FAQ
What is a TPA?
A Third Party Administrator is an expert in the management of employees’ benefit plans specifically but not limited to health and medical benefits. As such it seeks to pool together resources such as network providers, technology providers, financial providers, and HR management providers to be able to address specific corporate benefit programs.
Is the number of accredited hospitals same as HMO?
Currently, there are over 200 accredited hospitals and clinics and over 3,600 network of physicians and dentists nationwide. MEDI-access TPA has already accredited major facilities in strategic locations nationwide.
How can we benefit from MEDI-access TPA? Currently, we’re under an HMO.
The benefits of MEDI-access lies on the amount of savings it can generate for your company. The customization of the plan makes you in control of your own health plan. The unused portion is given back to the company.
What are the offerings of MEDI-access TPA over other TPA programs?
1. Computerized system – HR Portal is an online system used for enrollment/suspension, activation of members who will avail of MEDI-access Program. It can also generate real time case notification, utilization of members and other customized reports which are deemed necessary for the company. HR portal is a web-based portal that can be accessed via web: http://www.medi-access.com
2. Access to Healthway Medical clinics with no administrative fee.
3. Customized health and wellness program depending on your company’s health profile
What are the requirements to avail of a TPA program?
- Duly accomplished and signed MEDI-access Conforme letter (agreement)
- Accomplished Member Masterlist to be enrolled in MEDI-access HR Portal (employees, and dependents if applicable)
- Schedule of Benefits (SOB)
- MEDI-access fee of PHP 392.00/enrollee
- Health Fund equivalent to 6 months utilization
- Waiver Form signed by each Member authorizing Healthway MEDI-access to have access to the Member’s medical records relevant to their confinement and/or for the determination of coverage benefits.
Is my membership transferable?
No. The card is not transferable. Each member shall be provided with a membership card.
What should I do if I lose my MEDI-access card?
Please contact our call center at +632 381-0063. Report the lost card and ask for a replacement card. Card replacement is worth PHP 300.00/card.
Can I go to a non-accredited doctor for consultation?
MEDI-access shall not cover any consultation, treatment or procedure done by a non-accredited doctor, EXCEPT DURING EMERGENCY CASES, wherein the member may apply for reimbursement of his/her medical expenses.
What are samples of these emergency cases?
· Gun shot wound
· CVA (Cerebro-Vascular Accidents)
· Heart Attack
· Animal Bites
· Head Trauma
What are the documents needed for reimbursements?
· All original medical receipt
· Clinic abstract
How long will it take to get my reimbursement?
Normally, processing of reimbursements is 15 working days after receipt of the complete documents that include evaluation of the bills, investigation, approval of doctor, premium payment verification with Finance Department, and check preparation. All claims without outstanding premium balance MUST be released within the 15-working day period. Reimbursements that were initially given an action/disapproved memo will be processed 7 working days after receipt of the complete documents.
What is a pre-existing condition or CPX?
Pre-existing condition is defined as those illness or illnesses that a member already has prior to the effectivity of its health care plan.
What are pre-existing conditions?
· Hypertension
· Goiter
· Cataracts/Glaucoma
· ENT conditions requiring surgery
· Bronchial asthma
· Tuberculosis
· Chronic cholecystitis (Gall Bladder Stones)
· Acquired hernias
· Prostate disorders
· Hemorrhoids and anal fistulae
· Benign tumors
· Uterine myoma, ovarian cyst, endometriosis
· Buergher’s disease
· Varicose veins
· Arthritis
· Migraine headache
· Gastritis/duodenal or gastric ulcers
What happens to my PhilHealth benefit?
Once admitted you will be asked to fill out a PhilHealth Reimbursement form. The PhilHealth reimbursement shall be deducted from your tbill prior to discharge.
What is the minimum number of enrollees to apply for MEDI-access?
· 50 enrollees and above, combination of dependents and employees