Aetna International Overview For The Church of Jesus Christ of Latter-day Saints
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1 Aetna International Overview For The Church of Jesus Christ of Latter-day Saints Central America Missions Welcome to Aetna International! Aetna has partnered with Global Medical Management Inc. (GMMI), a large international health care administrator, with provider relationships in 20 countries in Latin America and the Caribbean. Their knowledge and experience in the Latin American and Caribbean countries make them a valuable partner for both Aetna International and The Church. As members of the Aetna International program, missionaries will receive an ID card directly from GMMI. This new benefit for the Mission President and young missionaries will: Simplify the administration of health care benefits for the Mission and the missionaries. Provide access to GMMI s large established provider network relationships with Latin American hospitals and physicians. Offer quality, cost-effective care with GMMI s years of experience in navigating the various Latin American country healthcare systems. Healthcare Provider Listings Please reference the Provider Directory located on the following website for instructions on how to access care. Choose your Mission Area and Country, then under the section Find health care during your mission, click on the provider directory link. Prescription Drugs purchased at Pharmacy and Dental Emergency Care **IMPORTANT** The Mission will need to pay for prescriptions and Dental care (accidents only) and the Mission will need to submit a Claim form to Aetna for reimbursement. ONLY dental procedures as a result of an accident will be covered by the Missionary Medical program. Any urgent dental needs such as extractions, root canals, pain relief procedures, abscesses, etc., should NOT be arranged or paid for by Aetna or our partners. For that type of care, the mission president or his wife or the mission nurse or medical advisor should help the missionary access the dental care needed; however, the mission president will then need to determine if the missionary s family will pay those bills or if the Church funds will be used to cover those costs (by using mission account #XXXX ). ID Cards The ID cards will be mailed directly to the Missions from GMMI. When the ID cards are received, please hand them out to the missionaries along with the ID card letter. The ID card letter explains the process to request medical care. This process has not changed. When a missionary needs medical attention, they must still get approval from the Mission President or his wife, who will contact GMMI on their behalf. ID Cards re-order (if lost or stolen) ID cards can be re-ordered by sending an to LDSIDCards@aetna.com Benefit Principles Missionary Medical has set forth some benefit principles to guide your medical care decisions. Contact GMMI for assistance with: Locating doctor/specialist and help with coordinating payment Verification of Benefits letter (VOB) and direct payment for in-network hospital Direct payment for hospital not in the network Phone Toll-free: Direct/Collect: customerservice@gmmi.com Contact Aetna International Status of claims sent to Aetna International (prescription drugs, providers paid with Mission funds) Phone Toll-free: Direct/Collect:
2 Follow this Process when a missionary needs to seek medical attention: Call or GMMI. The Customer Service Representative will need the following information which can be found on the ID card. Missionary Name Missionary Date of Birth Missionary Aetna member ID # ( W number on card) Group number xxx (the last 3 numbers are specific to your Mission office) see page 4 Specific medical need (description of illness) Country/city location of the missionary Your contact information For your convenience, the missionary information also will be provided to you on a monthly basis in Excel format, with all of the missionaries assigned to your Mission listed. This listing will be sent to the Mission address. Non-Emergency Care: Doctor or Specialist Appointments: After making an appointment for a missionary to see a doctor, call or GMMI for them to make contact to arrange payment for the services. Doctors or specialists can also call at the phone number on the ID card in order to verify payment. Scheduled hospitalization/surgery: Please notify GMMI of scheduled hospitalizations/surgeries by calling the above numbers or ing customerservice@gmmi.com. GMMI will notify the facility by sending them a Letter of Guarantee (LOG) and confirm acceptance of the LOG back with the Mission contact. GMMI will send a confirmation and copy of the LOG to the Mission and to the provider by password-protected . In order to open this , use password AetnaLDS10. If possible, the missionary should take a copy of the LOG to the hospital on the date of the scheduled surgery, along with their ID card. Emergency Care: Please call or GMMI as soon as possible to notify of missionary s need for emergency medical attention and to arrange payment to the provider. GMMI will notify the facility by sending them a Letter of Guarantee (LOG) and confirm acceptance of the LOG back with the Mission contact. GMMI will contact the Mission office to confirm that the LOG is accepted within about 60 minutes for urgent/same day care. GMMI will send a confirmation and copy of the VOB to the Mission and to the provider by password-protected . In order to open this , use password AetnaLDS10. Prescription Drugs purchased at Pharmacy and Dental Emergency Care Reimbursement A claim form and claims spreadsheet has been customized for the Church. 1. Mission President Claim Form This reimbursement approach applies only to mission presidents and their eligible family members when personal funds are used to pay for medical treatment; when mission funds are used to pay for medical treatment for missionaries or mission presidents and their families, reimbursement should be requested from Aetna International using the Claim Form-Reimburse Missionary Medical. 2. Claim Form Reimburse Missionary Medical Reimburse the Mission if Mission funds were used. 3. Claims Spreadsheet Reimburse Church Reimburse the Church if Mission funds were used. Claim forms are located on the Aetna website developed for the Church see page 4 for more information. Submitting the Claim 1. Complete the appropriate claim form. 2. Copy all receipts on a single piece of paper (or as many as necessary). Be certain that all receipts are legible. Receipts must be fully itemized bills and/or detailed receipts that include diagnosis (nature of illness) and the procedures or services performed. 3. Write the missionary s member identification number on each document submitted with the Claim form (refer to the Aetna International ID card or missionary listing sent to you monthly). 4. Be sure to indicate the name of the person who received care (the missionary). 5. Include contact information (phone and address) where the Mission office can be reached in case Aetna has any questions about the Claim. Send the Claim form/receipts via FAX to: Toll-free: Direct: Send the Claim form/receipts by mail to: Aetna; P.O. Box El Paso, T X USA Or to: AISERVICE@A ETNA.COM **IMPORTANT** The Mission will need to pay for prescriptions and Dental care (accidents only) and the Mission will need to submit a Claim form to Aetna for reimbursement. ONLY dental procedures as a result of an accident will be covered by the Missionary Medical program. See Page 1 for further clarification. 2
