February 2012, Issue 1 MOMENTUM CONTACT INFORMATION UPDATES / CHANGES. New born baby cover. Our Drugs Policy (Over a month s prescription drugs) NEW

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1 NEW February 2012, Issue 1 Dear Valued Members, We wish you a Prosperous and Healthy 2012! May this year be filled with first and foremost good health, happiness, prosperity and success throughout the year. It has been a long 12 months in 2011 of looking after your healthcare needs and we would like to use this opportunity to express our gratitude for the opportunity to be of service to you. With the merger internationally between Momentum and Metropolitan which will see a local integration of Metropolitan Life and Momentum Ghana, the New Year 2012 has a lot in store for our members. We have planned for new and improved services and systems to give our members efficiency and even more value for your money. Our Vision is to be a significant player and preferred provider of choice in satisfying the health insurance, life insurance (risk, savings, and investment) and pensions fund (including administration) needs of retail and institutional customers in Ghana. Below are some information and updates from Momentum/Metropolitan. MOMENTUM CONTACT INFORMATION Hotline no s : / (24hrs) Landline no s : / / / / / / / An address will be provided next month for all enquiries, complaints etc which are not urgent. UPDATES / CHANGES New born baby cover New born babies of members are covered on the mother s benefit until the child is one (1) month old. During this time, members are required to contact their HR to complete a supplementary form for the new family addition, and include one passport size photograph of the baby to be registered for his/her own benefits. Please note that babies older than one month will not be covered on their parent s benefits. Members must register their new babies within a month of delivery to ensure they enjoy their full benefit. Our Drugs Policy (Over a month s prescription drugs) Momentum policy allows service providers to supply at most 1 month prescription at a time in line with industry best practice and also in order to manage member s benefits. If your doctor has put you on more than a month s prescription please call us when you get to the Momentum accredited facility for help in getting one-month medication and obtaining back the prescription to get the remaining after a month. 1

2 MOMENTUM ON-LINE UTILIZATION CHECK With our on-line utilization check interface on our website, members are able to click on the log-in tab at the home screen and register their membership account. This will allow them see how much benefits they and their dependents have used up to 1-2 months to date. If members have gone to a facility up to two-months ago, this may not have been recorded yet as it takes a bit of time (about 90 days) for claims to be submitted. Below are details on how to access this service. 1. Log on to 2. Click on the Log-in tab (on the right hand side of the banner) to register your membership account. 3. On the registration page Select Member for USER TYPE 4. Enter your Momentum membership number without the suffixes, e.g and NOT Select Ghana for COUNTRY 6. Click YES to confirm This process is intended to confirm your membership details as registered with the Scheme. 7. Register a USERNAME & PASSWORD 8. Log onto the system with your Username & Password to view your utilization. The screen pops up with the 3 most recent claims submitted. 9. For Claims dating back to the 3 most recent claims, Click on the CLAIMS tab and enter the search date to generate these claims. PROVIDER RE-CLASSIFICATION Provider re-classifications was also implemented in July 2011, over the years we realized that Provider Plan restriction protocols have been abused by many members to the detriment of the entire scheme membership. Recent upward provider price adjustments necessitated a plan focused service delivery approach in order to ensure optimum quality care. The core of these reviews has been member s interest and satisfaction. Please refer to your new provider lists for the facilities on your plan list. info@gh.momentumafrica.com.gh for your plan list if you no longer have it. You can contact your HR or us at I am happy to inform you that Momentum has completed its negotiations with GHAPOHA Hospital-Takoradi and services have now been restored. Kindly be informed that GHAPOHA Hospital-Takoradi has been offering Medical Services to Momentum clients since 28 th December We sincerely apologize for any inconveniences these suspensions may have caused you and your family. Suspended Provider Services The following Provider facilities are temporarily suspended on our network due to ongoing negotiations. These include; Medlab Ghana (all branches in Ghana) The nearest alternative laboratory you can go to is Wellness Lab, behind Police Headquarters, Ako Adjei Interchange. Korle-bu 24hr Pharmacy The nearest alternative pharmacy is West Point Chemist, opposite the Korle-bu Police Station, Jan Aid Pharmacy in Mamprobi and All Life Pharmacy, Latebiokorshie near the Flamingo traffic lights. Asylum Down Pharmacy, Accra (to be restored by the end of 1 st quarter of the year) The nearest alternative Pharmacy is Health Watch Pharmacy in Asylum Down, Vicdoris Pharmaceutical, Ring Road next to Bus Stop and Longview Chemist in Adabraka, opposite ADB. Adenta Pharmacy have now resumed service to Momentum card holders. We do apologize sincerely for any inconveniences these suspensions may cause. We are however speeding up the discussion processes to ensure that these facilities are reinstated as soon as possible. Please check our Service Provider list for alternatives in your neighborhoods. Should you for any reason need to use these facilities by all means, you will kindly need to call our hotline numbers or for pre-authorization to access service at these facilities and you will have to make cash payments. Pre-authorized services will be refunded. 2

