Gp&Sp Presentation Slide-bi

8/12/2019 Gp&Sp Presentation Slide-bi

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SCA Hygiene Malaysia

GP & SP Medical Benefit


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AGENDA

April 22, 2013 GP&SP MEDICAL BENEFIT 2

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


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OVERVIEWWhat makes to change?

Administrative work for medical claim increase significantly.

Request from associate to have more network of panel clinics andhospitals.

To have a better control on claims .

2010 2011 2012

500

700

1300%%


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To manage employee medical benefits in better way:

The medical claim process of :

GP (General Practitioner) and

SP (Specialist Treatment)

will be administrated by Third Part Administrator (TPA)called


ChangesThird Party Administrator

MiCares

Effective 1st

may 2013

Outpatient


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DifferencesS/N Activity Current After

1 Panel clinic (GP) Only 4 panel Clinics:-1. Nadi Iman

2. Klinik Sejatera3. Klinik Bandaran4. Klinik Faridah

Follow Micares 1484panel clinic

From essential From Frontier E-HR Common area-medical benefitMICARES\GP panel list for SCA Hygiene08-04-13.pdf

2 Visiting panel clinic (GP) Must get medical chit from reception or guardhouse

Use Micares medical card

3 Visiting non- panel clinic (GP) Pay and claim Pay and claim

4 Panel Hospital(SP)

Only 4 panel hospitals:-1. KPJ Selangor2. Sime Darby medical center3. Pantai Klang

4. Asuntha, PJ

Follow Micares 121Private hospital & allgovernment hospitalMICARES\Hospital panel list.pdf

5 Visiting specialist- at Panelhospital

(Must get referral letter fromGP)

Guarantee letter (GL) is issued by Plant HR orC&B

Guarantee letter (GL) isissued by MicaresMICARES\Outpatient Specialist GL -Format.pdf

6 Validity of Guarantee Letter

(GL)

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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Differences-continue

S/N Activity Current After

7 Visiting specialist- at Non-

Panel hospital(Must get referral letterfrom GP)

Pay and claim Pay and claim

8 Medical claim form Use SCA medical claim form Use Micares medical form From essential From Frontier E-HR

Common area-medical benefitMICARES\Micares medical claim form.pdf

9 Submission of medicalclaim

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

Every 10th of the month Medicalclaim submit to Micares forverification & approval(pigeon hole will be prepared at

reception)

10 Reimbursement of claim Reimburse via salary Direct credit to associate account

11 Payment day 28th of the month (pay day) 3 weeks upon claim being approved

12 Claim status Check from payslip Check from Micares Portal

13 Validity of medical receipt No lock period Must be claimed within 3 months

from the visit date


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MicaresMEDICAL PROCESS


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Medical ProcessMicares Roles

1) Direct access to Micares panel of clinics

2) Issuance of GL for outpatient specialist visit3) Processing of Reimbursement Claims

Micares Roles


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Process Flow and ProceduresOutpatient Clinical (Panel)

,

( )

,


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Process Flow and ProceduresOutpatient Specialist

, 24/7

.

,

&

,

30

/

,

( )

/


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Process Flow and ProceduresReimbursement claim

. (

)

.

, .

.

,

.

(3

)


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Process Flow and ProceduresEmployee login module


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Employee login moduleMicares portal


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Employee login moduleMicares portal

&


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Contact Details

24 7 ():

( ):

. (24 ):


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Existing employee

Micares will only start to accept and process the submission of medical claimfor the non panel visit of GP&SP dated 1st May 2013 onward.

As such, medical receipts that are pending for claim dated 30th Apr 2013and below should be submitted to C&B latest by 10th May 2013 to bereimbursed via payroll.

Submission of medical claim after the deadline will not be entertained forreimbursement.

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 fromMicares.


What do I need to do?


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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, Essentialor F-drive -common area. You may also call Micares via their toll freenumber 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 1800-88-2678so that Micares may assist you.



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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 suchas: referral letter/incomplete diagnosis/original receipts and etcPlease 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



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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&BApril 22, 2013 GP&SP MEDICAL BENEFIT 20


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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 medicalcard to HR

Q16. What if I lose my medical card?Replacement cards processing fee of RM10.00 is applicable.



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Gp&Sp Presentation Slide-bi

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