| |
|
| Step
1. |
For
availing direct billing facility at Network
provider the member/dependant approaches the
Provider with WAPMED ID card. |
| |
|
| Step
2. |
For planned admission,
forward the Initial Intimation Letter (IIL)
along with a copy of WAPMED ID card to WAPMED,
3 – 4 days prior to the hospitalization/procedure. |
| |
|
| Step
3. |
For emergency
admission forward Initial Intimation Letter
along with a copy of WAPMED ID card within
24 hours of hospitalization to WAPMED. |
| |
|
| Step
4. |
WAPMED will issue
an authorization letter for the covered services
within the eligibility limits as per the policy. |
| |
|
| Step
5. |
Network provider
extends credit treatment to the Member / dependants
for the authorized services. |
| |
|
| Step
6. |
At the time of
discharge Member / dependant leaves back all
the original documents with the Network Provider
after signing on all the claim documents. |
| |
|
| Step
7. |
If any unauthorized
treatment for the ailment/disease, which is
not covered under the terms and conditions
of the policy or forms a part of excess/ Co-payment/deductible,
she/he will have to make the payment to the
Network Provider directly. |
| |
|
| Step
8. |
Submit all the
original claim documents (as mentioned above)
to WAPMED office within 7 working days after
the member’s discharge from the Network
Provider for early reimbursement. |
| |
|
| |
|
Q2.
Do’s for network hospitals while serving
WAPMED Members for In-Patient services/Day
care procedures/CT-MRI facilities/Specified
Out patient facilities? |
| |
|
| |
Dos- |
| |
|
| |
 |
Check the
member’s identification (WAPMED
ID card / authorization letter) before
extending direct billing facility. |
| |
|
|
Intimate WAPMED office
regarding the admission of member through
the Initial intimation letter (IIL). |
| |
|
|
Intimate WAPMED at least 3 –
4 days prior to admission for all pre
elective cases. |
| |
|
|
Intimate WAPMED office within 24
hours of admission for all emergency
cases. |
| |
|
|
Fill the IIL completely and duly
signed by the treating doctor before
sending (faxing/online) to WAPMED office. |
| |
|
|
Mention the plan of treatment, probable
duration of stay and estimated amount
for the treatment in the IIL. |
| |
|
|
Intimate WAPMED office regarding approval
for extension of authorized coverage
amount at least 24 hours prior to discharge
time. |
| |
|
|
In case timely authorization/letter
of guarantee is not received from WAPMED,
kindly intimate the same to WAPMED office
to obtain the authorization letter. |
| |
|
|
Extend the direct billing facility
as per the authorized guidelines by
WAPMED in the authorization letter. |
| |
|
|
Collect the over and above the authorized
eligible amount directly from the member
at the time of discharge. |
| |
|
|
Collect the amount billed for non-medical
items, which are not payable under this
insurance scheme. |
| |
|
|
Duly signed claim form by the member
has to be submitted along with the claim
documents. |
| |
|
| |
|
|
Q3.
Don’ts for Network Providers while
Serving WAPMED Members for In-Patient services/Day
care procedures/CT-MRI facilities/Specified
Out patient facilities? |
| |
|
| |
Dont's- |
| |
|
| |
 |
Do not hide
relevant and factual information regarding
the past and present medical history
of the member. |
| |
|
|
Do not extend direct
billing facility to unauthorized members
and for unauthorized ailments / procedures
on credit basis. |
| |
|
|
Do not hand over the original documents
like discharge summary, reports, bills
etc to the member at the time of discharge. |
| |
|
|
Do not extend direct billing facility
over and above the authorized limits
and services. |
| |
|
| |
|
|
Q4.
