Transcription of MediPhila - Medshield
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MediPhila - Medshield
12020 BENEFIT GUIDEB enefit adjustments are pending CMS 20202020 BENEFIT GUIDE2 MediPhilaMediPhila ContentsAn overview of the benefits offeredAbout MediPhilaInformation members should take note ofHow your claims will be coveredOnline Services In- hospital benefit access guideCo-paymentsIn- hospital BenefitsMaternity BenefitsOncology BenefitsChronic Medicine BenefitsDentistry BenefitsOut-of- hospital BenefitsDay-to-Day BenefitsWellness BenefitsSmartCare Ambulance ServicesMonthly ContributionsPrescribed Minimum Benefits (PMB)Contact detailsBanking DetailsFraudComplaints Escalation ProcessAddendums Exclusions34455691013 14 1415 16 17 192021212326262626273332020 BENEFIT GUIDEThis is an overview of the benefits offered on the MediPhila option:Major Medical Benefits (In- hospital ) Unlimited PMB subject to services being obtained in line with the Scheme s approved protocols Specified limit for non-PMB services, obtained in line with the Scheme s approved Rules and Protocols Your health is our priority The MediPhila Wellness Benefit allows for early detection and proactive management of your health, subject to the use of a MediPhila Family Practitioner (FP) Network Provider or a MediPhila Pharmacy MedicineBenefitsOut-of- hospital BenefitsChronic Benefits With a Day-to-Day Limit Sub-limits for specified benefits payable from the Overall Annual Limit Chronic
What is hospital pre-authorisation? Every member has to obtain pre-approval or pre-authorisation from the Scheme before the member, or their dependants, are admitted to hospital. The Scheme will provide pre-authorisation, upon your request, in line with the benefits available for the specific procedure or treatment, prior to admission.
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