INTERMEDIATE COURSE IN MEDEICAL & HEALTH INSURANCE - NON MEDICAL ASPECTS OF CLAIMS
Key learning Outcomes
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At the end of the course, participants will be able to :
•explain the key terminology/definition and calculate the various elements of the Hospital & Surgical Insurance benefit structure.
•match the various expense items to their respective benefit category and to calculate the amount of admissible and non-admissible claims.
•explain the situation where an upgrading of room becomes medically necessary.
•explain the meaning of specialist, customary and reasonable charges.
•explain M&H claims procedures and assessment.
•state the various warning signs relating to possible fraud.
•identify and state the responsibilities of the various parties involved in using, delivering and financing healthcare.
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Key Course Contents
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DAY 1
Session 1: Overview of Hospital & Surgical Insurance and Component of
Claims Assessment
Session 2: Structure of Hospital & Surgical Insurance
Session 3: Determine Claims Quantum based on Per one Disability
Session 4: Determine Claims Quantum based on:
- Hospitalization vs Daycare
- Length of Stay
- Room and Board
Session 5
: Determine Claims Quantum based on Specialist Consultation and Procedural Charges
DAY 2
Session 6: Annual and Lifetime Limit
Session 7: Family Annual Limit Profit / Experience Refund
Session 8: Claims Decision and Documentation
Session 9: Managing Excesses and Non payable Items
Session 10: Hospital & Surgical Insurance Fraud
Session 11: Obligations of:
- The Policy-Owner
- Insurance Company
- Healthcare Providers
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Who Should Attend
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Underwriters, claims assessors, sales intermediaries, customer service officers, trainers, product designers and those involved in pricing, healthcare professionals, software programmers, employee benefit professionals and third party administrators and those who are managing medical insurance claims
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Fees
| Category |
Local Fee (RM) |
International Fee (USD) |
| Non-Member |
1490 |
400 |
| Group (Non Member) |
1429 |
380 |
| Group (Member) |
1220 |
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| Member |
1280 |
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