How to extend direct billing facility to
WAPMED member for Out-patient facilities? |
| |
|
| Step
1. |
For availing direct
billing facility at Network provider the member/dependant
approaches the Provider with WAPMED ID card. |
| |
|
| Step
2. |
The network Provider
logs on to the WAPMED website with log-in
ID and password provided to them and checks
the availability of balance Sum Insured/Excess/deductibles
before extending the direct billing facility. |
| |
|
| Step
3. |
After that if
the Network Provider extends the direct billing
facility then, it has to enter the cost of
treatment on the wapmed health card screen
and block that amount. |
| |
|
| Step
4. |
Once the member
has availed the direct billing facility the
Provider’s executive would take a print
out of the screen from wapmed website mentioning
the balance Sum Insured/Excess/deductibles
and the amount authorized/utilized for present
facility and take members signature on the
same. |
| |
|
| Step
5. |
At the time of
leaving the network provider premises, Member
/ dependant leaves back all the original documents
with the Network Provider after signing on
all the claim documents. |
| |
|
| Step
6. |
If any unauthorized
treatment for the ailment/disease, which is
not covered under the terms and conditions
of the policy or forms a part of excess/ Co-payment/deductible,
she/he will have to make the payment to the
Network Provider directly. |
| |
|
| Step
7. |
Submit all the
original claim documents (as mentioned above)
to WAPMED office within 7 working days after
the member’s discharge from the Network
Provider for early reimbursement. |
| |
|
| |
|
Q5.
Do’s for Network Providers while serving
WAPMED Members for Out-patient facilities? |
| |
|
| |
Dos- |
| |
|
| |
|
Q6.
Don’ts for Network Providers while
Serving WAPMED Members for Out-patient facilities? |
| |
|
| |
Dont's- |
| |
|
| |
|
Do not hide
relevant and factual information regarding
the past and present medical history
of the member. |
| |
|
|
Do not extend direct
billing facility to unauthorized members
and for unauthorized ailments / procedures
on credit basis. |
| |
|
|
Do not hand over the original documents
like discharge summary, reports, bills
etc to the member at the time of discharge. |
| |
|
|
Do not extend direct billing facility
over and above the authorized limits
and services. |
| |
|
| |
|
|
Q7.
What are documents required to lodge claims
with WAPMED for reimbursement? |
| |
|
| |
General |
| |
|
| |
 |
Copy of Member
ID card with the member’s details. |
| |
|
|
Copy of Civil ID card |
| |
|
|
Copy of the policy papers, if any. |
| |
|
| |
|
|
| |
In-Patient
services/Day care procedures/CT-MRI facilities/Specified
Out patient facilities |
| |
|
| |
|
Copy of Initial
Intimation letter and WAPMED authorization
letter (In-Patient services/Day care
procedures/CT-MRI facilities/Specified
Out patient facilities) |
| |
|
|
Original detailed discharge
summary |
| |
|
|
Original investigation reports |
| |
|
|
Original Hospital Bill-consolidated
and with detail breakup with the patients
signature on it |
| |
|
|
Incase of surgical packages –
detail breakup of the package |
| |
|
|
Pharmacy bills and breakup |
| |
|
|
| |
Out-patient
facilities |
| |
|
| |
|
Copy of health
card printed from the website duly signed
by the member |
| |
|
|
Original consultation
papers |
| |
|
|
Original investigation reports |
| |
|
|
Original Bills-consolidated and with
detail breakup with the patients signature
on it |
| |
|
|
Pharmacy bills and breakup |
| |
|
| |
|
|
Q8.
What are the standard Billing Protocols? |
| |
|
Points
to be remembered for credit billing, before
forwarding the documents to WAPMED office,
we request you to kindly keep the following
points in mind – |
| |
|
| |
|
Consolidated
Bill for the entire amount raised for
the member towards his treatment. |
| |
|
|
Itemized bill break up
for all the details mentioned in the
consolidated bill. |
| |
|
|
Breakup for room rent ( In patient
facility) |
| |
|
|
Pharmacy bill Break up |
| |
|
|
OT consumables and disposable break
up |
| |
|
|
Package rate break up |
| |
|
|
Surgeon fee / Anesthetist fee / Asst
doctor fee |
| |
|
|
Miscellaneous Break up (kindly provide
a detailed Miscellaneous break to avoid
Disallowances by Insurance Company). |
| |
|
| |
|
|
Q9.