3 Aetna International will reimburse for the following: Prescription drugs Medical services given as a result of a sickness or injury Medications can be purchased in bulk and sent to Aetna for reimbursement please use Mission President s name and Aetna # and indicate bulk medication purchase on the claim form Not Reimbursable through Aetna International: Dermatological helps such as makeup, acne medicine, sunscreen, bug spray, lice shampoos and lotions Over-the-counter pain relief medications, i.e., Tylenol Vitamins Eye exams or eye care, unless as a result of an accident or injury Dental services, unless as a result of an accident or injury. Any urgent dental needs such as extractions, root canals, pain relief procedures, abscesses, etc., should NOT be arranged or paid for by Aetna or ou r partners. For that type of care, the mission president or his wife or the mission nurse or medical advisor should help the missionary access the dental care needed; however, the mission president will then need to determine if the missionary s family will pay those bills or if the Church funds will be used to cover those costs (by using mission account #XXXX ). Elective procedures any medical, dental or eye care that is not associated with sickness or injury Pre-mission conditions physical or mental condition that was diagnosed or treated, or that had treatment recommended, within two years before the missionary entered the mission field. The Church does not pay for treatment of physical or mental condi tions that existed before a mission, or for prescriptions resulting from these conditions. ***The Mission President has the discretion to override this under special circumstances*** Medical Assistance (90-day continuation of coverage) When a missionary is to be given an early medical or emotional release to return home in order to receive treatment associated with an injury or illness that occurs during missionary service outside of the United States, the Mission President contacts the IFR (In Field Representative) at the Church s Missionary Department. The IFR will contact the DMBA Nurse Team to retrieve all needed information from the Missionary Inquiry system. Once approved by the IFR, a Missionary Change Form is sent to Missionary Medical who in turn contacts Aetna to allow the additional 90 days of coverage. Extended medical coverage and medical assistance covers the specific injury or illness that began during the missionary s service. Aetna will receive notification of these missionaries through an established workflow administered by Missionary Medical. Please see the Aetna LDS website for checklists for the Mission President, and other helpful tools and resources. Aetna International Secure s Aetna International s containing missionary names, dates of birth and member ID numbers will come to you in a Secure format. In order to open these s you can do one of the following: Follow the instructions within the click on download below the message name save the message, then click View Downloads click on the envelope with a lock the and attachment will open ready for you to view and save to your computer Or Forward your Secure to zdm@vsn.voltage.com and they will send back your unencrypted and ready to view when the comes back to you, click on the link within the click on SUBMIT on the next screen and attachment will open click on download to open the attachment IMPORTANT: Please save the documents sent onto your computer for continued access. 3
4 Resources for the Mission President and Wife, Area Medical Advisors and Church Doctors Aetna International Overview (this document): Most critical information to know about medical care and how to seek reimbursement from Aetna. ID card Letter: Outlines the Missionary Medical process for the missionary on how and when to seek medical care. Benefit Principles: Benefit principles set forth by Missionary Medical to guide your medical care decisions. Claim form and Claim spreadsheet: Electronic versions provided by Aetna during implementation. The forms are located on the following website for your reference: Missionary Listing in Excel format: Monthly listing sent to the Mission address, with missionary name (as enrolled with Aetna), date of birth, Aetna ID#, and Mission number (in XXX format). The last three digits identify your specific Mission. (Please refer to Secure instructions) El Salvador-Santa Ana Honduras-Comayauela El Salvador-San Salvador West/Belize Honduras-San Pedro Sula El Salvador-San Salvador East Honduras-San Pedro Sula West Costa Rica-San Jose Honduras-Tegucigalpa Costa Rica-San Jose West Nicaragua-Managua North Panama-Panama City Nicaragua-Managua South Monthly Listing of Paid Claims by Mission: Monthly listing sent to the Mission President address, which contains all claims paid by missionary name, dates of service, and amount, plus whether paid to provider or reimbursed through Missionary Medical. (Please refer to Secure instructions) Provider Directory: Current providers with GMMI. A provider directory is included in the initial training provided to each Mission. If there are providers your Mission utilizes which are not on this listing, please let us know. Once GMMI has confirmed that the providers will accept payment directly from them without the Mission or missionary being required to pay, GMMI will list them on their website. Aetna LDS Website A website has been developed for the Church and will house the following: Contact information for both Aetna and GMMI Most recent Provider Directory Claim form and claims spreadsheet Missionary Medical guidelines: ID Card Letter and Benefit Principles Overview of how the program works in Central America To view the website: Click on your Mission Area, then country. 4
5 The Aetna International Team for the Central America Missions of The Church of Jesus Christ of Latter-day Saints looks forward to serving you. Should you need to escalate an issue, please contact us. Carol Griggs, Sr. Account Service Representative (speaks Spanish) Eric Blonshine, Call and Claims NOTES
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