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First Assistance International In Scope:
· Emergency Medical Evacuation

· Return of Mortal Remains

· Return of Minors

· Emergency Ground Transport and Arrangements for Family Members

· Translation and Interpreters

· Emergency medical referrals

· Replacement of Lost Traveling Documents Assistance

· Emergency Message Forwarding Assistance



First Assistance Workflow:
1.Determine the nature of the request. Ask caller what type of service they are requesting
2.Determine Shared Client status, member eligibility & verify benefits (if the policy is inactive you have to reach out to PSS)
3.Create a record of the request using the QuickBase Evacuation form
4.Stay on the line when you reach First Assistance (toll +44 (0) 1252 351 206)
5.CSR should forward the Global Assist Request Summary e-mail to the managing Actisure IHAT e-mail box and a copy to the Follow the Sun mailbox
6.Once you have sent an email, you need to call IHAT to alert them to the case and email. Check the FTS calendar to see if IHAT office is working; call or IM them to alert. Please refer to the following detailed workflow: [[Customer Service Call Transfer Process for Evacuations – First Assistance]]


Note: EXL DO NOT HANDLE THESE TYPE OF REQUESTS
Background Information


Effective, 3/31/2012, the Aetna International customer service phone number will be listed on Actisure member ID cards as the emergency contact number for members needing emergency evacuation services. All members should have their new ID cards by 4/23/12. CSRs will begin receiving incoming calls from Actisure members who may request evacuations, and other types of services. As of 08/11/14, First Assistance will be the new evacuation provider for all Actisure members with evacuation benefits.



Service Requests to Transfer to First Response:

•Emergency Medical Evacuation
•Return of Mortal Remains
•Return of Minors
•Emergency Ground Transport and Arrangements for Family Members
•Translation and Interpreters•Emergency medical referrals
•Replacement of Lost Traveling Documents Assistance
•Emergency Message Forwarding Assistance
When a member, plan sponsor, policy holder or provider calls requesting the services listed above, check Actisure for policy coverage and covered benefits and follow this workflow.

Note: Please ask the caller if he/she is calling about evacuation services for an emergency medical problem before quoting eligibility and benefits. Ask the caller if this is the first request for evacuation services. If the member has already opened a case, follow the workflow to transfer the call to the IHAT clinical team.



Emergency Medical Evacuation Process

Initial Contact

Anyone may notify Aetna International (AI) of the need for an emergency medical evacuation- policy holder, family, employer or medical provider.



1. Determine the nature of the request: ask caller what type of service they are requesting.

Greet the caller IMMEDIATELY: “May I have your policy number or ID# please?”

•Then ask for the caller’s name (Provider, Insured, Spouse, Child, or Other?)
•If a provider’s office, ask for the facility or Dr.’s name, PIN/TIN if a US provider, and phone number
•Patient’s Name and DOB
•Is the service requested Medical or Dental?
2. Membership Eligibility Determination:

Aetna International Actisure CSR determines if a claimant / patient is a valid member insured with Aetna International.

In addition to the First Name and Last Name, DOB and at least one of the following should be confirmed:

•Member ID number
•Policy Number
•Entity ID (as mentioned on the Membership Card)
•May also take employee’s address and phone number if neither of the above is available
•Group Name (where applicable)
Verification of Benefits:
Aetna International Actisure CSR determines the type and extent of a contractually defined benefit available to a member.

•Policy Number denotes:
◦Policy type (Product) - IHP / RHP / EHP / ASC, etc, and
◦The database a member belongs to [UK (1), HK (2), Dubai (3), Americas (4), AMEX (5), China (6), AGB Live (7), OH+ (9)]
•Note the Product Module – Major Medical / Foundation / Lifestyle / Lifestyle Plus and for IHP- Core, Essential, Plus and Elite.
•Note any bespoke benefits – Wellness, Vaccination, Extended Lifestyle Plus, etc
•Note Original start date of sub-benefits if renewal (Chronic, Maternity, etc)
•Check the applicable Deductible & / or Co-insurance
•Note Original Date of Joining and Current Policy dates.
•Note the type of Underwriting: Medical History Disregarded / Moratorium / Continuous Transfer Terms.
•Check any specific Underwriting terms (Permanent Exclusions, Conditions subjected to Moratorium, CTT, etc).
•Check if premium has been paid. If not, liaise with PSS department
•If a policy is due for renewal, liaise with PSS department.
PSS contact link Plan Sponsor Services. If after hours for the PSS unit managing this member, try contacting other PSS units that may still be working for assistance.



NOTE- if unable to authorize the evac:

§ After taking the above steps, if the member does not have coverage for the evacuation benefit or if the policy has lapsed and there has been no payment, the evacuation cannot be authorized.

§ If not able to authorize evacuation benefit, contact the managing IHAT team or use the Follow the Sun process to locate the covering IHAT unit to advise of the issue.



3. Create a record of the request using the Quickbase Evacuation form.



Use this link to the Quickbase form for evacuations

Link to First Assistance evac form https://quickbase.aetna.com/db/bfjbsmekt?a=GenNewRecord

(Genpact - https://quickbase.aetna.com/db/bfx4ycyae?a=GenNewRecord)



From the drop down menu, select the correct platform: ACAS or Actisure/OH+.



If the member has the First Assistance standard evacuation benefit, select Standard Carrier - First Assistance from the drop down box. Several more boxes will appear.



Type in your Aetna ID number in the User Information box.

Next check off the requested service, for example check the box marked Emergency/Urgent Medical Evacuation.

Additional fields will appear for you to fill in.

Collect the following information from the caller, if available:

•Member ID number (in the box marked Cumb Number)
•Name of caller
•Name of member
•Location of patient
•Patient date of birth
•Email address is available
•Phone number
•Word Traveler enter NO
•Plan sponsor name. If no plan sponsor, use the ‘Help’ feature that reads, “For Actisure business, enter NA if PS name is not available”.




•In Control Suffix Account (CSA) or Policy Number field, enter Policy number•Enter Eligibility Date
•Copy evacuation benefit wording into space provided
•Enter benefit limits like deductable and co-insurance in next space
In Summary of Services requested, the box you checked initially will automatically fill in the service.



4. Before clicking on ‘Save and Add Another’ at the bottom of the form, warm transfer the call to First Assistance toll +44 (0) 1252 351 206.

Click on ‘Save and Add Another’.

A copy of the Global Assist Request Summary will be generated to your Outlook Inbox.



5. Stay on the line when you reach First Assistance.

Introduce the caller and the type of request, and then put the caller through.



6. CSR should forward the Global Assist Request Summary e-mail to the managing Actisure IHAT e-mail box and a copy to the Follow the Sun mailbox.



Actisure IHAT Mailboxes

IHAT UK [email protected]

IHAT Dubai [email protected]

IHAT HKG [email protected]

IHAT Americas AETNA [email protected]

IHAT Shanghai [email protected]

IHAT Follow the Sun [email protected]



Requests for Emergency GOPs

Continue current workflow and transfer calls directly to IHAT or the Follow the Sun covering IHAT.



Non-Emergency Requests

During Business Hours, transfer phone requests directly to IHAT

•IHAT- In-Patient Medical Expense Guarantee and Medical Monitoring •Non-emergency Medical and Dental Referrals
•Assistance with Prescription Drugs
•Non-emergency Ground Transport and Arrangements for Family Members
After business hours, take information from caller and forward to managing IHAT team email box.

· Member’s name

· Member’s ID number

· Policy number

· Patient’s name

· Date of Birth

· Location of patient (country/city)

· Plan sponsors name (if applicable)

· E-mail address or phone if available

· Brief description of the request
     
 
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