Health Services L. I. C.C 09/15/2014 Lawrenso Korquoi 0
1 Table of Contents Policy... 2 What is the LICC Health Service?... 2 Enrolment process... 2 Period of Coverage... 3 Benefits Covered... 3 Health Premium... 3 Referral and Emergency... 3 Workplace Injuries/Illness... 4 Volunteers and Donations... 4 Reimbursement Claim Procedures... 4 General Exclusions... 5 Application... 6
2 Policy LICC is firmly committed to a policy enabling all to get the quality work and educational activities, to provide the best health care services to all students and employees. Healthy communities provide a framework for productive people. This policy, which includes the application and any changes agreed to in, writing, may not be changed or any provisions waived unless agreed to in writing by the designated authority Responsibilities Management: Will provide a safe and healthy working environment Will provide information, instruction, training and supervision that is necessary to ensure that each worker is safe from injury and risks to health a commitment to consult and co-operate with employees and students in all matters relating to health condition that will enhance a commitment to continually improve our performance through effective safety management. (what does this mean) Employees and Students: Comply with safe healthy work practices, with the intent of avoiding injury to themselves and others and damage to plant and equipment Take reasonable care of the health and safety of themselves and others Comply with any direction given by administration for health and safety Not misuse or interfere with anything provided for health reasons Report all accidents and incidents on the job immediately, no matter how trivial Report all known or observed health conditions to the medical personnel. Health Workers: Provide health services to support the well-being of employees and students Follow all legal and professional ethics in dispensing of functions as a health worker Possess all necessary local and national licenses as required by government Report all cases beyond the control of the health worker to the administration immediately Refer cases in a timely manner Maintain regular clinic hours What is the LICC Health Service? LICC Health Service is an on-campus health care program that provides quality medical and referral services to employees, their dependents and students through the LICC Clinic. LICC is committed to providing health services at an affordable cost to faculty, students, and their families to improve the quality of life and well-being for the LICC community. Enrolment process 1. Submit copy of employment letter or contract agreement to the Director of Health Services (Employees Only)
3 2. Submit copy of official school s receipt at the beginning of semester indicating that you are a student and have paid the health services fees (Students Only) 3. Fill out application forms 4. Indicate names of qualifying dependents along with ID and passport size photos of each dependent Eligibility All fulltime students, staff, faculty, and their dependents are automatically qualified to enroll upon employment or submission of registration receipt. Part-time employees may choose to participate by contacting the Director of Health services Any Part-time employee who qualifies must follow the application process describe in this policy. A parttime employee or faculty is does not benefit from dependents inclusion Who is an eligible dependent? An eligible dependent is one who meets at least one of the following conditions: A legal spouse of an employee A child or stepchild of an employee who is 21 years of age or under, and unmarried A person living with the employee who is 21 years of age or under, whom the employee is supporting at least 90% All qualified dependent must be included at the time of application, unless there s a status change such as birth or adoption of a dependent. Period of Coverage To benefit from LICC reimbursement, an employee must have been in the employ of the college for at least six months. Period of coverage for prolong illness The period an employee or student can be covered under the LICC health Services due to prolonged illness is up to three (3) months. Any extended coverage beyond this period must be approved by the administration through its assigned authorities. Benefits Covered Emergency cases referred or approved by the school nurse or designated authority Prescription and over the counter drugs Laboratory testing Free consultation, diagnosis and prescriptions at the LICC clinic Reimbursement of medical bills Health Premium Staff and Faculty - The LICC health premium is a monthly amount paid through salary deduction. Students The LICC health premium is a fixed semester amount charged to them. Referral and Emergency Only the Director of Health Services is authorized to refer a patient to a different facility for health services. In consultation with one of senior administrators a person may be authorized for referral. A regular employee and full-time faculty member and their dependent may be referred due to emergency. An emergency exists when at the time of the illness the nurse is absent from job or the school s clinic is closed. An employee traveling away from home could get sick and does not have the ability of reaching the school s clinic; such case will be treated as emergency. LICC reimbursement or referral is limited to
4 medical facilities in Liberia. Any referral or medical case treated outside of Liberia is not the responsibility of LICC. All emergencies must be reported within 48hours of occurrence. Referrals will be made to the following hospitals: Ganta United Methodist Hospital (GUMH), Ganta City, Nimba County. Tapitta Hospital, Tappita City, Nimba County Phebe Hospital, Gbarnga, Bong County Workplace Injuries/Illness In the case a faculty or staff member gets injured or becomes ill as a direct result of performing his/her work duties, LICC will cover 100% of the medical expenses per event. All job-related medical reimbursement is limited to a maximum of US$500 within a year. This does not apply to students. Volunteers and Donations Volunteers are people who offer services to LICC at no additional cost kind or cash. A volunteer can only benefit for clinic visit at LICC but is not entitle to reimbursement of medical bills. Donations of any kind donated to LICC health services becomes part of the LICC health funds and will be used or disbursed with the LICC policy manual and the health policy. Reimbursement