3 Service Provider exits The following Service Providers are also no longer on the scheme. Rose eye Clinic (Laterbiokorshie) Lashibi Chemist (Lashibi) New Providers added on to the Momentum Service Provider Network Twenty-Seven Medical Service Providers have been added on to our Network, sixteen hospitals, five pharmacies, two Laboratories, two Diagnostic services and two Optical Services across the country. These facilities are can be accessed by all Momentum plan holders. Please see below for more details. FACILITY NAME SPECIALTY TEL. NO. LOCATION Greater Accra Region Health Screen Ghana Dr. Richard GP Watson Ave, off D Almeida Boundary road, Adabraka Faith Medical Centre Angelina Enchil GP/Sur Kpone car park on Kpone barrier road Vebs Medical Centre Dr Kweku GP/Phys/Obs/Gyn No. 5 2 nd Atiakper Link DTD Klaast Batsonna. Medishop Pharmacy Pharmacy Haatso, Next to Emefa Jewellery PNT Pharmacy Ltd Pharmacy / Swan Lake, North Kaneshie 37 Inside Max Mart Life Pharmacy, Weija (inside Shoprite) Melcom Pus Shopping Mall, Tema 3M & C Medical Laboratory Laboratory East Legon, 1 Jungle Rd Diagnostic Centre Ltd Diagnostics East Legon, behind Emmanuel Eye Clinic Ultimate Diagnostics Diagnostics No. 10 Exams Loop, North Ridge Third Eye care and Vision Centre Optical Services Circle, Off Nsawam Rd Inter Star Eye Clinic Eye Clinic + Optical Services / Eastern Region Osu, 5 th Lane Hse No. F525/1 G.C.D. Hospital Dr John Bello GP/Gyn/Obs Akwatia Kunta Kinte Orthopedic Dr Frank GP/Sur/Gyn/Obst/Physi/ Anaes / On Adenta-Koforidua Hosp (Bryan Lowe Hospital) Yirenkyi Uro / Ortho / Highway Kade Government Hospital Dr. Joseph GP Kade, Oposite Main Lorry Tambil Park St Martin De Porres Hosp Mr Benjamin GP/Gyn/Obs Agomanya Nyakutsey Zinaida Pharmacy Pharmacy Somanya K.B. Pharmacy Pharmacy Asamankese, Hosptial rd, Akroso-Junction Haripel Pharmacy Kade Bus Stop Ashanti Region McKenzie Health Services Ltd Dr Archibald Badoe Mckenzie Dr Phyllis Tawiah GP/Phys/Obs/Gyn Ahensan Estate Plot 5, Blk L Metro Health Services Ltd GP /25518 Abrepo Junction, South Suntreso, Kumasi Madonna Health Sevices Dr Robert GP/Obs/Gyn/Sur/Paed / Sunyani rd, Asenemaso - Kweku Safoe Abuakwa Ultimed Pharmacy Pharmacy Hse No. KO2, Kwabra Foso, Obuasi Animwaah Medical Centre GP 3

