Aetna International Overview For The Church of Jesus Christ of Latter-day Saints

Transcription

1 Aetna International Overview For The Church of Jesus Christ of Latter-day Saints Greece and Cyprus Mission Welcome to Aetna International! Aetna has partnered with HealthWatch in Greece and Cyprus, who are very experienced in providing healthcare solutions and networks for expatriate plans to clients around the world. Their knowledge and experience in Greece and Cyprus make them a valuable partner for both Aetna International and The Church. As members of the Aetna International program, missionaries will receive an Aetna International ID card with the HealthWatch logo on it. This new benefit for the Mission President and young missionaries will: Simplify the administration of health care benefits for the Mission and the missionaries. Provide access to HealthWatch s large established provider network relationships with over 2000 clinics and hospitals throughout Greece, Cyprus and the Greek islands, as well as G.P. s (General Practitioners) Offer quality, cost-effective care with HealthWatch s years of experience in navigating the Greek and Cypriot healthcare system. Provider Listings for the AMA, Mission President and wife HealthWatch will direct care to the appropriate G.P. or clinic/hospital as appropriate HealthWatch s listing of General Practitioners, clinics and hospitals Aetna International Team for LDS Christine Gabriel, Account Manager GabrielC@aetna.com Carol Griggs, Sr. Account Service Representative GriggsC@aetna.com Eric Blonshine, Call and Claims BlonshineE@aetna.com Henry Newton, Account Service Representative (+44) NewtonH@aetna.com ID Cards The ID cards will be mailed directly to the Missions from Aetna. When the ID cards are received, please hand them out to the missionaries along with the ID card letter. The ID card letter explains the process to request medical care. This process has not changed. When a missionary needs medical attention, they must still get approval from the Mission President or his wife, who will contact Aetna International on their behalf. ***Please see enclosed ID card letter*** Benefit Principles Missionary Medical has set forth some benefit principles to guide your medical care decisions. ***Please see enclosed Benefit Principles document*** Contact Aetna International 24 hours a day, 7 days a week The Aetna International Member Service Center is available 24 hours a day, 7 days a week and 365 days a year. We can assist you with: Locating quality health care around the world Answering questions regarding Claims, benefit levels and coverage Processing Claims in virtually any language Coordinating reimbursement, offering options in over 180 currencies and payments through electronic reimbursement directly to bank accounts Phone Toll-free: Direct: Fax Toll-free: Direct: Website

2 Follow this Process when a missionary needs to seek medical attention: 1. Call the HealthWatch Service Center at: The Customer Service Representative will need the information which can be found on the last page of this overview. 2. If the matter is non-urgent and can wait up to 48 hours then the information can be ed to Healthwatch at: Aetna@healthwatch.gr 3. HealthWatch will use the information provided to find the nearest suitable provider, confirm the appointment with the missionary and confirm back that the appointment has been made. 4. HealthWatch will send the Letter of Authorisation (LOA) to the provider. For your convenience, the missionary information also will be provided to you on a monthly basis in Excel format, with all of the missionaries assigned to your Mission listed. 1. The Customer Service Representative will make the appointment for the missionary through HealthWatch. 2. HealthWatch has a medical team available who are capable of handling a variety of medical care requests. 3. The missionary will go to the provider and not be required to pay for the services as HealthWatch will pay the provider directly. Non-Emergency Care: HealthWatch lines are open 24 hours a day, 7 days a week in Greek and English for assistance in setting appointments. The missionary will set the appointment after the CSR contacts the Mission contact who made outreach on behalf of the missionary. Emergency Care: Call the Aetna International Member Service Center as soon as practicable, but please know that Accident and Emergency (A&E) facilities in Greece and Cyprus are obliged to treat any patient who presents without payment in the first instance. Once the patient identifies themselves as being covered by their Aetna plan and that HealthWatch is Aetna s local partner, the provider then will notify HealthWatch with the provider details and HealthWatch will facilitate for the bill to be sent to them for payment to the provider. Prescriptions **IMPORTANT** The Mission will need to pay for prescriptions and submit a Claim form to Aetna for reimbursement. Mission President Claims When direct-payment arrangements cannot be made through Aetna s provider network and mission presidents must use their personal funds to pay for their own medical needs, reimbursement should be sought by completing the Mission Presidents claim form as found on the Aetna site If mission funds are used to pay for medical treatment for missionaries or mission presidents and their families, reimbursement should be requested from Aetna International using the Claim Form-Reimburse Missionary Medical. MissionaryMedical.org The Missionary Medical website has set up a section focused entirely on the Aetna International program, with training, information materials, Claim forms, contact information, FAQs, and a link to the Aetna International website. The Aetna Internaiotnal reimbursement forms (claim forms) can be found on the website. On the site s home page, click on Provider Information and Mission Office Materials. At the bottom of the page under Aetna International Forms and Materials, click on any of the three separate links to access the appropriate reimbursement form. Submitting the Claim 1. Complete the appropriate claim form. (Claim forms located on ) 2. Copy all receipts on a single piece of paper (or as many as necessary). Be certain that all receipts are legible. Receipts must be fully itemized bills and/or detailed receipts that include diagnosis (nature of illness) and the procedures or services performed. 3. Write the missionary s member identification number on each document submitted with the Claim form (refer to the Aetna International ID card). 4. Be sure to indicate the name of the person who received care (the missionary). 5. Include contact information (phone and address) where the Mission office can be reached in case Aetna has any questions about the Claim. Send the Claim form/receipts via FAX to: Toll-free: Direct: Send the Claim form/receipts by mail to: Aetna; P.O. Box El Paso, TX USA Or to: AISERVICE@AETNA.COM 2

