Worldwide Healthcare

The benefits of Fairfirst Worldwide Healthcare Insurance Policy

You can choose where to receive treatments from, locally or globally. The policy covers hospitalization charges, Emergency /Accidental Out-patient, maternity-related expenses, Emergency Medical Evacuation and Repatriation and so much more.

The policy is customisable and extendable to family members.

A Health Insurance Plan To Suit Your Exact Needs

With 4 comprehensive plans to choose from, and benefits spanning across all geographical locations, we keep you covered through any twists and turns life may take on you. That’s the privilege we offer you.

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*Please note that inquiries received after office hours (8:30 to 5:00), on weekends and on mercantile holidays will be followed up on the next working day.

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Claims Pre-authorization

The Company requires pre-authorization of planned treatment to protect the insured person from unexpected costs. When issuing a confirmation of cover in this way, the company confirms that the planned treatment:

• Is eligible under the policy; and
• Is Medically Necessary; and
• Is within reasonable and customary(R&C); and
• Cost falls within the remaining benefit limit

The Company requires pre-authorization for the following treatment and services before the insured person’s treatment begins:

• All inpatient and day-care admissions
• All non-emergency
• Tests, diagnostics, treatment, surgery and other medical services
• Home Nursing
• Cancer treatment
• Kidney Dialysis

A request for pre-authorization should be submitted by the policyholder or insured person, at least ten (10) working days prior to the scheduled date of treatment. this is to allow the company to confirm if the treatment is eligible for reimbursement and/or direct billing can be arranged accordingly.

Upon the receipt of such requests, the company will give a verbal or written confirmation to the policyholder or insured person. Where pre-authorization is required and not obtained, the benefits may be declined or reduced.

In the event of an emergency hospital admission, where the insured person’s life or health status is at risk if the insured person is not immediately admitted to the hospital, the policyholder, the insured person’s family member the treating medical practitioner, or the hospital, must contact the company within the next seventy -two (72) hours or before the insured person’s discharge, whichever is earlier, otherwise benefits may be declined or reduced. If the insured person has worldwide cover and seeking treatment in USA.

• Before any treatment in the USA, the insured person must contact the hotline number as stated below for pre-authorization, who will in turn confirm the insured person’s entitlement, and arrange to contact the insured person’s medical provider to organise direct billing for him/her.
• If the insured person chooses to have his/her treatment without the company’s
  pre-authorization or if pre-authorization was not arranged before treatment, the eligible benefit may not be paid beyond 50% of reasonable and customary medical charge.

Claim Reimbursement Procedure

In relation to the medical claims, the company reserves the right to accept or refuse the request by the policyholder or insured person to use any medical provider outside the network, particularly when the network provider is available in the area where the treatment takes place, exception will be considered for medical emergencies and serious accident.

Please ensure all inpatient and day-care treatments are pre-authorized, and within the network to facilitate any direct billing arrangements, if applicable .in cases, where the company does not have direct billing arrangements in place, the company will offer a pay and claim reimbursement service. The policyholder or the insured person pays to hospital/provider first and then claims the costs from the company. Only costs incurred from eligible medical conditions and treatment will be reimbursed within the limits stated in the table of benefits. If the insured person is required to pay a deposit in advance of any medical treatment, the cost incurred will only be reimbursed after treatment has taken place.

It is the policyholder or insured person’s responsibility to retain any original supporting documentation (E.g.: medical receipts) as the company reserve the right to request original supporting documentation/receipt for claims settlement and auditing purpose.

If the policyholder or the insured person paid for treatment while they were outside Srilanka or received an invoice for covered services in a currency other than the currency the premium was paid in, the company makes a currency conversion to Srilanka rupees (LKR)as published by state bank of Srilanka. The company will use the exchange rate that applies on the date on which the treatment was done or for inpatient, day-care treatment on the insured person’s date of discharge from hospital for that claims.

The company will not be liable for any bank charges, credit charge or losses due to currency fluctuation.

Claim Notification and Submission

While the policy is valid, all claims together with a completed claim form and supporting information/original documents must be submitted to the company within thirty (30) days.

Where it is not reasonably possible to submit claims within thirty days, the claim may be submitted later with the company’s prior approval but in no case later than ninety days of the date of commencement of the event which gave rise to the claim. the company will not be liable for any claims submitted after this period.

While assessing the submitted claims, the company may request for further documentation and/or requirements, which the policyholder must provide within thirty days of receiving such request.

For claims reimbursement when incurred outside the network of hospitals, the company will.

• a. Require the reason why the hospital was used instead of a hospital within the network.
• b. Reimburse the claim incurred at a non-Network hospital that are within the reasonable and customary medical charges for such treatment.

If the policy coverage has ceased, eligible claims incurred during the policy period of insurance must be submitted within thirty days of the date of expiry or termination of the policy. the company will not be liable for any claims submitted after this period and all claims received will be returned.

Contact Details

Local Hospitalization /Inquiries to fairfirst

• Hotline 011 2 428428
• Submit preauthorization documents to Worldwidehealth@fairfirst.lk

For overseas hospitalization/inquiries call paramount healthcare management Pvt ltd(Third Party Service Provider for overseas claims)

• Regular Helpline Nos: +91 2 240 004 219
• U.S. Toll-Free No: +866 978 5205
• Submit preauthorization documents to Email: travelhealth@paramount.healthcare

Claims Submission methods

• To submit online via Health e- portal or via email to Worldwidehealth@fairfirst.lk
• To submit physically, send the supporting document at,

  Fairfirst Insurance Limited
  Access Tower II (14th Floor),
  278.4, Union Place,
  Colombo 02,
  Srilanka.

Network Hospitals

• Local Hospitals – https://www.fairfirst.lk/partner-hospitals/
• For overseas Hospitals – http://www.paramount.healthcare/providerNetwork.aspx