Corporate & Groups


MedCom Health-Care
has the pleasure to offer Health-Care plans specially designed to fulfill the requirements of the Human Resource Managers; enabling them to meet the needs of their employees through flexible, tailor-made medical services applying the highest quality standards.
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OUR CORPORATE & GROUP HEALTHCARE PACKAGES

Cover limits
Start from EGP 15’000 up to EGP 250,000.
Inpatient (Hospitalization)

Covering medical expenses for a patient who occupies a bed for a day case or for at least one night in the course of treatment, examination, or observation inside MedCom’s medical network, including accommodation, surgery, physicians fees, MRI, CT scan, laser treatments, intensive-care … etc.

Outpatient
Covering medical expenses MedCom’s medical network of clinics, labs, pharmacies..etc, for a treatment that does not require an overnight stay, such as doctors’ visits, diagnostic tests, medication..etc


Medication

Covering prescribed drugs within MedCom’s medical network, with or without co-insurance as per the client’s requirements.


Room & Board
Private /Single.

Pre-Existing & Chronic Conditions
Covering medical expenses whether inpatient and/or outpatient with a sub-limit of 20% from the annual overall limit per person throughout the year for any condition existing prior to the commencement date of cover (pre-existing); or any illness starting after the start date of cover and thereafter developing into a chronic condition.

 

Critical Cases
Critical conditions not falling under Chronic and Pre-existing are covered up to the annual limit for all employees, including emergency transportation ( local ambulance ) costs to hospital.

Vision (Optional)
Covering all sight correction treatments, including medical frames & lenses up to an agreed sublimit.

Dental (Optional)
Covering all routine dental treatment, including examinations, gum treatment, normal compound fillings, simple or non-surgical extractions up to an agreed sublimit.

Merged Vision & Dental (Optional)
Where dental and optical cover limits could be merged under a combined single limit according to the client’s requirements.

Maternity (Optional)

Natural and Caesarian delivery as well as legal abortion are covered up to an agreed sublimit.

Direct Billing
We offer a direct billing service to your employees, through Medcom’s access card within MedCom’s medical network.

Reimbursement
In case of Outpatient services,
We are committed to a 10
working days recovery of your
reimbursement.

Family Coverage (Optional)
All above mentioned coverage can be extended to the employee’s family (wife/husband/kids) and parents as well up to age of 70 taking in consideration their age and prices.

CORPORATE ONLINE APPLICATION FORM

GENERAL TERMS & CONDITIONS

1 – The Agreement

  • A – Content:
  • The tariffs, the General Terms and Conditions, the financial structure of the agreement, agreed benefits and any attachments or modifications to any of the above mentioned documents form an integral part of this agreement. The signing of this agreement confirms that the “client” has accepted the terms & conditions of this agreement in his name and on behalf of all members eligible for the program.
  • B – The headlines:
  • The headlines included in this agreement are an integral part of the contract, including the list of definitions.
  • C – Amendments:
  • Once this agreement is signed by the client, it becomes active and in force. No adjustments are to be made neither to the financial structure nor to the table of benefits during the validity of this agreement and especially after the start of implementation.
  • D – Termination procedures:
  • In case of termination, this Agreement will continue to cover existing in-patient cases already accepted at the hospital at a date preceding the termination until the date of discharge from the hospital. “MedCom” will also reimburse to the customer all out of network claims prior to the date of cancellation. The client also certifies to repay “MedCom” within 30 working days all expenses that exceeded the ceilings set out in Table Benefits as well as all incurred expenses to cover excluded conditions as stated before in this agreement.
  • E – Renewal Procedures:
  • At least one month before the expiration date of the contract “MedCom” should start taking the necessary procedures towards renewal. In the case of non-compliance of “MedCom” to take action within one month from the termination date of the contract, “MedCom” is committed to provide coverage for emergency cases during the month deadline whether the contract will be renewed or not, bearing in mind that the “client” would be settling these amounts with “MedCom” in the case of non-renewal .

