GP & SP Medical Benefit

SCA Hygiene Malaysia

AGENDA
What makes to change? What is the changes? Benefit of Third Party administration (TPA) Comparison of before & after Medical Process What would I need to do? FAQ Q&A session

April 22, 2013

GP&SP MEDICAL BENEFIT

OVERVIEW
What makes to change?
Administrative work for medical claim increase significantly.

86% 40%

1300 700

500 Year 2010

Year 2011

Year 2012

Request from associate to have more network of panel clinics and hospitals. To have a better control on claims .

April 22, 2013

GP&SP MEDICAL BENEFIT

Changes
Third Party Administrator
To manage employee medical benefits in better way: The medical claim process of : GP (General Practitioner) and SP (Specialist Treatment) Outpatient will be administrated by Third Part Administrator (TPA) called

MiCares Effective 1st may 2013

April 22, 2013 GP&SP MEDICAL BENEFIT 4

Third Party Administrator

Benefit
Provide a cashless primary healthcare service Have a higher coverage of panel clinics & hospitals through out Malaysia Panel clinic = 1484 Panel Hospital = All government hospital & 121 private hospitals 24/7 medical support Employee Self Service Portal to asses and check on claim status

April 22, 2013

GP&SP MEDICAL BENEFIT

Comparison of before & after Differences

S/N 1 Activity Panel clinic (GP) Current Only 4 panel Clinics:1. Nadi Iman 2. Klinik Sejatera 3. Klinik Bandaran 4. Klinik Faridah Must get medical chit from reception or guard house Pay and claim After Follow Micares 1484 panel clinic
From essential From Frontier E-HR Common area-medical benefit

MICARES\GP panel list for SCA Hygiene 08-04-13.pdf

2 3

Visiting panel clinic (GP) Visiting non- panel clinic (GP)

Use Micares medical card Pay and claim

Panel Hospital (SP)

Only 4 panel hospitals:1. KPJ Selangor 2. Sime Darby medical center 3. Pantai Klang 4. Asuntha, PJ Guarantee letter (GL) is issued by Plant HR or C&B

Follow Micares 121 Private hospital & all government hospital

MICARES\Hospital panel list.pdf

Visiting specialist- at Panel hospital (Must get referral letter from GP) Validity of Guarantee Letter (GL)

Guarantee letter (GL) is issued by Micares

MICARES\Outpatient Specialist GL Format.pdf

Multiple visit for the same disability up to period of 1 month

Single visit for the same disability up to period of 1 month

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April 22, 2013

GP&SP MEDICAL BENEFIT

Comparison of before & after Differences-continue

S/N 7 Activity Visiting specialist- at NonPanel hospital (Must get referral letter from GP) Medical claim form Current Pay and claim After Pay and claim

Use SCA medical claim form

Use Micares medical form From essential From Frontier E-HR Common area-medical benefit
MICARES\Micares medical claim form.pdf

Submission of medical claim

Every 10th of the month Medical claim submit to C&B for verification & approval

Every 10th of the month Medical claim submit to Micares for verification & approval (pigeon hole will be prepared at reception) Direct credit to associate account 3 weeks upon claim being approved Check from Micares Portal Must be claimed within 3 months from the visit date
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10 11 12 13

Reimbursement of claim Payment day Claim status Validity of medical receipt

Reimburse via salary 28th of the month (pay day) Check from payslip No lock period

April 22, 2013

GP&SP MEDICAL BENEFIT

MEDICAL PROCESS
Micares

Medical Process
Micares Roles

Micares Roles 1) 2) 3) Direct access to Micares panel of clinics Issuance of GL for outpatient specialist visit Processing of Reimbursement Claims

April 22, 2013

GP&SP MEDICAL BENEFIT

Process Flow and Procedures

Outpatient Clinical (Panel)

Patient arrives at clinic, produces Member card

Clinic nurse verifies name against on-line real time MiCARES system

Patient signs Medical Record of Attendance

Clinic submits eClaims

Patient collects medication, pays uncovered charges (if any) and leaves clinic
GP&SP MEDICAL BENEFIT

Patient seeks consultation

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April 22, 2013

Process Flow and Procedures

Outpatient Specialist

Patient obtained appointment date for Specialist visit

Before the appt, call the 24/7 for a Guarantee Letter. Fax over the referral letter or appointment card

Alternatively, the hospital can also contact us with Outpatient Claim Form

Our Call Center validates & authenticate info, issues Guarantee Letter within 30 minutes upon receipt of relevant documents

Patient collects medication, pays for Uncovered Charges (if any) before they leave the clinic/hospital
April 22, 2013

Patient seeks consultation

Outpatient specialist clinic/hospital receives Guarantee Letters

GP&SP MEDICAL BENEFIT

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Process Flow and Procedures

Reimbursement claim

Employee submits reimbursement claims documents via MiCares Portal. (User ID and Password will be provided)

Employee needs to upload scanned copy of original receipt via MiCares Portal. If scanned copies not provided, claims will not be processed.

