellCare).

What do I do if I have an automobile accident?
First, report your claim to the Plymouth Rock Claims Department. If you are involved in an accident wherein you incur medical bills, follow the normal procedures of your primary health care plan, visit your own doctor and send the bills to your health insurance carrier. Plymouth Rock will coordinate with you to ensure your bills are handled properly.

What happens if my health carrier will not provide coverage for my automobile accident?
Don’t worry, we’ve got your back. As long as you had health insurance in effect at the time you made the health care primary selection and have confirmed your selection, Plymouth Rock will waive the additional $750 deductible that previously would have applied and will waive any premium difference. We will pay your medical benefits through the PIP portion of your automobile insurance policy.

I am interested in this savings opportunity. How do I sign up?
To immediately lower your premium, simply download and return a Coverage Selection Form to P.O. Box 903, Lincroft, NJ 07738. If you have any questions, do not hesitate to give us a call at 855-268-2363 or contact your agent.

Find a Doctor — Signature Medical Concierge Program
We at Plymouth Rock are proud to offer you our innovative Signature Medical Concierge Program. Concierge is leading the way to a new level of customer service with the focus on you as our valued customer.

Our goal is to provide superior service through the utilization of our Signature Medical Concierge Program, which consists of a sophisticated network of doctors, facilities and service providers. These networks are voluntary. Utilization of this program provides the highest level of coverage under your policy. If you decide not to use the diagnostic, outpatient facility, and medical equipment networks, additional copayments may apply.

Consumer Health Network

800-225-4246 ext. 5513
609-570-2041 (direct)

Pharmacy

Mitchell ScriptAdvisor: 866-221-6588
Optum: 877-494-9195

Outpatient Facility

Consumer Health Network: 800-225-4246

Medical Equipment

Consumer Health Network: 800-225-4246
Optum: 877-494-9195

Diagnostic Testing

One Call Medical: 800-453-0574
[email protected]

If you need to find a doctor, specialist, or outpatient facility near you, Consumer Health Network has a comprehensive directory of medical providers to choose from. One Call Medical can assist you in finding a diagnostic testing facility should you need an MRI, CT scan, or any other diagnostic test. If you require any type of medical equipment (TENs units, wheel chairs, canes, walkers, shower/tub accessories, etc.), Optum will assist you in obtaining those items. Do you need prescription medications? Mitchell ScriptAdvisor or Optum can assist you in obtaining any medications related to your accident via their mail-order program or through a pharmacy near you.

Additional New Jersey Medical Online Resources:
Has your doctor received any disciplinary action from the State of NJ?
State of New Jersey Hospital Profile Report

New Jersey PIP Precertification Hours of Operation

Our Wall, New Jersey hours of operation are Monday through Friday from 8:00 am until 5:00 pm. Requests for Precertification and Decision Point Review treatment received outside of normal business hours will be recorded as received on the next business day. Precertification and Decision Point Review requests will be responded to within three business days.

Plymouth Rock observes the following holidays and will be closed for business on the following days in 2021:

  • New Year’s Day – Friday, January 1
  • Martin Luther King Jr. Day – Monday, January 18
  • Presidents’ Day – Monday, February 15
  • Memorial Day – Monday, May 31
  • Independence Day (observed) – Monday, July 5
  • Labor Day – Monday, September 6
  • Thanksgiving – Thursday, November 25
  • Day After Thanksgiving – Friday, November 26
  • Christmas Day (observed) – Friday, December 24

 

If you are a New York resident who has filed a claim with Plymouth Rock, you may need to provide additional information to resolve your claim as quickly as possible. For a list of Claim Forms, click here.  

 

Additional resources for the state of New York can be found below:

 

 

If you are a Pennsylvania resident who has filed a claim with Plymouth Rock, you may need to provide additional information to resolve your claim as quickly as possible. For a list of Claim Forms, click here.

Find a Doctor — Signature Medical Concierge Program
Plymouth Rock’s innovative Signature Medical Concierge Program is leading the way to a new level of customer service with the focus on you as our valued customer.

Our goal is to provide superior service through the utilization of our Signature Medical Concierge Program, which consists of a sophisticated network of doctors, facilities and service providers.

These networks are voluntary. Utilization of this program provides the highest level of coverage under your policy. If you decide not to use the diagnostic, outpatient facility, and medical equipment networks, additional copayments may apply.

 

Consumer Health Network

800-225-4246 ext. 5513
609-570-2041 (direct)

Outpatient Facility

Consumer Health Network: 800-225-4246

Medical Equipment

Consumer Health Network: 800-225-4246
Optum: 877-494-9195

Diagnostic Testing

One Call Medical: 800-453-0574
[email protected]

If you need to find a doctor, specialist, or outpatient facility near you, Consumer Health Network has a comprehensive directory of medical providers to choose from. One Call Medical can assist you in finding a diagnostic testing facility should you need an MRI, CT scan, or any other diagnostic test. If you require any type of medical equipment (TENs units, wheel chairs, canes, walkers, shower/tub accessories, etc.), Optum will assist you in obtaining those items.

Submitting Medical Bills Electronically (eBills)

Plymouth Rock has engaged the AccidentEDI Clearinghouse to handle our eBill platform.**

 

They can be reached at 800-297-6909 or [email protected]

To set up direct billing: https://secure.icompedi.com/Main.Aspx

For general inquiries: https://www.accidentedi.com/plymouthrock


Treatment

If you are injured in an accident, it is important that you call your own doctor and ask him or her for advice on what to do, what specialists to see, and how to protect yourself. Information about Medical Insurance Fraud can be found here.

Additional Medical Online Resources:
American Board of Medical Specialties
American Cancer Society
American College of Cardiology
American Medical Association
Centers for Disease Control
Mayo Clinic
Medline
National Board of Medical Examiners
Society of Cardiovascular & Interventional Radiology
U.S. Department of Health and Human Services

Consumer Online Resources:
Consumer Products Safety Commission
Food & Drug Administration
National Safety Council
Notice of Faulty Products
American Society for Testing and Materials

For additional information regarding PIP and MedPay, read our Claims FAQs.

 

*Each claim will be investigated and evaluated based upon the policy coverage purchased and active at the time of a loss. Nothing stated on this website should be construed or interpreted as an admission of coverage. If you have questions regarding a particular claim, please address these to your handling claims representative.

**eBill is only accepted in New Jersey, New York and Pennsylvania.