Health Care Primary Frequently Asked Questions

FAQ's

1. What are the benefits in electing Health Care Primary on my policy?

  • Lower your Personal Injury Protection (PIP) premium.
  • Utilize providers who already know your medical history and have your overall care in mind.
  • Follow the same health care processes and procedures already familiar to you.
  • Depending on the terms of your health carrier plan, you may have less out-of-pocket expenses. PIP deductibles range from $250 to $2,500 with a 20% copayment for the first $5,000 in medical expenses, per accident.

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2. What happens if I elect Health Care Primary and my carrier does not cover a specific type of care?

If your plan does not cover treatment(s) rendered by a particular specialist, your PIP coverage will provide primary benefits for those services. Your health insurance carrier will remain primary for all other care.  Please note that the treatment received must be medically necessary and related to the accident in order for it to be covered under your PIP (Personal Injury Protection) coverage with Plymouth Rock.

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3. What happens if I have an outstanding balance after my health care insurance pays?

If you have any balances remaining after your health insurer has processed a claim, you or your provider may submit a copy of the medical bill(s) and a copy of the health care carrier’s Explanation of Benefits to Plymouth Rock for consideration.

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4. What happens if I lose my health care coverage after I had an accident and I already started treatment?

If your health care insurance terminates, your PIP carrier will step in and process your claim as primary from that point forward.

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5. What happens if I treat with a provider that is not in my health carrier’s network?

If you choose to treat with a provider that does not participate in your health care plan, your PIP coverage will provide primary benefits for that provider only.  Your health insurance carrier will remain primary for all other care. Please note that the treatment received from the non-participating provider must be medically necessary and related to the accident in order for it to be covered under your PIP (Personal Injury Protection) coverage with Plymouth Rock.

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6. What happens if my health insurance will not cover as primary once I have had an accident?

You will not be left without coverage if you are injured in an automobile accident. NJ law dictates that if your health insurance policy excludes injuries from automobile accidents, your automobile carrier is required to provide PIP benefits as primary.  However, any treatment received must be medically necessary and related to the accident in order for it to be covered under your PIP (Personal Injury Protection) coverage with Plymouth Rock.

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7. What if I lose my health care insurance during the policy period?

You should inform your agent or Contact Us if you have lost your coverage. Your policy will need to be adjusted to reflect that PIP coverage is your primary.

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8. What should I do before deciding to elect this coverage?

If you have health coverage (other than plans governed by Medicaid or Medicare, or a or a New Jersey Family Care Plan -- provided by Aetna Better Health, AmeriGroup Community Care, Horizon NJ Health, UnitedHealthcare Community Plan or WellCare), you may select this option.

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9. What should I do if my health care insurance carrier changes while my automobile policy is in force?

You should inform your agent or contact our Customer Solutions Center if there has been a change in your coverage.

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10. Who is not eligible for Health Care Primary?

Individuals who are 65 years of age or older and are eligible for Medicare or Medicaid, or those with a New Jersey Family Care Plan (provided by Aetna Better Health, AmeriGroup Community Care, Horizon NJ Health, UnitedHealthcare Community Plan or WellCare) are not eligible to elect Health Care Primary.

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