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 South America S. Missions: ARGENTINA Welcome to Aetna International! Aetna has partnered with Swiss Medical Medicina Privada, a large medical services company in Argentina. Membership with Aetna International automatically offers access to Swiss Medical s large network. As members of the Aetna International program, missionaries will receive an ID card directly from Swiss Medical, which will give them access to all the services available through Swiss Medical. This new benefit which goes into effect September 1, 2015 for the Mission President, his family and young missionaries will: Simplify the administration of health care benefits for the Mission and the missionaries. Provide access to Swiss Medical Group s large established provider network relationships with hospitals, medical centers, pharmacies and physicians. Offer quality, cost-effective care with Swiss Medical s years of experience in navigating the Argentina healthcare system. Directory of Clinics and Hospitals for the AMA, Mission Nurse, Mission President and wife Swiss Medical Medicina Privada Medical Professionals: To help you locate hospitals, clinics, pharmacies and physicians participating with Swiss Medical, the following resources are available to you: Booklet entitled Cartilla Docthos Premium, with medical professional listings by Zone. and Each Mission should register on the Swiss Medical website at for access to the medical network (see page 2 for registration instructions). No Swiss Medical Medicina Privada Medical Professionals: If no Swiss Medical professional is available in the location where the missionary needs medical attention, please pay with Mission funds and send claim form to Aetna for reimbursement to the Church. ID Cards (Credenciales) The ID cards will be mailed directly to the Missions from Swiss Medical. 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, his wife or a Mission Nurse, who will direct the missionary to a Swiss Medical Medicina Privada medical professional. ***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 Swiss Medical Medicina Privada: Initial and Replacement ID Cards (credenciales) Locating doctor/specialist and help with making the appointment Appointments: Authorizations for surgery: Emergencies (to call Ambulance): or Questions about plan, coverage, participating providers or any other information: (24 hours 365 days a year) Contact Aetna International Status of claims sent to Aetna International (providers paid with Mission funds) Toll-free: (English or Spanish) For help dialing a U.S. phone number: Direct/Collect: (English only)

2 REGISTRATION ON SWISS MEDICAL WEBSITE FOR PROVIDER LOOK-UP: For help with registration questions, call Each Mission should register on the Swiss Medical website with the Mission President s Information. Registration Steps: Select Swiss Medical Medicina Privada Select Regístrese Nombre (first name) Apellido (last name) Genero (gender) Tipo Documento (type of document) select one DNI (if Mission President is a citizen of Argentina and has a DNI document) PA (Passport if Mission President is a foreigner or citizen of a country other than Argentina) Fecha de Nacimiento (Date of Birth) ( address) Mission address should be provided here Tipo de (type of ) Personal or Business Contraseña (password selected) Repetir Contraseña (repeat password selected) Pregunta Secreta (secret question) Respuesta Secreta (answer to secret question) Acepto los terminos y condiciones del Sitio (Accept the terms and conditions of the Website) Siguiente (Next) PROVIDER LOOK-UP: For help with provider look-up process questions, call Mission can log back into the website to find participating medical professionals. LOST OR STOLEN ID CARDS (CREDENCIALES): If a missionary loses their ID card(credencial) or their ID card is stolen, immediately report it to Swiss Medical s call center at open 24 hours 365 days per year. Swiss Medical will de-activate their ID card so it cannot be used fraudulently. Two options for receiving replacement ID card(credencial): Option 1: Request a replacement ID card(credencial) by calling Swiss Medical s call center at Swiss Medical Representative will request a fax or address from the caller, for delivery of the temporary card. This temporary card can be used for one month, until the new ID card(credencial) has been received. This process takes approximately 4-5 days. Option 2: Request for replacement ID card can be made in person at any Swiss Medical clinic/sanatorio. 2

3 WALK-IN CLINICS, PROGRAMMED CONSULTATIONS AND LAB, RADIOLOGY SERVICES: With the simple presentation of the credential and passport, missionaries will be met at any of the Swiss Medical Centers and clinics, as well as make an appointment with any provider in the network. The Lab, Radiology and Imaging Facilities require a doctor s order. APPOINTMENT REQUESTS: From the provider network list please choose a specialty and call the providers directly for an appointment without the need for a referral, or call for help in making the appointment. AUTHORIZATIONS: Certain practices such as elective surgery, any procedure which requires the use of anesthesia or some studies of high complexity (Resonance of the heart, coronary angiography) require prior authorization. Any authorization requires a doctor s order. Permission is managed within 72 hours and sent to the medical provider directly. For questions about authorizations, contact the Central Authorization line: Authorizations can be requested through the following channels: Online: entering the missionary s personal information on the website by selecting Trámites online, Autorizaciones. Remember, the missionary must be registered and have the medical order in digital format (photo/scan) To register the missionary: Sending your medical order by FAX to (011) hours in advance, Monday through Friday 9-18hs. Remember to record the registration code that will be provided to you on the phone call. Walking into a Swiss Medical branch. EMERGENCIES AT HOME: In an emergency or situation requiring medical care at home please call or These operators will request personal data, telephone, where you are and symptoms. QUESTIONS ABOUT PLAN AND COVERAGE: You can call online 24 hours 365 days a year, where advice will be provided on your benefit plan and provider network. PROVIDER NETWORK ONLINE: You can view hospitals, medical centers, pharmacies and physicians participating with Swiss Medical Group at any time by logging into Select Swiss Medical Medicina Privada Select Mi Cartilla Select Specialty (Especialidad) Select Province (Provincia) Click Search (BUSCAR) 3

