HMO Important Reminders

Post date: 2020 Jan 19 10:21 PM by KAJJ1 (Public)

Dear Valued Member,


Thank you for trusting KAJJ Health Solutions Inc. and choosing Carewell Health Systems Inc. We would like to inform you some of the important points on your HMO benefits. Attached with this are your HMO card, booklet and lists of diseases/conditions covered.

 

§ first year membership

For your first year, you are only covered for services under the list of DISEASES COVERED FROM THE FIRST YEAR OF MEMBERSHIP.

 

§ Pre-Existing Conditions

Pre-Existing Conditions (known or unknown to member) shall be covered after 12 consecutive months of membership. It is also stated that determining/ruling out of Pre-Existing Conditions during the first 12 months of membership is excluded in the policy (EXCLUSIONS #37 on the booklet). This means that if the assessment of the doctor falls under the Pre-Existing Conditions and member is under 12 months of membership, the member may only avail himself of the first consultation only from an accredited clinic. Other services like laboratory tests/procedures; follow-up checkups; confinement; etc. will not be covered yet. However, according to Carewell Health Benefits, it will be covered on the 13th month of membership.

 

§ CONFINEMENT

For a member to avail of the confinement benefit, member is required to pay in full his/her total HMO Annual Fee. Payment shall be made before discharge from the hospital.

 

Example:

Member’s HMO anniversary month is SEPTEMBER. This means that member’s annual coverage is from SEPTEMBER to AUGUST next year. If member is admitted on the month of DECEMBER, to avail of the confinement benefit, member has to pay his/her total HMO fee for the months of JANUARY to AUGUST.

 

§ DUE DATE OF PAYMENT

Due date of payment and endorsement to KAJJHSI is every 25th of the month (23rd for February and December) for your coverage next month. Proof of payments should be received by KAJJHSI Head Office on the said dates. Proof of payments received by KAJJHSI Head Office after the due date shall be active the following Tuesday. In the event of non-payment of HMO fee on time, member has to pay arrears up to the present month for coverage to be active.

 

Example:

Due date for November coverage is on October 25. 

 

§ CONTACT INFORMATION

For payment and coverage details, please contact KAJJHSI:

Sun                   - 0922-282-2654 Mon-Fri 10am to 5pm

Globe               - 0926-113-3500 Mon-Fri 10am to 5pm

Landline           - (02) 7507-9854 Mon-Fri 10am to 5pm

Messenger      - Kajj Hsi Mon-Fri 10am to 5pm

Email                 - kajjhsi@gmail.com Mon-Fri 10am to 5pm

 

For benefit details, accredited providers, services denied, emergency, confinement, please directly call CAREWELL:

Sun         - (0932) 862-5697

Smart      - (0998) 988-4692

Globe     - (0917) 538-7499

 

(02) 3434-4868 Mon-Fri 8am to 06pm

(02) 8935-1237 Hotline 24/7

(02) 7796-6423 Hotline 24/7

(02) 8871-5586 Hotline 24/7



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