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Immediatly responding not only to medical emergencies but to
everyday, health-related concerns. |
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The Medical Assistance Program/ Third Party Administration will be made available
to the members 24 hours a day, 7 days a week in any accredited
hospital or clinic nationwide. The members can call EA Philippines’
Alarm Center
for immediate assistance. |
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ARRANGEMENT FOR PAYMENT OF MEDICAL EXPENSES |
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When a patient avails himself of Inpatient or Outpatient benefit in any EA accredited
hospital or clinic, EA will arrange for payment of medical expenses up to the policy
limits subject to the authorization of Client except where blanket authority is
required (such as for Makati Medical Center and St. Luke’s Medical Center among
others). |
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HOSPITAL ADMISSION ASSISTANCE |
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In emergency cases where the Member requires to be hospitalized, the Member may
request EA to arrange for cashless hospital admission. |
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MEDICAL COORDINATION |
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EA will coordinate through telephone with the emergency room staff, admitting section, billing
department, credit and collection, and nurse’s station to assist the Member. |
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MEDICAL BILLS MONITORING |
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During the period of hospital confinement, EA will monitor the medical expenses
incurred by the Member to determine if the expenses are within or exceeding the limits of the plan/ policy. |
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COORDINATION WITH THE CLIENT |
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EA will communicate with Client pertaining to enrollment of members, required
authorization,
schedule of benefits, hospital bills, and other issues that will help in implementing the program
properly for the benefit of the Members. |
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COORDINATION
WITH THE MEMBER |
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EA will assist the Member and/ or the attending companion through telephone as to the admitting
procedures, hospital bills, deductibles, hospital discharge procedures, and required
claims documentations for whatever reimbursement items not covered by the Hospital Assistance Program. |
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MEDICAL REFERRAL
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If the Member needs medical referral of a doctor, hospital,
and/or clinic, EA shall provide the address and telephone number of the requested medical provider. |
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PROGRAM/ BENEFITS INQUIRY |
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On special cases, a
Member may contact EA to inquire about the schedule of benefits and availment procedures. |
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REGULATION OF PROFESSIONAL FEES |
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For Inpatient and Outpatient professional fees of all
EA accredited doctors, EA shall apply regulated fees whenever applicable. This service
will be based on EA’s internal standardized rates. |
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CLAIMS INFORMATION ASSISTANCE |
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EA will provide general claims
information to the Members related to filing of medical reimbursable claims and
its required documentation. |
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CLAIMS REPORTS |
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If requested by the Insurer, claims reports can be furnished
by EA. Ex. Total cases handled, total claims incurred, total claims settled, outstanding
claims to-date, total in- patient services, and summary of all accounts. |
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BENEFIT UTILIZATION MONITORING |
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EA shall record and monitor the utilization of the members' benefits based on the
remaining balance available against the schedule. |
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HOSPITAL CASH FLOAT |
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The Insurer will provide a refundable Hospital Cash Float
based on the number of Members to be enrolled.
The Insurer shall replenish the Hospital Cash Float upon notification by
EA. |
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MEMBERSHIP CARDS |
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Magnetized membership cards will be provided by EA to the
Insurer FREE of charge (ongoing
project). |
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For Sales and Marketing Concern
please email us at marketing@eaphils.com |