1 / 21

Revised Outpatient Medical Benefit Effective 1 October 2012

Revised Outpatient Medical Benefit Effective 1 October 2012 . REVISED OUTPATIENT BENEFIT SCHEME. Company will self-insure outpatient medical coverage Reasons for Change More family-centric, beneficial to both single and married employees Cost effective and easy to understand for the staff

orsen
Download Presentation

Revised Outpatient Medical Benefit Effective 1 October 2012

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Revised Outpatient Medical Benefit Effective 1 October 2012

  2. REVISED OUTPATIENT BENEFIT SCHEME • Company will self-insure outpatient medical coverage • Reasons for Change • More family-centric, beneficial to both single and married employees • Cost effective and easy to understand for the staff • Flexibility to set our own criteria on outpatient medical coverage 2

  3. OUTPATIENT BENEFIT SCHEME 3

  4. NEW OUTPATIENT BENEFIT SCHEME • Key Changes • Inclusion of staffs’ dependants for outpatient GP and Specialist • Staff and their dependants can visit panel, non-panel and TCM registered doctors • Referral letter from panel doctor not necessary for Specialist visits • Treatment can cover congenital conditions, vaccinations, mental conditions • Annual capping of staff entitlements. Capping will be reviewed and lifted for staff with critical / chronic illness if 70% of entitlement are used for staff’s medical expenses related to critical / chronic illness eg. cancer, stroke, diabetes 4

  5. PARTNERS in medical & insurance benefits Far East Organization Pan Resources Insurance Broker PanFlex Benefits Administrator Pan Group 24-hour Helpline +65 6220 9119

  6. How it works • Outpatient Medical Benefit Period • Calendar Year: 1 January to 31 December For 2012 - 1 October 2012 to 31 December 2012 • Incurred date of receipts will commence from date of hire or 1October 2012, whichever is later • Staff will be allocated $ entitlement. The entitlement can be used to claim reimbursements for staff and/or eligible dependants • Entitlement will be prorated for employee who joined after 01 January 2012

  7. Cut off date for submission of AVIVA and NTUC outpatient claims (incurred from 1 January 2012 to 30 September 2012) is by 15 October 2012 From 1 October 2012, all outpatient claims to be submitted via PAN Benefits Portal under revised Outpatient Medical Benefit scheme Please return your existing Aviva PCP / NTUC iMedicare cards to Group HR (GHR) by 30 September 2012 Any usage at existing Panel clinics after 1 October 2012, amount will be clawed back from your flex points. Some A&E are not able to check whether you can still allowed to use the card as they are not connected by any system to Aviva Transition Period 7

  8. Eligibility • Permanent Employees • Dependants as defined below: - • Spouse who are legally married and not separated from the staff • Children, including legally adopted children or stepchildren, up to 25 years old and whose parents are lawfully married (including divorced or widowed parents) • Parents

  9. Staff is required to update and verify their dependant’s information (eg. NRIC and Date of Birth) before he/she is allowed to submit a claim via PANBenefits Portal. Addition of Dependants If you get married or have a new born child during the Outpatient Benefit Scheme period, please submit a copy of your marriage certificate / your child’s birth certificate to GHR department. Upon Pan receiving the relevant information from HR, an email will be sent to inform the staff that the request has been approved by PanFlex within 2 working days. PANBenefits portal will then be updated for claims submission. Dependants Verification 9

  10. Some Benefits Covered: Traditional Chinese Medicine registered under Singapore Ministry of Health (please refer to http://www.tcmpb.gov.sg/tcm/ for the full list) Vaccinations e.g. Hepatitis, Flu Specialist treatment without referral letter Diagnostic X-ray, Lab Tests, MRI and CT Scans Physiotherapy, Kidney Dialysis, Speech therapy, Cancer treatment, Podiatry treatment Pre-existing medical or congenital conditions Mental Treatment Outpatient GP & SP 10