2 – Terms of coverage

  • A - ID card:
  • The user eligible for the program will receive a membership card issued by “MedCom”. Coverage begins either from the start date of the agreement or from the date of issuance of the ID card provided that “client” had named the eligible user among the opening list of employees before the start of this Agreement.
  • “MedCom” will provide the “client” with all necessary instructions and program information applied to qualified members and the explanation of how to use the ID card.
  • The ID card is owned by eligible members only. In case of loss of that card, the member must notify “MedCom” immediately; which will in turn- within 48 hours of the date of notification- issue a new card at a cost of 20 Egyptian pounds to be paid by the “client”.
  • In case of emergency during those 48 hours or delay the member will be able to access the service in coordination with the company “MedCom”.
  • B – The main role of health care management:
  • According to the health care program applied and all provisions of the agreement which includes a direct settlement facility, where “MedCom” will pay all expenses to cover benefits to the holder of the membership card according to the limits specified in the table of benefits (enclosed) except for items excluded (exclusions).
  • C – MedCom‘s General Rules:
  • Having signed this contract the “client” transfers the decision making process regarding the claims assessment to “MedCom”. As for the decision making regarding treatment procedures of medical conditions remains the sole responsibility of Service Providers that are accredited for those therapeutic decisions.
  • If any treatment requiring a prior approval -as mentioned and described in the contract- is received by eligible members without this approval, such services would have to be at their own expenses. “MedCom” will have to notify the “client” who in turn has a responsibility of notifying the User that these services will not be paid by “MedCom” and that the User will have to fully pay it to the accredited Service Providers.
  • If the “client” approves to bear all the expenses at their own account or at the account of the eligible User, the “client” has to issue a written letter to “MedCom” pledging that he agreed to pay this amount on behalf of the member. “MedCom” has the right to request a cash advance as a down payment to those expenses.
  • D – The information provided by the “client.”:
  • The “client” is held responsible for providing complete, correct, and clear information regarding eligible members of the program and will notify “MedCom” as soon as possible of any fundamental changes that may occur to the member and have an impact on the information provided in the opening list at the signing of this Agreement.
  • E – Additions and Deletions of Members:
  • Any new employee eligible for joining the health care program, the “client” has to notify “MedCom” in writing attaching to the request a personal photo of the additional member. Failure to send this picture the addition will not be processed.
  • Adding new subscribers after contract’s commencement date, “MedCom” will request the client to pay part of the annual subscription proportional to the remaining number of months covered for new subscribers with a minimum of 50% of the value of the annuity. Accordingly, benefits ceilings & sub-ceilings will be also adjusted proportionally for the remaining period of the contract.
  • In the case of deleting a member from the program the “client” must send a letter to request cancellation and collect the membership card from the User, bearing in mind that the “client” would be fully responsible for any medical expenses incurred after deletion if the card was not returned. Therefore, the client has to make sure to withdraw the ID card from the employee, when quitting work or signing of the letter of termination.
  • “MedCom” will refund the client part of the annual subscription proportional to the remaining number of months not covered for deleting subscribers if there are no incurred claims. Otherwise, “MedCom” will be entitled to keep the full annual subscription. Additions and deletions invoices are settled separately from principal payments, which have to be paid full before issuing the membership cards. Medical coverage services are stopped from the date of sending a letter requesting deletion. Nevertheless, such deletion would only be settled financially after the delivery of membership cards and after 3 months from deletion date.
  • Additions of families of employees to the contract are only allowed during the first month of the agreement start date. Family member’s additions will not be after the end of the period, except in the following cases:
  • ·         In the case of new marriages. Additions will only take place within a month of the date of the marriage.
  • ·         In case of newborns. Additions will only take place within a month from the date of birth.
  • The present Contract shall prevail till its expiry date and may be renewed by agreement of the parties (the company and the client) for similar periods against payment of the renewal subscription as agreed by both parties.
  • F – The plan’s maximum ceilings & sub-limits:
  • The coverage area is Egypt only. In areas where there are no contracted Service Providers, “MedCom” will reimburse 100% of the invoice value. For emergencies outside Egypt an eligible member will be refunded 80% of MedCom’s contracted prices with service providers. (Such arrangements must have a prior agreement with the client).

3- Scope of coverage according to the schedule of benefits

  • The company and the client may agree to amend the medical benefits contained in this Agreement or attached to them at any time without the need to obtain the consent or involvement of the individual members. It is the responsibility of the client to inform the subscribers about the amendments and change in terms & conditions.
  • The Company may at any time request the examination of any member who a filed a claim through an accredited medical provider.

EXCLUSIONS

WARS / SPORTS

1. Injuries and illness resulting from any attempt in any  assault , crime , aggressive acts or rebellion , strikes or riots , injuries caused by live bullets and cartridges , injuries resulting from military operations during permanent or temporary service at the armed force also injuries as a result of practicing sports.

2. Wars, sedition, invasion or hostilities for a foreign enemy either an announced war or not, civil war and revolutions, rebellion and insurrection, civil disorders, acts of terrorism, vandalism and demonstrations.

3. Any illegal action or any action that contravene with the law done by the participant.

4. Injures resulting from natural disasters such as Earth quakes, floods, soil erosion, volcanoes and lightening, cleavage and nuclear fission or radioactive or chemical pollution.

GENETIC

5. Birth defects , congenital diseases , impairments  and deformities or old injures , cosmetic  surgeries , surgeries and endoscopic surgeries of palate , uvula and deviated nasal septum , snoring , studies and treatment of sleep apnea.

PSYCHIC

6. Self-inflicted injures or diseases , and those resulting from neurological diseases and mental disorders , addiction , injuries and illness resulting from suicides and mass accidents also psychological diseases and psychiatric sessions ,treatment of  speech and language defects, speech sessions , difficulties in education and reading ,disabilities in growth , memory  and  understanding , diseases or injures which arise due to the abuse of drugs , stimulants and sedatives.

Specific Conditions

7. Infertility and impotence , fertility follow-up services for both sex  including artificial insemination or IVF , contraceptives and any complications resulting from them, sexual diseases , spermatocele and nocturnal enuresis , vaccines and immunization in general , premature and newborn incubations  and circumcision for all ages.

