Insurance is essentially a financial instrument that 'covers' your health/medical and accident expense so you don't spend for it yourself. I like the idea that it's something you have when you may need it but hope not to. Or, on the other hand, something you can maximize while you're covered ;)
In any case, insurance policies can be quite tricky and complicated. Here's a rundown of the most common questions about our current policy that hopefully answers them in simpler fashion.
I passed probation, I filled up an insurance application form. What does that mean for me now?
It's great news for you because it generally means, you won't need to spend for visits to the doctor, prescribed medication and procedures or accident expenses! That's as long as you go to accredited hospitals and under specific criteria covered by Mäd's insurance policy.
Make it a habit to have your insurance card with you at all times. Throw out the old card to avoid confusion.
Can I get my family covered under the Mäd policy?
You sure can. However, the cost of your family (i.e. partner, child/children, parent/s) will be deducted from your salary. The cost depends on the age of the member you want insured.
They will also need to fill up an insurance application form and provide an ID each.
When can I use my insurance card? When is it not applicable?
Your card covers Out Patient (OP) visits, In Patient (IP) visits and accidents.
OP visits are doctor consultations or doctor-prescribed procedures where you aren't required to stay in the hospital. Any medications prescribed are also covered by the insurance.
However, there are certain visits that are not currently covered by our policy: any maternity-related visits (i.e. pre-natal care, delivery, C-section, postnatal care), infant care, immunizations.
IP visits are when the doctor recommends that you stay at the hospital (minimum of 12 hours) as needed. The hospital will need to coordinate with the insurance provider/insurance agent to confirm that the procedure is necessary and is, indeed, covered by the policy.
Worldwide accident insurance is also covered. This means, if you get into an accident anywhere in the world - as long as it's not via extreme sports and is not self-inflicted - you won't spend a cent for the medical attention you need.
However, if you die, transporting your remains back to your home country is not covered. So stay alive!
What is NOT covered in our policy?
Annual physical exams
Vision care - eye glasses, contact lenses, etc.
Dental benefits - i.e. teeth cleaning, extraction, dental treatments, etc.
Cosmetic treatments - laser eye surgery, weight reduction, breast enlargement/reduction, nose reconstruction, plastic surgery, etc.
Reproductive treatments - birth control, infertility, (some) abortions, sexual/erectile dysfunction, etc.
For full details of exclusions, see our policy details.
What is a pre-existing condition?
It's a medical condition that you had even before you were enrolled in the insurance policy. Insurance policies will not always cover these conditions; they are almost always subject to the insurance provider's approval.
If, for example, you never had cancer before but suddenly you get it while covered by the Mäd policy, any treatment you need for it will be covered 100% by the insurance.
If you have had cancer before and you suddenly relapse (meaning, it comes back after remission) while covered by the Mäd policy, the insurance might not be able to cover all your medical expenses.
Where in the world is our medical insurance coverage accepted?
Cambodia, Thailand, Malaysia, Brunei, Japan, Vietnam, Indonesia, Korea, Myanmar, Philippines, Laos.
However, not all hospitals are part of the hospital network of MSH/Forte. Within these countries are a selected list of hospitals that are accredited. See the list here.
I needed to get to a clinic/hospital quickly and didn't get to check the hospital list. I paid for the bill myself. How can I make a claim?
Firstly, make sure you have ALL the documentation and paperwork from the hospital/doctor. These would usually include medical certificates, prescriptions, receipts, all and any reports/results if any medical tests were taken. These documents will be used by our agent to satisfy 'Part B - Medical Information' of the Claim Form.
Next, fill in the 'Non-Direct Billing Claim Form - Part A' (accessible here). Make sure you give specific information especially on Payment Information.
Scan all the hospital documentation, zip them in a folder. Email your completed Claim Form and zipped supporting documents to Marie Nhean (firstname.lastname@example.org). She will work directly with the insurer and yourself to arrange for the claims.
If there are no missing requirements, reimbursements average 15 working days. If there is missing information or documents, expect it to drag on.
Best to process your claims within 3 months of your hospital visit.
I injured myself and went to a doctor to get checked. I was informed to have surgery done abroad. What should I do?
Firstly, make sure you went to a doctor within MSH's hospital network. If you did, you will likely be referred to a sister hospital at another country. Your doctor/hospital will prepare the necessary documentation stating this recommendation and coordinate with the insurance agent.
Any requests or preferences you might have, pls communicate this to our insurance agent, Marie Nhean of AG Cambodia via Whatsapp (+855 12 254 757) or email (email@example.com), so she can help facilitate for you.
If the surgery or required procedure is not an emergency, flights and accommodation are not covered by the insurance but will be shouldered by yourself.
I have a problem with my bones and went directly to a chiropractor referred by a friend. Can I get this reimbursed from Forte/MSH?
Ah, unfortunately not.You need to get an official recommendation/prescription from a doctor of a hospital within the accredited network to a referred specialist first. To be sure that you won't spend your own money, you can check with our agent if the referred specialist is part of the policy.
There are also instances where you could get reimbursed for your expense. Again, best to check with our agent.
I suffer from mental breakdowns every so often. Is this covered in our policy?
If you need to be admitted to the hospital for your mental issues, you are covered for up to $5,000. If you only need OP services, sorry, but there's no cover for that.
I (secretly) need to be treated for alcohol and drug abuse. Is this covered?
As long as you keep it within $3,000/year, you're covered. Discretion will be on you.
Why don't we have dental and maternity cover?
Cost of dental work/ maintenance is relatively affordable in Phnom Penh and the cost to include this in the policy just doesn't make sense (an additional $320 per person).
If, on the other hand, your condition counts as an emergency dental situation, you are covered up to $800.
Maternity cover could not be included in the policy because the insurance product is not designed to cover only specific individuals in the group. This means, everyone under the policy will need to be covered by maternity benefits - which does not make financial sense because not everyone will need it.