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In order to ensure that you receive the best possible claims service the procedures noted below should be followed in the event of treatment being required by you or one of your dependants. Members are recommeded to submit claims via email (stated at bottom of this page).
MEDICAL HELPLINE
All insured persons have access to our medical helpline which is available 24 hours a day, 365 days a year and is staffed by multi-lingual operators who can arrange admission to hospital, ambulance transfers and air evacuation where necessary. To obtain medical assistance, please use the medical helpline number nearest to you as shown on your membership card. You will need to provide your name, reference number, telephone and/or fax number, location and medical condition. In any given situation, if you are unsure what to do, contact the medical helpline.
DEFINITION
We/Our/Us: Aetna Global Benefits
OUT-PATIENT TREATMENT
Out-patient treatment is treatment received in a doctor’s office that does not require admission to a hospital bed.
Outside the USA: Out-patient services and treatment received outside the USA are required to be paid by you at the time of treatment. After paying for your treatment you should submit a claim form to be processed. To ensure prompt settlement of these expenses, please make sure to take your claim form with you in order for it to be completed by the treating general practitioner, specialist or dental practitioner.
Exceptions may be made for high cost procedures. In this case you will be required to contact us prior to receiving your treatment, in order for us to arrange direct payment with the medical facility concerned. Please note that not all medical facilities will accept direct payment. In these instances you will be required to settle the bill and submit a claim for reimbursement.
Providing all relevant information is submitted to support your claim, we will reimburse you accordingly by the payment method of your choice. Please clearly state your preferred payment method on your claim form. Where this is by bank transfer, clearly state the name of your bank, account number and SWIFT (or IBAN) code. Provided all required information is present, eligible claims will be reimbursed in fifteen (15) working days.
Inside the USA: Some policies allow for treatment to be undertaken in the USA. Please check your program‘s schedule of benefits to ensure that you have the appropriate coverage before undertaking any treatment within the USA.
Where your policy allows, out-patient services and treatment received within Aetna’s provider network can be billed to us directly. In most cases, you will be required to show your membership card to the provider who will contact us to confirm direct billing. This may not immediately happen and, should you be asked to pay for the treatment please ensure you state clearly to the facility that you wish to have your bill settled directly by us, and for them to contact the number on the reverse of your membership card.
In the unlikely event that you are still required to pay your bill, please follow the steps as outlined in the ‘Outside the USA’ section above.
Our claims department will process the claim according to the applicable portion payable by us taking into account your excess and any co-insurance applicable. Once our portion is paid, we will send both you and the provider an ‘Explanation of Benefits’ (EOB) with details of settlement and a statement of what you are responsible for.
Claim Form: When submitting any claim forms and any other documents pertaining to the claim, please ensure that:
- the first page of the claim form has been completed in full by you for each medical condition treated. The declaration must be signed by the insured person and dated to enable the claim to be validated.
- you attach to your claim form, the copy of paid receipts and any other documents pertaining to the claim (or other proof of payment) for all treatment for which you are making a claim.
- where your treatment has been provided by a registered physiotherapist, chiropractor, osteopath, homeopath, podiatrist or acupuncturist, please ensure that you attach to your claim form a copy of the ‘referral letter’ that was provided by your medical practitioner.
- where applicable laboratory tests results and/or x-rays were provided, please include the test results with your claim.
- for all claims under US$200 per medical condition, you need only complete sections A, B and C and return your claim form with the copy of receipt(s) showing the diagnosis and a full breakdown of costs for each condition being claimed for. All sections MUST be completed in full for hospitalisation claims and all claims over US$200. A ‘referral letter’ from your specialist should be attached when you are claiming for diagnostic tests.
Please note that any charges that may be made by an attending medical practitioner for completing your claim form are not eligible for reimbursement under the terms and conditions of the policy and you will be responsible for settling these costs.
Where it is not possible to have the claim form completed by the medical practitioner, specialist or dental practitioner, we will accept the claim for assessment provided your receipt(s) for treatment include the date of service, the diagnosis of your medical condition, the treatment provided, the amount charged and the stamp of the facility concerned.
To ensure prompt settlement of any eligible claims please ensure that you submit all necessary documents at the time of the claim. We accept copies of original receipts for claim processing and to facilitate the assessment of your claim, however do keep your originals properly as we may require them under certain circumstances. When submitting claims via email, please adhere to the procedure stated on this link.
Note: Should a member make a claim and receive reimbursement (of any size), their NCB discount will revert to a level two years below their current level at their next renewal. However, if their reimbursement exceeds US$15,000 the NCB discount will drop all the way down to the standard premium, i.e., no discount.
General Claims Information: We reserve the right to reject any claim which is not submitted within 90 days of the date that treatment took place. All documents and materials (including, but not limited to original accounts, certificates and x-rays) that we require to support a claim, shall be provided without expense to us (including, if requested by us, a medical report from your medical practitioner or specialist and details of the your medical history).
In cases where medical information is required by us for consideration of a claim, but it is not made available to us, it is your responsibility to obtain such information from your current or previous medical practitioner, as appropriate. Claims may only be made for treatment actually given during a Period of Cover and benefit will be available only for expenditure incurred prior to expiry or termination of such cover.
An insured person must, without delay, give us written notification of any claim or right of action against any third party arising out of circumstances which gave rise to a claim under this policy and must continue to keep us fully informed in writing and take all steps we reasonably require in making a claim upon that other party. We shall be entitled to take legal action in any insured person's name for our own benefit and claim for indemnity or damages or otherwise which relates to any benefits and costs paid or payable under this policy. We shall have full discretion in the conduct of any such proceedings and in the settlement of any such claim.
If You have any questions concerning the above or any other aspect of your policy please do not hesitate to contact your local Aetna claims office.
Contact Details: For all pre-authorisation, claims or benefit queries please contact Aetna Worldwide claims office closest to you. Please ensure you have your policy number at hand prior to calling, as this will be required to verify your cover:
- Britain
- Tel: + 44 870 442 4386
- Fax: + 44 870 442 4387
- Hong Kong
- Tel: + 852 2104 7486
- Fax: + 852 2866 2555
- Dubai
- Tel: + 971 4 438 7600
- Fax: + 971 4 428 7100
- America
- Tel: + 1 813-775-0220-------------Toll Free (inside the USA only): + 1 866-545-3252
- Fax: + 1 860 262 9111
- Email: claims@talent-trust.com