Medical+answers

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Question from the I S Tianjin – Teacher council

Is there any coverage of traditional Chinese medicine treatments that are performed by a licensed practitioner? TIECare covers a small amount per year (maybe US$500 but I can't remember the exact amount).

We can confirm that alternative medication is covered under the Gold & Platinum levels of cover up to $ 500.

What cover will I get in my home country? Under TIE Care, I only get reimbursed for up to 80% of medical costs. IST may cover the remaining 20% but I think this is at the school's discretion. Will the ACAMIS plan cover 100%?

This is dependant on which zone or area of cover you take, if you Take Zone 2 then you would get 100% cover in any country outside of North America. If you are American with Zone 2 cover, you would only have Emergency Medical coverage in North America. If you are American and require full cover in North America, then you need to have Zone 1 Coverage.

The ACAMIS policy states that it pays "100% of prescribed medicines for chronic conditions." Could someone please clarify this? Does this meant that prescriptions for short-term illnesses such as colds, flus, viruses, ear infections, etc. is not covered by the policy?

We can confirm that all prescribed medication, irrespective of whether it’s for a chronic condition or just a short term illness, is covered under the policy terms & conditions.

Also, in terms of medications for chronic conditions, will the policy allow us to get a 6 or 12 month supply of the prescribed medicine at one time or can we only get month at a time? Some people get medications from their home countries (where they visit only once or twice per year), so for medications brought from home (which might not be readily available in China) they need to be acquired in 6 or 12 month supplies.

This again relates to the Zone or Area of cover that you have, for instance, if you are American with only Zone 2 cover, and you buy medication in the US, it will not be covered. However if you are American with Zone 1 ( Full cover in the US ) and then obtain prescribed medication in the US, it will be covered.

Is there a wellness benefit with the ACAMIS policy? With TIECare we get US$400 for wellness and there is no deductible charged when using the benefit.

We can confirm that routine check ups are covered under the Platinum level of cover, $ 500 per policy year.

The ACAMIS proposal states that maternity care is US$15,000 or US$10,000 depending on which plan of coverage the school chooses. Does this US$15,000 or US$10,000 include all pre-natal checkups and ultrasounds or is this just for the delivery of the baby? Also, with TIE Care, maternity coverage is limited to US$10,000 but TIECare also covers 50% of charges after the US$10,000. Is this the same with the ACAMIS policy?

We can confirm that the total normal Maternity benefit for Gold is $ 5,000 and for Platinum it’s $ 10,000. This includes all check ups, scans & delivery. It would appear from the schools existing policy, that the maternity benefit mentioned also includes complications within the same benefit amount, whereas under the Acamis policy, complications are under a separate heading with it’s own benefit amount. $ 10,000 under Gold, and $ 15,000 under Platinum.

Often ex-pats living in China are sent to Bangkok or Singapore for treatments/tests that are not available here in China. If this happens under the ACAMIS policy, does the policy pay for flights to/from Bangkok or Singapore and/or accommodation whilst in one of these places (assuming you are not hospitalized and are going for tests)?

This has to be pre-authorized and part of the cover under the Acamis policy is the 24 hour service of Medex, any member requiring assistance with either hospital treatment / flights or accommodation are recommended to use this service. Medex will ensure that you as a member recive the correct advice and treatment.

What treatments need pre-authorization with this policy? How do we go about getting pre-authorization? If there is a need for pre- authorization in an emergency situation, how do we go about getting it? With TIECare, we just call an office/mobile in Shanghai, which is relatively easy and painless. Is there a similar system with the ACAMIS policy?

We can confirm that pre-authorization is required for all In-patient or Day-Care treatments. No pre-authorization is required for emergencies. There will be a phone number available to all members in China, which will be a Shanghai number. There will also be a 24 hour free phone number for “ Medex ” who look after all emergency situations and arrange air – ambulance transportation if required

Are there schools that have switched from TIECare to this ACAMIS policy? If so, what were their experiences with the switch? Is it possible to contact a school who has done this to get some feedback from the staff at the school on how ACAMIS compares to TIECare?

This is the first year that the ACAMIS plan is being introduced so there are no existing schools with this plan. However, all of the companies involved with the plan have several years of experience working with International Schools and are dedicated to providing a top level of service to ensure that the ACAMIS board continue to endorse the plan for many years to come.

Is there a deductible? The document we received wasn't exactly clear on this. What exactly does this statement mean: "The higher the excess/deductible the lower the premium. By reducing the number of small claims, schools can choose to keep their policy costs low."

There are a choice of policy excess’s from a Nil Excess right up to $ 4,000. ( annual ) It is entirely up to the individual school to decide what level of excess they prefer. However it has to be recognized that by having a low or Nil Excess has a very negative effect on the claims loss ratio.

If the ACAMIS group policy changes in the future, to what extent will we have a say in the changes? For example, currently with a policy dedicated only to our school, the teaching staff are consulted before the school opts for policy changes. With such a large group of teachers/schools will we get to give input on policy changes that might happen in the future?

Ultimately it is the individual schools choice to join the group or not, ACAMIS does not force member schools to have this health insurance.

To what extent can we direct bill our claims at the medical facilities we frequent here in China (i.e., Tianijn SOS, Beijing United Family, etc.)? To what extent can we direct bill our claims at other medical facilities we go to in our home countries? Is there a possibility to direct bill at places in Bangkok or Singapore where ex-pats residing in China are often sent for treatment/tests that are not available in China?

We can confirm that Direct billing is available via a number of Medical Providers, both in China and in other countries. If a member is taken or goes to any Hospital as an admission and requires a direct settlement. This can & will be arranged at the time of the pre-authorization. For out-patient claims there will be certain providers that can offer direct billing and a full list of these providers will be available shortly.

Can we have a list of which other schools in ACAMIS have already joined this insurance group? As well, are there any teachers at these schools that would be willing to receive questions from us via email about the policy? It would be nice to hear about other teachers experiences with things such as direct billing, reimbursements, etc. Maybe we could have a variety of contacts at different schools such as a married couple, a married couple with kids, a single, etc. just to see what different families' experiences are with this insurance plan?

Please see answer above relating to this being a new policy.

Is it possible to see what the reimbursement form looks like? How to complete it? Where to post it? Can it be done online? In what currency will be reimbursed and to what account?

We can confirm that all claims incurred in China will be processed in Shanghai, as most of these treatment accounts will be via direct settlement, then the insured member will not have to be involved. There are in fact four claim centers, Shanghai, Dubai, Paris & North America, so that in the event of a member traveling or incurring a claim outside of China, they can if they so wish, submit any out of pocket expense claims to any office.

All insured members recive an ID & password so that they can access the On-Line Claims system, by accessing the system members can see exactly what the current situation is regarding any submitted claim.

Out of payment ( Self paid ) claims can be reimbursed via Bank to Bank payment to any Bank, as long as those details are supplied on the claims form.

Is the school thinking of setting aside each year a large sum of money in case somebody needs emergency/essential and very expensive treatment?

For the school to answer.

Will I get 100@ cover at beijing Unites Hospital? Currently, under TIECare, I only get cover for about 70% of my costs.

We can confirm that BJU claims are covered at 100% although it is recognized that this Hospital is extremely expensive. Excessive use of this facility could at some future date cause underwriters to either increase the premium, or introduce a Co-pay on treatment at this Hospital.