To collect a cash payment under an NTA Life supplemental policy after a covered screening or physician consultation, you fill out the one-page NTA wellness benefit claim form, attach your provider’s bill if you have one, and send it to the claims processing center by email, fax, mail, or through the MyNTALife portal. NTA Life pays the fixed benefit directly to you, not to your doctor.
Check That Your Policy Includes a Wellness Benefit
Not every NTA Life policy carries one. The claim form itself covers three policy types: Cancer, Heart Attack/Heart Disease and Stroke, and Disability Income. Cancer policies pay on screenings like mammograms, Pap smears, colonoscopies, and biopsies that do not result in a cancer diagnosis. Heart and stroke policies pay on cardiovascular screenings such as resting EKGs, stress tests, echocardiograms, and even outpatient ER visits for evaluation of cardiac symptoms. Disability income policies include a physician consultation benefit instead of a screening list — you write in the reason for the visit rather than check a procedure box.1NTA Life. NTA Life Wellness Benefit Claim Form
The form itself notes that procedures listed may not be covered under every policy, and some policies include no wellness or consultation benefit at all. Your declarations page or benefit schedule is the final word on what is covered and the dollar amount NTA Life will pay. If you are not sure, call (888) 671-6771 before you file.2NTA Life. Contact Us
How To Fill Out the Form
Download the form from ntalife.com/forms or through the MyNTALife policyholder portal.3NTA Life. Forms It has four sections, plus signature lines. Completing each section in full the first time is the easiest way to avoid a back-and-forth with the claims department.
Policyowner Information
The top section asks for the policyholder’s full name, Social Security number, occupation, mailing address, email, and phone number. This is the policyholder, who may not be the same person as the patient.1NTA Life. NTA Life Wellness Benefit Claim Form
Patient Information
If someone other than the policyholder had the screening, enter the patient’s name, Social Security number, date of birth, phone, height, weight, and relationship (policyowner, spouse, or dependent). If you are both policyholder and patient, you still fill out both sections.1NTA Life. NTA Life Wellness Benefit Claim Form
Provider Information
Enter the name, phone, fax, and full address of the doctor or facility that performed the screening. Pull these details straight from the billing statement. Mismatched provider information is one of the easier ways to slow a claim.
Policy Numbers and Procedure
The form provides four slots for policy numbers. List every NTA Life policy under which you might be eligible. Check the box next to the specific screening or consultation and write in the date it was performed. If the procedure is not on the pre-printed list, check “Other” and describe what was done.1NTA Life. NTA Life Wellness Benefit Claim Form
Signatures
Both the patient and the policyholder sign and date the bottom. For a patient under 18, a parent or legal guardian signs. By signing, you certify that the information is accurate and that you have read the state-specific fraud warning printed on the following page. The form does not require your doctor’s signature.1NTA Life. NTA Life Wellness Benefit Claim Form
What To Attach
The instructions say to include a copy of the statement or bill showing the service provided, if one is available. It is not described as mandatory, but attaching it strengthens the claim and reduces the chance NTA Life will write back for proof. An itemized bill or receipt that shows the procedure name, date, and diagnosis code works well. In some cases the claims department may request additional proof-of-loss documentation, so keep a copy of everything you send.1NTA Life. NTA Life Wellness Benefit Claim Form
Where To Send It
NTA Life accepts the completed form through four channels:
- Email: Wellness@NTALife.com
- Fax: 1-855-512-5247
- Mail: P.O. Box 2369, Addison, TX 75001-2369
- Online: the MyNTALife portal at ntalife.com, under “File a Claim”
Email is the fastest of the paper options. Scan or photograph the signed form and any supporting documents, then attach them to a single message.1NTA Life. NTA Life Wellness Benefit Claim Form3NTA Life. Forms4NTA Life. NTA Life
After You File
The claims department reviews the information against your policy terms. If anything is missing or unclear, expect a letter or call asking for more. Keep the phone number and email on the form current so the reviewer can reach you.
When a claim is approved, NTA Life pays the benefit directly to you, not to the medical provider. The amount is the fixed dollar figure your policy specifies for that screening or consultation, regardless of what you paid out of pocket. Your policy’s benefit schedule lists the exact amount.
To check on a pending claim, call the wellness claims line at (855) 512-5247 or the general NTA Life number at (888) 671-6771.2NTA Life. Contact Us
Mistakes That Delay Payment
A few errors come up repeatedly with these claims:
- Wrong or missing policy number. Use all four slots if you hold multiple policies, and double-check the digits.
- Filing a screening under the wrong policy type. A mammogram is covered under a cancer policy, not a heart disease policy, and claims filed against the wrong policy get denied rather than redirected.
- Missing signatures. Both patient and policyholder must sign; an unsigned form comes back.
- No bill attached when one was available. The form says it is optional, but leaving it out invites a follow-up request that adds weeks.
- Illegible handwriting. If the reviewer cannot read your provider’s name or your policy number, the form stalls. Print clearly or type before printing.
Is the Payment Taxable
Benefits from an accident or health insurance policy are generally not taxable when you paid the premiums yourself with after-tax dollars. The IRS says so directly in Publication 525: if you paid the premiums on an accident or health insurance policy, the benefits you receive are not taxable.5Internal Revenue Service. Publication 525 – Taxable and Nontaxable Income Most NTA Life policyholders pay their own premiums, so the wellness check typically is not taxable income. If your employer paid all or part of the premium with pre-tax dollars, the answer can change; a tax professional or Publication 525 will cover your specific situation.