What are the different formats used for
WAPMED operational related activities? |
| |
|
| |
 |
Initial Intimation
Letter |
| |
|
|
Authorization letter
/ Credit Letter |
| |
|
|
Denial Letter |
| |
|
|
Claim forms |
| |
|
|
Checklist |
| |
|
|
Discharge Summary |
| |
|
|
Additional Information Sheet |
| |
|
| |
|
|
Protocol
for Direct billing facility In-Patient services/Day
care procedures/CT-MRI facilities/Specified
Out patient facilities |
| |
|
Member
(along with ID card / WAPMED Authorization
letter) |
|
Network Provider |
|
Member Enrollment
and Eligibility Verification, through
ID card / policy papers by the Provider |
|
Initial intimation
Report sent to WAPMED office by the
Provider |
|
Confirmation /
denial for the admission on credit
basis by WAPMED through Authorization/denial
letter |
|
Admission and
Inpatient treatment as per the Authorization
letter |
|
Generation of
Credit Bills |
|
Patient signature
on the Bill and Claim form (essential
for claim settlement) |
|
Forwarding the
bills for reimbursement to WAPMED |
|
|
| |
| Protocol
for Direct billing facility Out patient facilities
|
| |
| Member
(along with ID card) |
| |
Network Provider |
|
Network Provider
logs on to WAPMED website through
login ID and password |
|
Checking of Sum
Insured/sub limits/ excess/deductibles
by the Provider |
|
Extending direct
billing facility on basis of information
retrieved from the website |
|
Blocking and saving
the amount utilized by the member
for present facility |
|
Taking a print
out of health card and taking members
signature on it |
|
Generation of
Credit Bills after collection of excess/deductibles/non
payable expenses |
|
Forwarding the
bills for reimbursement to WAPMED |
|
|
|
| |
| |
Corporate
/ Tailor Made Policy FAQs |
| |
Q1.
What are the services offered by WAPMED
to its beneficiaries? |
| |
| |
A.
WAPMED is the service provider for required
Health care service to corporate/ind members
through its activities like -
Direct Billing Facility in Kuwait as well
as worldwide (based on the insurance cover
opted by the member) at our Network Hospitals/Clinics/Diagnostic
centres/Nursing Homes, Member Reimbursement
facility for non-network hospitals, Personalized
client servicing, Enrollment and Claims administration. |
| |
| |
|
Q2. How different
is WAPMED from Health Insurance Company? |
| |
|
| |
A.
WAPMED is a Third Party Administrator (TPA)
in health Insurance Sector servicing all insurance
companies. Group Mediclaim Policy of Insurance
Companies is the basic product on which WAPMED
adds value and facilitates smooth operation
through its value-addition like network of
healthcare service providers, medical care
standardization, Claims management, Client
servicing, expert opinion etc. Thus WAPMED
administers a `healthcare package' for its
clients with customized healthcare delivery. |
| |
|
| |
|
Q3.
Can a corporate suggest inclusion of certain
conditions/ailments as part of the package? |
| |
|
| |
A.
Yes, Insurance packages are always customizable
to the requirements of the corporate. But
certain minimum number of employee/families
are required to avail benefits under corporate
nomenclature. |
| |
|
| |
|
Q4.
Are emergencies / ailments that happen on
overseas trips covered by WAPMED? |
| |
|
| |
A.
Yes, WAPMED has a presence around the world
through its association with International
Assistance Companies. But the coverage outside
Kuwait will be based on which Insurance plan
member/group is insured under. |
| |
|
| |
|
Q5.
What are the criteria for a corporate to
subscribe to the WAPMED TPA Services Company? |
| |
|
| |
A.
WAPMED has no such pre-set criteria. Since
most of our packages are customized to the
client's requirements, we would be able to
extend an effective administrative healthcare
services to every prospective client with
an insurance coverage from an insurance company
associated with WAPMED. |
| |
|
| |
|
Q6.
Would WAPMED extend direct billing facility
for Out Patient / Out door services covered
under the insurance policy? |
| |
|
| |
A.
Yes, If Out patient treatment coverage forms
a part of your insurance cover, WAPMED would
extend direct billing facility to the members
at its Network Providers. |
| |
|
| |
|
Q7.
Where can the member avail the required
services? |
| |
|
| |
A.
