Post on 17-Dec-2015
transcript
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What is the Claims Online with e-Card XP Debit card?
• Solution subscribed by Generali Pilipinas from MediLink to be able to offer electronic hospitalization program to its corporate clients
• First membership and payment system in the healthcare industry
• Offers “real-time” processing and settlement of claims
• Members are treated as private patients (own choice of doctors)
• Utilizes the Multi-purpose application of Equitable Card Network’s e-Card XP VISA Debit card
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GENERALI PILIPINAS
e-Card XP VISA Debit Card
Front
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Jane De La Cruz
Back
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Equitable Card Hotline: to report lost / damaged cards
Existing Availment vs Claims Online with e-Card XP
NESTLENESTLE• Manual Issuance of Letter
of Guarantee (LOG) • Claims settlement after
confinement.– Hospital sends bill to
NESTLE– Excess determination
largely up to accredited hospital.
• Accepted in 76 Service Providers nationwide
Claims Online with e-Card XPClaims Online with e-Card XP• Swipe technology• Electronic Eligibility
verification prior to Admission• Plus claims settlement during
confinement– Electronic claims settlement – Excess to be identified and
paid prior to discharge.• Accepted in 94 key
Designated Hospitals nationwide (to become 160++ by mid year)
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BENEFITS TO NESTLE EMPLOYEES
• Cash-less hospitalization plan in more hospitals• Members are treated in hospitals as “private” patients.
– Member can choose his own doctor/s• Automatic reconciliation of hospital bills.
– Members informed of updated benefits on the day of Admission at e-Card XP designated hospitals.
– Electronic loading of benefits on the day of discharge.• No need to secure Letter of Guarantee prior to admission• Employee and Dependents will be given individual
Medilink e-Card XP Debit Cards (except those below 13 years old)
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STEP 1: CARD ACTIVATION
WHEN Admission
EMPLOYEE or Qualified Dependent
Presents card for swiping at the MediLink’s POS Terminal. If eligible: Signs the electronic Notice of Activation (NOA) generated by the terminal
DESIGNATED HOSPITAL
Swipes card to signify admission. Performs normal admission process.
IN-PATIENT (IP) AVAILMENT
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Sample Notice of Activation (NOA) Slip
SAN JUAN DE DIOS HOSPITALROXAS BLVD., PASAY CITY
61000295 80000000009238
MEDILINK4559689100003333* CARD VER 000001 MAY 25, 05 09:45 499222750145 782808 TRANSPOS47 TOTAL PHP0.00
GENERALI PILIPINAS –INPATIENT 29P NOA# 782808 25DEC2006HUMILDE, MARILYNN11111-2-00NESTLE PHILS.CARD# 4559689100003333RNB: Php550/DAYPHILHEALTH REQUIRED SLIP MEANS CARD HAS BEEN ACTIVATED. PLEASE SWIPE DURING DISCHARGE FOR LOADING OF BENEFIT. MEMBER AUTHORIZE HOSPITAL TO PROVIDE ALL RECORDS TO GENERALI PILIPINAS.
Marilyn Humilde
Line 1: Generali Pilipinas ; Coverage; Age
Line 2: Activation Number ; Date of
Transaction
Line 3: Name of Member
Line 4: Policy Number
Line 5: Corporation Name
Line 6: Card Number
Line 7: Room and Board
Line 8: With PHILHEALTH/NONE
Line 9: Disclaimer
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• Note: Pls. Ask your HR for a copy of the signed PHILHEALTH FORM
STEP 2: VERIFICATION OF COVERABILITY
GENERALI Authorizes admission (w/n 24 hours). Calls the Patient confined in the MediLink Designated Hospital
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IN-PATIENT (IP) AVAILMENT
STEP 3: LOAD PROCESSING
WHEN Discharge
EMPLOYEE or Qualified Dependent
Presents card for swiping at the MediLink POS Terminal to signify discharge. Signs the Notice of Load processing slip.
HOSPITAL Swipes Member’s card Faxes Final Statement of Account (SOA) upon request of the member.