Claim Procedures Only referral and emergency cases are entitled to reimbursement claim 1. Proceed to the Director of Health Services to collect reimbursement claim form 2. The Director of Health Services or Nurse in Charge will verified all referral or medications 3. Proceed to the Business Office for application of percentage, authorization and subsequent payment 4. LICC will pay reimbursement when we receive proof (valid institution receipt) that you have incurred an eligible expense. We determine the amount to be paid by: applying the reimbursement percentage then applying the maximum How we calculate the amount we'll pay We, LICC or approving authorities, confirm all expenses you submit are eligible expenses. We determine if there are any limitations which are described in the applicable provisions. If any of the expenses aren't eligible, we subtract that expense from the total amount you are claiming. For each eligible expense, we compare: the amount you are claiming the customary charge for the expense, and the maximum amount you can claim as described on reimbursement schedule Reimbursement is limited to the schedule listed below based on your gross annual contribution to the health premium. The reimbursement for student is 50% of medical bills per medical event and the maximum per semester is US$6.00 or academic year is US$12. Annual Gross Health Premium Reimbursement maximum limit
5 Contribution US$0----$50 per annual* US$40 51 100 75 101 200 100 201 300 200 301 400 300 401 500 400 501 600 500 601 700 600 801 and above 800 *Annual is defined as academic year for students, as indicated by the school academic calendar. Annual is defined as fiscal year (August-July) for full time staff. Employee and dependent reimbursement is limited to 80% of eligible medical expenses. All receipts for reimbursement must be submitted within one academic year or not later than the last day of the fiscal year (July 31), whichever is earlier. Before you incur expenses not included in the list of reimbursable items please contact the Director of Health Services. There is no cumulative amount of reimbursement reserved for an employee once the fiscal year has ended. Any reimbursement will be based on the current fiscal year annual gross health premium contribution. Students are not eligible for reimbursement. General Exclusions We will not pay for expenses: for services or items that we consider cosmetic-services at your choosing but not advise by medical professionals for delivery, transportation and administration charges, for services and products that are self-prescribed. for services or supplies that are not approved by referred doctor or school nurse for services or supplies such as herbs for services or supplies that do not qualify as medical expenses for all medical treatment or surgery which is received or performed out of Liberia We will also not pay for intentionally self-inflicted injuries Pre-existing condition-which is any injury, illness, sickness, disease, or other physical, medical, mental or nervous condition, during the last three years prior to the effective date of enrolment or employment (I don t recommend this statement you can say that pre-existing condition exclusions will apply if a student/faculty/staff chooses not to participate in the plan and tries to enroll after they get sick?)
6 Application if a student/faculty/staff chooses not to participate in the plan and tries to enroll after they get sick Pregnancy, childbirth, birth control or abortion Subsequent, chronic or recurring complications or consequences related thereto or arising therefrom, whether or not previously manifested or known, diagnosed, treated or disclose.
7 LICC Health Care Services Enrollment Form Primary applicant information: Male Female Last Name First Name Middle Initial Date of Birth: Month Date Year Home Address: City: County: Phone 1 # Phone 2 # Email address: ID#: Are you a Liberian? Yes No Marital Status: Single Married Divorced Widowed Spouse Name: Last Name First Name M.I Are you Pregnant? Yes No Do you have any pre-existing illness? Yes No If yes, please attached explanation Eligibility Status: Full-time Employee Part-time Employee Student Dependent Information: Last Name First Name M.I DOB Gender Relationship Signed: Date: Note: By signing and dating this form, you agree to the terms and conditions of the Policy. Office Use Only: Approved Date: Rejected and reason: Date:
8 LICC Health Care Services Enrollment FORM TERMS AND CONDITIONS 1. To the best of my knowledge, all statements and answers in this application are complete and true. I understand that if I provide false or fraudulent information, misrepresentation or fail to provide complete or timely information on this application, I may face action, including, but not limited to, loss of coverage, employment action, and/or criminal charges/sanctions in accordance with the LICC handbook and laws of the Republic of Liberia 2. I authorize the LICC administration or designated authority to obtain any information from any source necessary to administer this service. 3. I agree to pay in advance the current premium for this service, and I authorize my employer (the remitting 4. agent) to deduct from my wages or salary an amount as specified by my employment contract to provide for regular premium payments that are not otherwise contributed. 5. I understand that eligibility for benefits may be conditioned upon my willingness to provide written authorization permitting my health services and/or LICC to obtain medical records from health care providers who have treated me or any dependents. 6. I agree to respond to questions from the Director of Health Services and LICC, including, but not limited to, audits, in a timely manner. 7. 5. I have reviewed and understand the eligibility criteria for dependents under this policy and affirm that all listed dependents are eligible. I understand that children may be covered through the end of the month they turn 2. 8. I understand that it is my responsibility to notify the LICC, or if there is a change affecting my services, including but not limited to, a change in eligibility due to divorce, marriage or a change in the dependent status. 9. Furthermore, failure to provide timely notice may result in loss of coverage, delay in payment of claims, loss of continuation rights and/or liability for claims paid in error. Upon request, I agree to provide any documentation that LICC deems necessary to substantiate my eligibility or that of my dependents.