Employee to submit original receipt to pigeon hole at reception

Assessor screen through the claims documents, check validity of policy terms and conditions.

Employees claims are paid via direct TT to their bank account (3 weeks upon claims being approved)
April 22, 2013

Employee can check reimbursement claims status via MiCares Portal

GP&SP MEDICAL BENEFIT

Assessor proceed to assess the claims via MiCares portal.

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Process Flow and Procedures

Employee login module

User-ID and password will be emailed to employee (via companys email address)

April 22, 2013

GP&SP MEDICAL BENEFIT

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Employee login module

Micares portal

April 22, 2013

GP&SP MEDICAL BENEFIT

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Employee login module

Micares portal

Upload Original Receipt & relevant documents

April 22, 2013

GP&SP MEDICAL BENEFIT

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Contact Details
MiCares Contact Centre 24 x 7 Medical Helpline (Toll-Free): 1-800-88-2678 Alternative Helpline (Office Hour): 603-7843 9459 Fax No. (24 Hours): 603-7847-4304 (24 hours)

April 22, 2013

GP&SP MEDICAL BENEFIT

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What do I need to do?

Existing employee Micares will only start to accept and process the submission of medical claim for the non panel visit of GP&SP dated 1st May 2013 onward. As such, medical receipts that are pending for claim dated 30th Apr 2013 and below should be submitted to C&B latest by 10th May 2013 to be reimbursed via payroll. Submission of medical claim after the deadline will not be entertained for reimbursement. New hired Medical card will be distributed a month after the hired date. Medical treatment endures during the first month need to pay and claim from Micares.

April 22, 2013

GP&SP MEDICAL BENEFIT

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Frequently Asked Questions

Q1. What if I forget to bring my medical card to clinic/hospital? Please advise the hospital/clinic to contact Micares via the toll free number so that Micares may verify your particulars via their system. Q2. What if I go to a non panel hospital/clinic? You may need to pay & file claim for consideration. Q3. Who are our panel hospitals and panel Clinics? Panel hospital & clinics listing can be obtained from E-HR, Essential or F-drive -common area. You may also call Micares via their toll free number to enquire on the list of panel hospitals and clinics. Q4. Who should we call if we have difficulties with clinics/hospitals? Kindly contact Micares via the toll free number at 1800-88-2678 so that Micares may assist you.

April 22, 2013

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Frequently Asked Questions

Q5. What if the fax cant go thru for GL request? If the fax not able to get thru, other option is contact Micares via the toll free number at 1800-88-2678. Q6. What if claims has rejected? The rejection of claim is might be due to uncompleted documents such as: referral letter/incomplete diagnosis/original receipts and etc Please resubmit the claims and attached with the relevant documents. Q7. Is there a cap/limit for the GP&SP medical benefit? No. Unlimited and follow the existing coverage & exclusion list of GP&SP. Q8. Is the medical card can be used for admission/inpatient treatment? No. please use RHB medical card.MICARES\RHB CARD.bmp

April 22, 2013

GP&SP MEDICAL BENEFIT

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Frequently Asked Questions

Q9. Is this card can be used for dependents? No. This outpatient medical card is valid for SCA associates only. Q10. When is the cut off date for the medical claim submission? Every 10th of the month. Q11. What if the claim submitted 3 months after the visit date? The claim is rejected and cannot resubmit again. Q12. How the medical claim is reimburse to me? Direct credit to Individual account. Q13. How do I get my user id & password for Micares portal? An email will send out to associate before 1st May 2013. Q14. What if I forget my password to log in Micares portal? Kindly contact Micares via the toll free number at 1800-88-2678 or C&B
April 22, 2013 GP&SP MEDICAL BENEFIT 20

Frequently Asked Questions

Q15. Does this medical card has expiry date? No. As long as the associate is in service to SCA, the associate can use the card. Those associate who resign need to return their medical card to HR Q16. What if I lose my medical card? Replacement cards processing fee of RM10.00 is applicable.

April 22, 2013

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April 22, 2013

GP&SP MEDICAL BENEFIT

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