At all Network Providers if he / she wants
direct billing facility or at any Health care
Service provider where he/she has to pay the
amount first and have to submit the bills
along with complete documents for re-imbursement. |
| |
|
| |
|
Q8.
In case of employee transfer to another
location, is there any procedure involved
to continue the scheme? |
| |
|
| |
A.
Change of location does not affect the operation
of our WAPMED scheme, since our Network is
countrywide. However, if there is a change
in the employment, this may affect the continuity.
WAPMED’s contract is primarily with
the corporate employer and not with any individual
employee or his/her family. Hence on termination
of employment, an employee ceases to be a
member of the WAPMED, unless the corporate
requires otherwise. Enrollment is a continuous
function all through the year. Hence the employers
are expected to provide us with the list of
additions (recruitments) and deletions (resignations/
terminations) periodically. Since our healthcare
packages are operative from year to year,
the premium payable towards our packages towards
the said additions and deletions shall be
adjusted proportionately with the insurer. |
| |
|
| |
|
Q9.
Will location of dependent family matter
in availing services under WAPMED? |
| |
|
| |
A.
No, Location does not affect the operational
activities, main member or the dependant member
can avail same and equal benefits irrespective
of their location. WAPMED’s Network
of Healthcare Service Providers is across
the country and worldwide. These accredited
healthcare providers would assure qualitative
healthcare delivery to WAPMED members and
WAPMED proactively monitors and reviews the
outcomes of its network. The worldwide coverage
would be provided depending on the policy
that member/group has chosen. |
| |
|
| |
|
Q10.
Will the change in names in between policy
period matter? |
| |
|
| |
A.
Yes, According to the Insurance Company the
claim will not be settled (unless prior intimation
to WAPMED and Insurance company) if there
is any alterations in the name and in bills
/ reports (documents) submitted by member
/ Healthcare service provider. |
| |
|
| |
|
Q11.
Can I change my or my dependants name in
between the policy period? |
| |
|
| |
A.
Yes, you can change but you need to intimate
WAPMED / Insurance company before hand with
necessary documents (attestation from relevant
Government office). |
| |
|
| |
|
Q12.
Should the claim be submitted with the insurance
company or with WAPMED? |
| |
|
| |
A.
Preferably at WAPMED only. |
| |
|
| |
|
Q13.
In case of part settlement of claims, can
the member claim for the balance by producing
the required documents? |
| |
|
| |
A.
Yes, but only eligible amount as per the terms
and condition of the policy shall be paid.
The member has to quote the Claim ID &
UHID for such re-settlement. |
| |
|
| |
|
Q14.
In case of change of residence, can the
cheque be sent to the new address? |
| |
|
| |
A.
No, unless an endorsement from the policy
issuing office of such change of address is
produced. |
| |
|
| |
|
Q15. Are there chances of 'claim
rejection' ? |
| |
|
| |
A.
WAPMED's network is wide and is customizable
to suit the requirements of the users. Thus
there is little chances of a member utilizing
the services of any other provider out of
WAPMED network. Within the network, if ailment
is covered as per the terms and conditions
of the package, the providers will extend
the facilities, on proper verification of
the 'Member’s Manual'. If it is not
covered, the member may not be given the direct
billing facility, instead they will be asked
to pay. If the member avails healthcare facilities
out of the network and submits the bills for
reimbursement, the same shall be subject to
the terms and conditions of the healthcare
insurance policy. |
| |
|
| |
|
Q16.
If I have not utilized my permissible eligibility
amount in a particular policy period will
I get any benefits like carry forward for
the next period if I renew the policy? |
| |
|
| |
A.
The amount will not be carried forward to
subsequent periods, transferred / shared between
family members. |
| |
|
| |
|
Q17.