4 Reimbursement NOTE No Claim Form is needed if using a Swiss Medical Group provider, as the provider will be sending the invoices to Swiss Medical Group for payment. Send claim form to Aetna if Mission funds were used to pay a provider. 1. 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 contacting Steve Bunker in the Church s Missionary Department. He may be reached at or bunkerse@ldschurch.org. This reimbursement approach applies only to mission presidents and their eligible family members; when 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. 2. Claim Form Reimburse Missionary Medical Reimburse the Church if Mission funds were used. Submitting the Claim 1. Complete the appropriate claim form (see separate more detailed instructions in document entitled Mission Claim Forms. 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 or missionary listing sent to you monthly). 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: or Send the Claim form/receipts by mail to: Aetna; P.O. Box El Paso, TX USA or to: AISERVICE@AETNA.COM Note: Only 10MB of information can be sent in 1 . If more than 10MB, please send in various s. 4

5 Aetna International will reimburse for the following: Prescription drugs Medical services given as a result of a sickness or injury Not Reimbursable through Aetna International: Dermatological helps such as makeup, acne medicine, sunscreen, bug spray, lice shampoos and lotions Vitamins Eye exams or eye care, unless as a result of an accident or injury Dental services, unless as a result of an accident or injury Elective procedures any medical, dental or eye care that is not associated with sickness or injury Pre-mission conditions physical or mental condition that was diagnosed or treated, or that had treatment recommended, within two years before the missionary entered the mission field. The Church does not pay for treatment of physical or mental conditions that existed before a mission, or for prescriptions resulting from these conditions. ***The Mission President has the discretion to override this under special circumstances*** Medical Assistance (90-day continuation of coverage) When a missionary is to be given an early medical or emotional release to return home in order to receive treatment associated with an injury or illness that occurs during missionary service outside of the United States, the Mission President contacts the IFR (In Field Representative) at the Church s Missionary Department. A Missionary Change Form is sent to Missionary Medical. If medical assistance is needed, the IFR will contact the DMBA Nurse Team by (MissionaryMa@dmba.com) to formally request medical assistance. The nurse team will retrieve all needed information from the Missionary Inquiry system. Extended medical coverage and medical assistance covers the specific injury or illness that began during the missionary s service. The missionary, Stake President and Bishop will receive an notification when medical assistance has been granted. An Aetna representative will contact the missionary, Stake President and Bishop and provide instructions on how to receive medical attention paid for by Aetna. Aetna International Secure s Aetna International s containing missionary names, dates of birth and member ID numbers will come to you in a Secure format. In order to open these s you can do one of the following: Follow the instructions within the click on download below the message name save the message, then click View Downloads click on the envelope with a lock the and attachment will open ready for you to view and save to your computer Or Forward your Secure to zdm@vsn.voltage.com and they will send back your unencrypted and ready to view when the comes back to you, click on the link within the click on SUBMIT on the next screen and attachment will open click on download to open the attachment IMPORTANT: Please save the documents sent onto your computer for continued access to the information, as Secure s and their contents will not be available after a period of time 5

6 Resources for the Mission President and Wife, Area Medical Advisors, Mission Nurses and Church Doctors Aetna International Overview (this document): Most critical information to know about medical care and how to seek reimbursement from Aetna. 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. Claim form: Electronic version provided by Aetna during implementation. 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 (in XXX format). The last three digits identify your specific Mission. (Please refer to Secure instructions) Bahia Blanca Neuquen Buenos Aires North Posadas Buenos Aires South Resistencia Buenos Aires West Rosario Comodoro Rivadavia Salta Cordoba Santa Fe Mendoza Buenos Aires East Bi-Monthly Listing of Paid Claims by Mission: Bi-monthly listing sent to the Mission President address, which contains all claims paid by missionary name, dates of service, and amount, and reimbursed to the Church through Missionary Medical. Claims paid directly by Swiss Medical will not appear on this report. (Please refer to Secure instructions) Provider Directory: To help you locate hospitals, medical centers, pharmacies and physicians participating with Swiss Medical Group, the following resources are available to you: Booklet entitled Cartilla Médica Global, with provider listings by Zone. Website for provider look-up Select Swiss Medical Medicina Privada Select Mi Cartilla Select Specialty (Especialidad) Select Province (Provincia) Click Search (BUSCAR) 6

7 The Aetna International Team for the South America South Missions of The Church of Jesus Christ of Latter-day Saints looks forward to serving you. Should you need to escalate an issue, please contact us. Carol Griggs, Sr. Account Service Representative (speaks Spanish) Eric Blonshine, Aetna Claims NOTES