3 Resources for the AMA, Mission President and Wife User Guide: This more extensive resource will follow, with website resources available through International.com, Mission President and AMA website access instructions, reference tools for the AMA s, and process to identify providers to become direct-settlement providers. Aetna International Overview (this document): Shortened version of User Guide with most critical information to know. ID card Letter: Outlines the Missionary Medical process for the missionary on how and when to seek medical care. Benefit Principles: Benefit principles set forth by Missionary Medical to guide your medical care decisions. LDS Claim Form Instructions: Detailed instructions for which claim form to use and how to complete it and send in for reimbursement to Aetna International. Claim forms: Electronic versions provided by Aetna during implementation. The forms are housed on the website for your reference. Missionary Listing in Excel format: Monthly listing sent to the Mission address, with missionary name (as enrolled with Aetna), date of birth, Aetna ID#, and Mission number ( ) The last three digits identify your specific Mission. HealthWatch Physician/clinic/hospital listing: This listing is for your information only so you can view the extensive network of physicians, clinics and hospitals. When needing to seek medical care for a missionary, please or HeathWatch directly to obtain guidance on where best to seek medical care based on the immediate need and the location of the missionary. The HealthWatch network in Greece, Cyprus and the Greek Islands encompasses > 2000 hospitals, medical centers, clinics, radiology centers, behavioral/mental health providers, and physicians available to provide cashless direct settlement access to medical care for the missionaries (through the Letter of Authorization process). Requests for Letters of Authorization/Referrals may be initiated 24/7 by calling the HealthWatch Service Center at or ing HealthWatch at Aetna@healthwatch.gr The Aetna International Team for the Greece and Cyprus Mission of The Church of Jesus Christ of Latter-day Saints looks forward to serving you.

4 Should you need to escalate an issue, please contact us. Christine Gabriel, Account Manager Carol Griggs, Sr. Account Service Representative Eric Blonshine, Call and Claims Henry Newton, Account Service Representative NOTES

5 Aetna International Form for requests for Letter of Authorization (LOA) for care. Information needed whether request is made via Phone or to HealthWatch Instructions: Complete below & either copy and paste below into an or send as an attachment to an and send to with a copy to ailoa@aetna.com for Non-urgent requests (needed after 48 hours) or For Urgent requests (care needed in 48 hours or less), please call HealthWatch and be prepared to provide the following information: Caller s Name & Relationship to the Mission (position/role): Caller s and Phone Number (including Country & City Code): Caller s Location (City/Country): Patient Name * Patient s Aetna ID * Patient Date of Birth * (mm/dd/yyyy) What is the nature of the illness/injury? (brief explanation necessary) Requested Place of Service (if applicable): Provider name Provider address Provider phone number Planned Date of Service/Admission * Type of service requested