What are the documents required to be submitted
to WAPMED to claim under reimbursement procedure? |
| |
|
| |
General |
| |
|
| |
|
Copy of Member
ID card with the member’s details |
| |
|
|
Copy of Civil ID card |
| |
|
|
Copy of the policy papers, if any. |
| |
|
|
| |
In-Patient
services/Day care procedures |
| |
|
| |
|
Original
detailed discharge summary |
| |
|
|
Original investigation
reports |
| |
|
|
Original Hospital Bill-consolidated
and with detail breakup with the patients
signature on it |
| |
|
|
Incase of surgical packages –
detail breakup of the package |
| |
|
|
Pharmacy bills and breakup |
| |
|
|
| |
Out-patient
facilities |
| |
|
| |
|
Original
consultation papers |
| |
|
|
Original investigation reports |
| |
|
|
Original Bills-consolidated and with
detail breakup with the patients signature
on it |
| |
|
|
Pharmacy bills and breakup. |
| |
|
| |
|
|
| |
Note:
Member needs to retain a photocopy of all
the documents he is submitting for future
reference. |
| |
|
| |
|
Q18.
In the event of an emergency what should
a WAPMED member do? |
| |
|
| |
A.
The member should immediately approach one
of the providers within the network to avail
healthcare facility. Where it is not possible,
the member may approach the nearest nursing
home, clinic or hospital for stabilisation
and could be shifted to one of the providers
within the network. The relevant details of
the provider network, (contact persons, numbers,
address etc.) are contained in the Member’s
Guidebook. |
| |
|
| |
|
| |
|
|
| |
|
| |
General |
| |
|
| |
|
Copy of Member
ID card with the member’s details |
| |
|
|
Copy of Civil ID card |
| |
|
|
Copy of the policy papers, if any |
| |
|
|
| |
In-Patient
services/Day care procedures |
| |
|
| |
|
Original
detailed discharge summary. |
| |
|
|
Original investigation
reports |
| |
|
|
Original Hospital Bill-consolidated
and with detail breakup with the patients
signature on it |
| |
|
|
Incase of surgical packages –
detail breakup of the package |
| |
|
|
Pharmacy bills and breakup |
| |
|
|
| |
Out-patient
facilities/CT-MRI facilities |
| |
|
| |
|
Original
consultation papers |
| |
|
|
Original investigation
reports |
| |
|
|
Original Bills-consolidated and with
detail breakup with the patients signature
on it |
| |
|
|
Pharmacy bills and breakup |
| |
|
|
| |
|
| |
|
| |
|
| |
|
Individual Health Insurance
Policy Holder. |
| |
|
| |
|
Q1.
What are the services offered by WAPMED
to its beneficiaries? |
| |
|
| |
A.
WAPMED is the service provider for required
Health care service to its members through
activities like -
Issuance of ID cards for easy access at network
providers, Direct billing facility at Network
Providers, Member Reimbursement facility for
treatment/consultations at non-network providers,
Personalized client servicing, Enrollment
and Claims administration. |
| |
|
| |
|
Q2.
How different is WAPMED from Health Insurance
Company? |
| |
|
| |
A.
WAPMED is a Third Party Administrator (TPA)
in health Insurance Sector servicing all insurance
companies. Health Insurance policies for individuals
are basic products of Insurance Companies
on which WAPMED adds value and facilitates
smooth operation through its value-addition
like network of healthcare service providers,
medical care standardization, Claims management,
Client servicing, expert opinion etc. Thus
WAPMED administers a `healthcare package'
for its clients with customized healthcare
delivery. |
| |
|
| |
|
Q3.
Would WAPMED extend direct billing facility
for Out Patient / Out door services covered
under the insurance policy? |
| |
|
| |
A.
Yes. If Out patient treatment coverage forms
a part of your insurance cover, WAPMED would
extend direct billing facility to the members
at its Network Providers. |
| |
|
| |
|
Q4.
Where can the member avail the required
services? |
| |
|
| |
A.
At all Network Providers if he / she wants
direct billing facility or at any Health care
Service provider where he/she has to pay the
amount first and have to submit the bills
along with complete documents for re-imbursement. |
| |
|
| |
|
Q5.
Will location of dependent family matter
in availing services under WAPMED? |
| |
|
| |
A.
No, Location does not affect the operational
activities, main member or the dependant member
can avail same and equal benefits irrespective
of their location. WAPMED’s Network
of Healthcare Service Providers is across
the country and worldwide. These accredited
healthcare providers would assure qualitative
healthcare delivery to WAPMED members and
WAPMED proactively monitors and reviews the
outcomes of its network. The worldwide coverage
would be provided depending on the policy
that member/group has chosen. |
| |
|
| |
|
Q6.