4 St Augustine Hospital Anglogold Hospital GP GP Rokolab Laboratory Plot 6, Blk L Sefa Boakye Mem Hse-Bantama Western Region UQ Specialist Medical Services Dr Samuel Agyeman GP/Sur/Gyn/Obs/Paed/ Opt/ Opth/Physio/Uro/Anaes/Derm Anaji Westline Takoradi High Street Clinic GP Takoradi Cape Coast Hy Life Sciences Diagnostic Centre Dr Jimah Bashiru GP Glory Oil Opposite UCC Primary School Key GP - General Practitioner Phy - Physician Obs - Obstetrics Uro - Urologist Physio - Physiotherapist Opt - Optician Ortho Orthopedics Sur - Surgeon Gyn - Gynecologist Paed - Pediatrics Anaes - Anesthetist Derm - Dermatologist Opth Ophthalmologist CHRONIC MEDICATION PROGRAM Momentum s Chronic Medication Program focuses on identifying members and empowering them to manage their chronic benefits, together with their doctor thereby ensuring compliance. Although a condition maybe defined as chronic, we may not be able to cover it from the chronic illness benefit. Disease Management In order to ensure an optimal health status for members suffering from chronic illnesses, the following is necessary: A well-informed, motivated patient. Provision of appropriate treatment. Regular monitoring of disease specific markers. Regular follow up. Support systems where necessary. Chronic Medication Application When your doctor prescribes chronic medication for you or a dependent, a Chronic Medication application form needs to be filled out by your doctor in order to enjoy these benefits. Chronic Disease list The following chronic conditions are covered under the chronic medication limit. If you suffer from one or more of these listed conditions, medicine and treatment is subject to the scheme s applicable rules and registration procedures. You will need to register on this chronic medication program to enjoy the chronic benefit and this is subject to registration and approval with scheme. Hypertension HIV Aids Glaucoma Diabetes (Insipidus, Mellitus Type I & II) Asthma Hypothyroidism 4

5 Hyperlipidaemia Ulcerative Colitis Hemophilia Cardiomyopathy Parkinson s Disease Dysrhythmias Addison s Disease Rheumatoid Arthritis Epilepsy Coronary Artery Disease Chronic Obstructive Pulmonary Disease Cardiac Failure Multiple Sclerosis Bipolar Mood Disorder If you have any other chronic conditions which are not listed above, please contact our hotlines or us at MarjorieG@gh.momentumafrica.com to verify. Members who have a chronic condition(s) for which they are required to take regular medications must contact the address above to register on to the Chronic Medication Program which will give you access to your Special Benefit of your day to day benefits and the Chronic Medication Program. OUR REFUND POLICY Medical refunds from members who have made payment at various facilities will be honoured if these three conditions have been satisfied, they are; 1. An emergency situation where a member could not reach an accredited facility on their list in the area they were in at the time of needing medical attention (proof of emergency may be required). Authorization can be sought after member is stabilized but within 48hrs. 2. There were no accredited providers in the community or town at the time of needing medical care. Pre-authorization is required before accessing service. 3. A referral by a specialist from an accredited facility to a non-accredited facility. Pre-authorization is required before first visit to specialist. Members must call the hotline numbers or in non-emergency situations before assessing service at a non-accredited facility or making payment at an accredited facility. Members are required to use hospitals, clinics, laboratories, pharmacies, dental clinics and optical centers on their accredited provider list included in the Welcome Packs, if for any reason they are unable to they must call our hotline numbers for preauthorization to use another facility. OUR REFUND PROCEDURE After calling the hotline for pre-authorization to make payment or having made payment, a code will be given if payment is authorized and full cost incurred is known. The authorization code and your membership number given must be written on the receipt as proof of authorization for a refund. Receipt(s) for payment for services (except consultation only) must include the ff; *Payment for drugs original prescription(s) required. *Payment for lab tests or scans or x-rays original lab/scan or x-ray request required. *Payment for treatment should state details of treatment (itemised) & cost. *Payment for admission should include an itemised bill. *Referral to a non-accredited facility - referral letter required. *Combined receipts stating payment for consultation, lab test, scans etc should state price for each service. Prescription and lab request(s) must also be attached to claim as this is required to process the claim against each service. Claims sent in with no authorization code may be rejected or payment delayed. Photocopies of lab requests, prescriptions or receipts will not be accepted, originals only. Submit receipts and supporting documents to your HR officer for a claim refund form to be completed and sent to us. 5