  11. Some Exclusions: Hospitalisation claims including GST Birth control measures e.g. infertility or impotency treatment Pregnancy related e.g. maternity Cosmetic treatment e.g. acne, hair loss, lasik Alternative treatments e.g. Naturopathic, Osteopathy, Homeopathy, Chiropractor Optical e.g. eye refractions, fitting of glasses, contact lenses Dental e.g. gingivitis, wisdom tooth extraction, Orthodontic Medical Appliances e.g. hearing aids, artificial limbs, wheelchairs, crutches, nebulizers, thermometers, prostheses, implants, etc Medical Reports Health Screening Outpatient GP & SP 11

  12. MHC Panel Clinics – Outpatient GP & SP • For cashless outpatient medical treatment, staff present their Staff Identification Card with MHC sticker at a MHC Panel Clinic. • Medical Expenses incurred at MHC Panel Clinics will be uploaded into PANBenefits Portal on a monthly basis • Staff to check their available balance in the system before visiting the clinic • If card is used at panel clinic when entitlement is exceeded, company will recover the excess amount from staff’s payroll • Note : • If staff has forgotten to bring Staff Identification Card, please do the following: • Pay First • Collect receipt • Submit claim online

  13. MHC Panel Clinics – Clinic Listing available in the following location • MHC website • http://www.mhcasia.com/managedcare/managed-care-2/clinic-networks/clinic-network-singapore • Enter your name, NRIC, email and Program (MHC Program), and you will be able to search for any MHC panel clinic • As long as the employees are registered in their system and have been issued with MHC sticker, they will be able to log in anytime to locate their nearest clinic

  14. Claims Submission (for Staff’s Non-panel & Dependants’ medical claims) • Log in to PANBenefits Portal • https://www.panbenefits.com.sg/FEO • Go to “E-claims”, then “Benefits Claims Submission” • Select Incurred date • Choose claim type and claimant • Enter claim details and click on “submit” button • Indicate reference number on original receipt(s)/document(s) • Drop original receipt(s)/document(s) into claim box Cut-Off Submission: 25th of the month @ 12pm Collection Date: Every Monday & 26th of the month after 10am Reimbursement: Via Payroll – on pay day of the following month Location: Far East Plaza Riverside Point Changi Village Hotel Orchard Parade Hotel If any of the dates above fall on a public holiday or a weekend, collection, cut off and reimbursement date will be the before working day.

  15. Overseas Claims Submission • All incurred receipts must be in English • You need to do your own translation if it is not in English • Claims will be reimbursed in SGD • Conversion will be based on supporting documents provided such as credit card statement or exchange rate slip • If not, PanFlex will use reference rates from www.oanda.com to do the conversion • Based on actual incurred date of the claim • Oanda uses the Average Sell Rate 15

  16. After submission into claim box PAN verifies claims based on business rules Approved? Yes No Email staff to request for further documentation or rejection. Staff has 2 weeks to revert if they wish to submit the required documents Successful Claims will be reimbursed via payroll and reflected in staff’s pay slips. Claims status amended to “PAID” Reply? Yes No Claims will be processed after receiving outstanding documents Unsuccessful Claim Documents will be returned to staff 16 Note: Employee who did not submit any documents, status in E-Claims Portal will indicate as “Pending Verification”

  17. General Notes • New Joiner • Entitlement will be prorated based on the number of calendar days remaining from date of hire • Leaver • Amount will be prorated based on the number of calendar days served in the calendar year • No encashment on any balance • Clawback on over-utilized amount • Entitlements which are not utilized will be forfeited at year end • Original official receipts only

  18. PANBenefits Portal Demo

  19. Pan Group 24 Hours Helpline : +65 6220 9119 Email: eclaims@pangroup.com.sg Disclaimer - This presentation describes briefly all the benefits provided in this program. The specific terms, conditions and exclusions applicable to this insurance will be governed by the Master Policy kept with the Company.

  20. Pan Group All employees can enjoy staff discounts* at the following places when they present the Pan Group’s Helpline Card. 20 * All offers are subject to changes.

  21. Q & A THANK YOU

More Related