Will the change in names in between policy
period matters? |
| |
|
| |
A.
Yes, According to the Insurance Company the
claim will not be settled (unless prior intimation
to WAPMED and Insurance company) if there
is any alterations in the name and in bills
/ reports (documents) submitted by member
/ Healthcare service provider. |
| |
|
| |
|
Q7.
Can I change my or my dependants name in
between the policy period? |
| |
|
| |
A.
Yes, you can change but you need to intimate
WAPMED / Insurance company before hand with
necessary documents (attestation from relevant
Government office). |
| |
|
| |
|
Q8.
Should the claim be submitted with the insurance
company or with WAPMED? |
| |
|
| |
A.
Preferably at WAPMED only. |
| |
|
| |
|
Q9.
In case of change of residence, can the
cheque be sent to the new address? |
| |
|
| |
A.
No, unless an endorsement from the policy
issuing office of such change of address is
produced. |
| |
|
| |
|
Q10.
Are there chances of 'claim rejection' ? |
| |
|
| |
A.
WAPMED's network is wide and is customizable
to suit the requirements of the users. Thus
there is little chances of a member utilizing
the services of any other provider out of
WAPMED network. Within the network, if ailment
is covered as per the terms and conditions
of the package, the providers will extend
the facilities, on proper verification of
the 'Members' Manual'. If it is not covered,
the member may not be given the direct billing
facility, instead they will be asked to pay.
If the member avails healthcare facilities
out of the network and submits the bills for
reimbursement, the same shall be subject to
the terms and conditions of the healthcare
insurance policy. |
| |
|
| |
|
|
Q11. If I have not
utilized my permissible eligibility amount
in a particular policy period will I get
any benefits like carry forward for the
next period if I renew the policy? |
| |
|
| |
A.
The amount will not be carried forward to
subsequent periods, transferred / shared between
family members. |
| |
|
| |
|
Q12.
What are the documents required to be submitted
to FHPL to claim under reimbursement procedure? |
| |
|
| |
General |
| |
|
| |
|
Copy of Member
ID card with the member’s details |
| |
|
|
Copy of Civil ID card |
| |
|
|
Copy of the policy papers, if any |
| |
|
|
| |
In-Patient
services/Day care procedures |
| |
|
| |
|
Original
detailed discharge summary |
| |
|
|
Original investigation
reports |
| |
|
|
Original Hospital Bill-consolidated
and with detail breakup with the patients
signature on it |
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|
|
Incase of surgical packages –
detail breakup of the package |
| |
|
|
Pharmacy bills and breakup |
| |
|
|
| |
Out-patient
facilities/CT-MRI facilities |
| |
|
| |
|
Original
consultation papers |
| |
|
|
Original investigation reports |
| |
|
|
Original Bills-consolidated and with
detail breakup with the patients signature
on it |
| |
|
|
Pharmacy bills and breakup. |
| |
|
| |
|
|
| |
Note:
Member needs to retain a photocopy of all
the documents he is submitting for future
reference. |
| |
|
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|
Q13.
In the event of an emergency what should
a WAPMED member do? |
| |
|
| |
A.
The member should immediately approach one
of the providers within the network to avail
healthcare. Where it is not possible, the
member may approach the nearest nursing home,
clinic or hospital for stabilization and could
be shifted to one of the providers within
the network. The relevant details of the provider
network, (contact persons, numbers, address
etc.) are contained in the Member's Manual. |
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|
| |
|
Q14.
What are the mandatory requirements for
getting Photo ID card? |
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|
| |
A.
Original Policy paper with the member's name,
age, relationship and other relevant details
attached in the proposal paper along with
a photograph of the member. |
| |
|
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|
Q15.
Is Photograph of dependant family members
Mandatory for obtaining ID card? |
| |
|
| |
A.
Any member covered under the policy along
with the main member as dependent Photo is
mandatory. |
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|
| |
|
Q16.
I have changed my residence; can the card
be sent to the new address? |
| |
|
| |
A.
Sure provided you get an endorsement from
the insurance company, which has issued the
policy stating that the address has changed. |
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