6 Refunds must be submitted to us within 3 months from the date of receiving medical care. Claims older than 3 months from the date of receiving medical attention is stale and will not be honoured. Refunds take up to 10 working days for processing, some claims may take longer depending on the status of the claim. ACCESSING MEDICAL CARE AT GOVERNMENT HOSPITALS The procedure for assessing medical care at government hospitals such as 37 Hospital, Korle-bu, Komfo Anokye, Effia Nkwanta, Tarkwa General and others are as follows; On reaching the hospital, you will need to go to the insurance office on each visit for a chit to the specific department you have been referred to. The insurance officer may advise members if their referral department do not accept insurance hence a chit may not be given. At this point please call the hotline numbers or for further advice. There are also some departments in Korle-bu and 37 Military hospital where insurance is not accepted, these are; - Cardiothoracic Centre, (Korle bu) - Ghana Dental school clinic, (Korle-bu) - 6 th floor Maternity block (Executive only), (Korle-bu) - Endoscopy, Laparoscopy and Colonoscopy procedures, histology tests at the lab section (Korle-bu & 37) - Radiotherapy unit. (Korle-bu) In case of an emergency outside working hours or at weekends when the insurance office is closed, payment can be made however please call the hotline within 48hrs to inform us and for post authorization to claim refund. A proof of emergency and contact person to verify this may be required. The Insurance office in Korle-bu is located on the 2 nd floor of the Administration block and at 37 Hospital it is located in the Pay office building which is behind the Hospital Headquarters building. At Komfo Anokye Hospital you will need to go to the Revenue Office in Block A, Ground floor for a claim form to take to the specific department. Please ask a hospital staff if unsure. STRESS MANAGEMENT TIPS HEALTH TIP FOR FEBRUARY 2012 We are only a month into the New Year 2012, regardless of your occupation, status, or salary level; we are spending more and more of our work hours feeling stressed and out of control, instead of alert and relaxed. While some stress is a normal part of the workplace, excessive stress can interfere with your productivity and reduce your physical and emotional health. Here are some simple tips to help us manage stress; Identify stressors (things that stress you) and develop a plan to avoid or manage them Exercise at least 30 minutes at least 3 times a week Get as much sleep at night as practicable. Prioritize your schedule and organize your job and life. Get a good orthopedic office chair which would support your spine Take 1 minute off every 2 hours and think of something relaxing Smile and laugh more. 6

7 HAPPY VALENTINE S DAY FAQ S 1. What do I do if I go to a Momentum accredited facility and they are refusing to take my card? Please call us immediately to inform us, so that we can immediately investigate the reason for this and get it resolved. We may ask you to go to another nearest facility or make payment and claim for a refund. 2. What do I do if my card gets missing and I need to go to the hospital? Call the hotline before going to the hospital or when at the hospital, a member of staff will be able to do an intervention at the facility so that you can be seen to without making payment. Afterwards you will need to contact your HR office for a new card to be ordered for you at your cost of GH Are major government hospitals accredited on Momentum? Some government hospitals across the country such as Korle-bu, 37 Military, Komfo Anokye, Effia Nkwanta, Kwesimintsim, Tarkwa General, Bogoso District Hosp, Huni Valley, Central Regional Hospital etc. Please check your Service Provider list for Government hospitals in your region. You will need to go to their insurance office of the hospital on arrival before going to the specific department. Momentum is still reviewing and accrediting regions without facilities. 4. How difficult is it for a dependent to be registered on the Momentum scheme? It s easy, contact your HR office for a Supplementary form and complete this and include 1 passport size photograph of your dependent(s). Your employer will endorse it and send it to Momentum for registration. 5. How soon will I receive the membership card(s) after submission of forms? After Momentum receives the completed supplementary forms with passport sized photograph, it takes between 3-5 working days for membership cards to be printed and dispatched to your employer. 6. Can I sometimes use facilities which are not accredited by Momentum because I prefer to go there or that is where my doctor works from? No, you are required to use facilities on your service provider list given to you; refunds are only permissible under 3 conditions, 1) If this was an emergency and the nearest facility you could reach. 2) There are no Momentum accredited facilities in the town you were in at the time of needing medical attention. 3) If you had been referred to a specialty which was not available on any Momentum accredited facility. Number 2 and 3 must be pre-authorized before accessing medical service there. 7