Transcript Document

WELCOME TO
ULTIMATE HEALTH
A PLAN THAT DELIVERS
Medical
Reimbursement
Executive
Physicals
Clinical Support
Services
Travel & Medical
Emergency
Support
ARMADA HEALTHCONNECTIONS
Navigation
Guiding you to the most experienced
and skilled specialists
Affirmed
Top Specialty
Physicians
Facilitated Access
Facilitating appointments to get
you access more quickly
Virtual Second Opinions
Personalized advice from leading
medical minds
Medical Information
Helping you make informed decisions and
get questions answered
TRAVEL & MEDICAL
EMERGENCY SUPPORT
Take Me Home
Fully paid medical
air evacuation from
anywhere to home*
Urgent Care Referrals
Over 50,000 pre-certified
dentists, hospitals and
doctors around the globe
Member Portal
Information and
tools to keep you
prepared and safe
while traveling
*Available when hospitalized 100+ miles from home. Subject to FrontierMEDEX terms and conditions.
MEMBER TRAVEL PORTAL
Immunization
Requirements
Secure Medical and
Travel Records Storage
Global Pre-certified Hospital
and Provider Listings
Country Specific
Health & Security
Information
Drug Translation Tool
Pre-Travel Medical
Destination Reports
Country Medical Quality
And Security Ratings
DESTINATION MEDICAL REPORT
MEDICAL REIMBURSEMENT
Executive
Physicals
Most 213(d)Eligible Expenses
Rx Co-Pays and
Brand Name Rx
Dental and Vision
Out-of-Pocket Expenses
Out-of-Network Balance Bills
Deductibles, Co-Pays, Co-Insurance
EXPANDED COVERAGE
Deductibles
Co-Insurance
Co-Pays
Balance Bills
Out-of-Network
Exclusions &
Limitations
Vision
Dental
In-Network
Prescriptions
Wellness
Adult and Child Orthodontia
Crowns, Bridges and Implants
Prescription Sunglasses
Contact Lenses
LASIK Surgery
Wigs
Hearing Aids
Rx: Co-Pays, Brand Name and Lifestyle
Chiropractic, Acupuncture and
Massage Therapy
Executive Physicals
SUMMARY OF PLAN BENEFITS
Platinum
$5,000
Per-Occurrence
Additional Coverage Per Covered Person: Annual Benefit Maximums
$4,000
Dental Treatments
$1,000
Vision Treatments
$2,000
Mental Health
$2,500
Prescriptions
$2,000
Durable Medical Equipment
$1,000
Certain Wellness Treatments
$2,000 each
Executive Physicals (Member & Spouse)
$50,000
Annual Family Maximums
Please see your certificate of coverage for a list of exclusions and limitations.
PRESCRIPTION MASTERCARD
Use
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Swipe-and-Go Convenience
Still submit claim to primary plan first
Use at pharmacies: in-store, online and mail order
Use “credit” button at checkout
Has certain limits per carrier; if depleted, use claim forms
Don’t Use
®
Reminder:
Your Rx card
will come to
you directly
from
For Anything Other Than Prescriptions
the bank.
• Not for over-the-counter items
• Not for physician, dental or vision co-pays
• Not for any prescription prior to card activation
EXECUTIVE PHYSICALS
What Are They? Top-to-Toe Physical Exams
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Detailed medical history and physical exam
Lab screening and tests
Conducted at Centers of Excellence
Benchmark
Review of available results and recommendations
How We Help
Navigation Services
• Locate center close to you
• Find specialists for any follow-up
Reminder:
We provide
coverage
toward these
physicals for
you & your
spouse.
SUBMITTING CLAIMS
First Step
Processed by your primary plan first
• EOB is required
• If no EOB, itemized bill and proof of payment required
Submit
Separate claim form for each person
• Can include more than one claim on each form
• Submit your claims via mail or fax
Processing Takes 5 to 7 business days
• Allow time for mailing each way
Reminder:
Complete the
forms & your
designee can file
claims on your
behalf.
MEDICAL CLAIMS
Most
Submit an EOB
• Include all pages (footnotes and YTD summaries)
• Include even if the charge is denied by primary plan
If OON
Out-of-Network
• Indicate if the provider is out-of-network
• Include any balance bill invoice from the provider
Exception Physician Co-Pay
• Use a detailed receipt instead of an EOB
• Show treatment/services received, date of service and patient name
• No cash or credit card receipts
DENTAL AND VISION CLAIMS
Submit an EOB
yes
For orthodontic claims, submit:
1) Treatment plans
2) Invoices with the entire amount
you’re responsible for
3) Primary EOB (if applicable)
Do you have:
Vision
coverage?
Dental
coverage?
no
Submit a detailed receipt
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•
Show treatment/services received, date of service and patient name
No cash or credit card receipts
OTHER CLAIMS
Rx
213(d)Eligible
Expenses
Submit an
Rx slip.
Don’t black
out drug
name.
Submit a
prescription
and detailed
receipt.
Executive
Physicals
If accepted
by insurance,
submit an
EOB.
If not, submit
the contract
and invoice.
Manage Your Claims:
1) Check your EOB from
ArmadaCare® when it
arrives in the mail.
2) Tell the person filing
your claims when you
receive payment or EOB.
MEMBER WELCOME KIT
 Wallet Cards
 Member Guide with FAQs
 Specific Inserts
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At-a-Glance
Prescription MasterCard ®
Travel Portal
Claim Submissions
 Claim Forms and Envelopes
Note: Your Certificate of Coverage may be sent separately from your
Member Welcome Kit.
CONTACT US
Travel
Support
Member
Services
• Medical air evacuation
• Other Travel and Medical
Emergency Support Services
• Claims
• Coverage or eligibility
• Referral to a specialty physician
Armada
• Center of Excellence (Executive
Health
Physical)
ConnectionsSM • Virtual Second Opinion
One Number:
1-800-448-0085
Monday–Friday
8:30 a.m. to 6:30 p.m.
Eastern
THANK YOU
Insured by Transamerica Financial Life Insurance Company and Monumental Life Insurance Company is rated by A. M.
Best as A+ (Excellent, 2 out of 16 categories) as of 4/13/12.
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