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IN-PATIENT (IP) AVAILMENT
SAN JUAN DE DIOS HOSPITAL ROXAS BLVD., PASAY CITY
61000295 880000000009238 MEDILINK4559689100003333* AUTHORIZE 000001 MAY 30, 05 09:45 499222750145145 782145 TRANSPOS47 TOTAL PHP0.01
GENERALI PILIPINAS –INPATIENT 29P NLP# 782145 30DEC2006 HUMILDE, MARILYN
KINDLY FAX SOA: 8865238BENEFITS WILL BE LOADED TO CARD:4559689100003333I WILL USE AMOUNT LOADED TO SETTLE HOSPITAL BILL. I AUTHORIZE HOSPITAL TO PROVIDE GENERALI ALL DOCS OF MY CONFINEMENT.
Sample Notice of Load Processing (NLP) Slip
Marilyn Humilde
Line 1: Generali Pilipinas ; Coverage; Age
Line 2: Load Processing Number ; Date of Transaction
Line 3: Instructions
Authorization
Disclaimer
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STEP 4: COMPUTATION OF BENEFITS (FAX
LOA) AND MEMBER ALERT
WHEN Discharge
GENERALI Received Final SOA from the HospitalProcesses claim and loads Member’s card based on approved benefits. Alerts/Informs the Member of approved amount (via SMS Notification)
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IN-PATIENT (IP) AVAILMENT
Total Hospital Bill P30,300.00.GENERALI has loaded P30,300.00 inclusive of PF of DR. ABELARDO MENDEZ
Options Back
(PHP12,000.00), DR.INOCENTE PEREZ (PHP 6,000.00). Pls proceed to cashier to settle bill.Thank you.
Options Back
Sample Member’s Text Notification
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STEP 5: PAYMENT
WHEN Discharge
EMPLOYEE or Qualified Dependent
Presents card at the Cashier. Signs Credit Card Receipt
HOSPITAL Swipes the card in the Credit Card Terminal and enters amount given by the Member. Accepts payment
MEMBER Submits original hospitalization documents to NESTLE Site Nurse within five (5) working days (from date of Employee’s return to work)
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IN-PATIENT (IP) AVAILMENT
SAN JUAN DE DIOS HOSPITALROXAS BLVD.PASAY CITY
TERM# 60000005 MER#720500007CARD TYPE VISA4559689100003333MARILYN HUMILDEAUTHORIZE EXPY DATE 05/06BATCH NO.000001 TRACE NO. 597201DATE/TIME MAY 30, 05 13:25REF.NO.000040597143 APPR.CODE015424
TOTAL PHP 30,300.00
Marilyn Humilde
Sample Credit Card Receipt
REMINDERS• Present your e-Card XP Debit Card on the day of your admission (Card
Activation) and on the day of discharge (Load Processing and Payment). • Qualified Dependent is defined as a NESTLE Principal Member’s Dependent
who is 13 years old and above and qualified to be given an e-Card XP VISA Debit card
• For Dependents of Principal Member less than 13 years of age, it will be the Principal’s e-Card XP which be loaded on the day of discharge. Only the Principal Member is allowed to sign on behalf of the Dependent
• Be familiar and read your customized e-Card XP Member Guide. • In cases where the Professional Fee of your Attending Doctor is not part of
the Hospital Final Statement of Account (SOA), the Employee/Patient will have to advance the payment. However, as an alternative, you can ask for Generali’s help by calling the 24/7 hotline. Generali will try to convince your doctor to include his PF in the hospital Statement of Account. But of course, final decision rests on the doctor and you should still be ready to advance payment if ever they don’t agree to include it in the Hospital bill
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REMINDERS• Special Arrangement hospitals
– These are hospitals that accept VISA payments, but has no Medillink POS facility for card activation upon admission
– For these hospitals, please contact Generali to notify them of your admission and discharge via these numbers:
• (02) 894-1135 (Mon-Friday: 7 am to 10 pm;Sat-Sun: 8 am – 5 pm)
• 0917 – 8941135 up to 36 (24 by 7 hotline)
– Or send a Text Message given the format below • NOA <Card number> <Hospital Code*> IP then send to 0917
8942901• NLP <Card number> <Hospital Code*> IP then send to 0917
8942901
* Refer to Member Guide
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REMINDERS• Take care of your E-Card XP:
– Report any damage / loss immediately (see back of card or call Generali) and advise Nestle HR
– Replacement cards will have the ff charges:• Lost Cards: Php150.00• Damaged Cards: Php100.00
• Notify HR of personal changes immediately:– Especially NEW dependents or change in Marital
Status– Nestle HR should report these changes to
Generali within 30 days from the effectivity date.
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IN-PATIENT (IP) AVAILMENT
Thank You!