8. Female hormonal disorders, Hirsutism and hormonal replacement the rapy  , osteoporosis , growth hormones and diseases resulting from growth disturbances and delay , susceptibility to allergy tests , immunity diseases and its tests , acquired immune deficiency syndrome (AIDS) , Syphilis , Gonorrhea and other diseases transmitted through sexual intercourse.

9. Drug eluting stents (smart), Pace maker and artificial heart valves , Brain stent and catheterization , Chemo and Radiotherapy for Malignant tumors , organs and bone marrow transplantation, Prosthetic devices, orthotics and joints replacement , Intra and Inter-articular Injections of artificial Hyaline Materials ( e.g. Orthovisc ) .

10. Alzheimer’s disease, Parkinsonism, multiple sclerosis, Alopecia and hair fall, Acne and ruptured Eardrum.

11. Lasik for the treatment of Myopia, cases of keratoconus, intraocular lenses implanted after cataract operation and the measurements of its strength and the treatment of squint.

12. Orthodontics and its equipment, stents, calcareous removal, teeth whitening and polishing and Panoramic x-ray.

13. Treatment of alcoholism or any type of addiction and treatment of obesity, slimness and loss of appetite.

14. Medicines not registered in Ministry of Health and all the medications related to any excluded case , pharmaceutical preparations, cosmetic  medicines or materials not considered as a drug such as bleaching cream , sun protection cream , Shampoos , skin and hair lotions , food supplements and baby milk , soaps and alternative medicine which has not been confirmed scientifically (Treatment with Chinese Acupuncture and Herbal treatment , ………)and gargles and mouth wash , lozenges , pollen grains , royal jelly and Ginseng , Arcalion , Apifortil , prophylactic drugs also vitamins and tonics (except with an approval and for a medical necessity) , supplies and medical equipment (hearing aids, glucose monitoring devices , nebulizers, crutch, knee and wrist support and compression bandage ,…….).

15. Treatment of Viral Hepatitis by, Interferon, Sovaldi , Baraclude and their alternatives and its related investigations , Also PCR test.

16. Hemodialysis and peritoneal dialysis for Renal Failure.

General

17. Pre-existing conditions and critical cases as defined, pregnancy, delivery and legal abortion unless otherwise is stated in the table of benefits.

18. General check-up, general health tests, pre-employment and pre-marriage examinations, and/or rehabilitation, or during quarantine period, treatment of epidemic diseases, in-patient accommodation to perform tests that can be done through outpatient clinics, complications or completing surgeries done outside MedCom’s medical network or before Contract’s start Date and Doctors Home visits.

19. Treatment outside MedCom’s medical network, treatment outside Egypt, treatment by visiting foreign experts, patient escort, telephone, cafeteria and other non-medical fees.

20. Members over 60 years old, maternity and delivery cases for participant’s families and   newborns except after 14 days of birth.

21. Transportation expenses other than the ambulance and ambulance expenses in non-emergency cases.

22. Staying in the incentive care for more than 14 days.

FAQs

Q: Who is MEDCOM ?

A: MEDCOM Health-Care S.A.E. was established on 10/10/2010, with an issued capital of EGP. 20 million, it was registered as a Third Party Administrator (TPA) managing Health-Care programs.

Q: Is MEDCOM an Insurance Company ?

A: MEDCOM is a TPA .

Q: What role does MEDCOM play ?

A: MEDCOM is specializes in providing complete Health Insurance management and Third Party Administration services to its members.

Q: How can we get a quotation as a corporate ?

A: Your corporate can get a quotation by filling out a corporate Application form and send it by email to info@medcom-hc.com, or send it by fax to +(202) 26 43 89 35, so we can study your needs and quote it accordingly.

Q: How can we use our health insurance cards ?

A: You need to present your MEDCOM Health Insurance card each time you visit a health services provider within our network before receiving any service in order to qualify for direct billing.

Q: Can we visit an out of the network provider?

A: Yes it is. However, MedCom will not be able to settle your bills directly. You will have to pay the charges in full and file a reimbursement claim for eligible expenses. Please check the procedures for reimbursement.

Q: What is considered a Pre-Existing condition?

A: Any health condition known to the beneficiary and/or to the contract holder that exhibited symptoms or was a consequence of an injury or Illness for which medical, Surgical and/or pharmaceutical treatment, medical diagnosis or other advice was provided three years prior to the beneficiary’s enrollment date.

Q: Are we protected if we traveled outside Egypt?

A: MedCom Health Care Plans cover medical expenses that occur outside the Geographical Area of Cover. Reimbursement will be affected at MedCom local contracted prices with a 20% Co-insurance (reference to Misr International Hospital tariff).

Q: Can we include our families in the Corporate Policy ?

A: Yes, you can add your first degree dependents (spouse or any unmarried children up to the age of 25) in your corporate policy for an additional premium.

Q: Is there is any General Exclusion on MedCom Health Plan ?

A: Yes, all exclusions are clearly stated in your policy. Please read them carefully.

Q: Are Chronic conditions covered ?

A: MedCom Health Care covers the diagnosis and the initial stabilization of a chronic condition arising after the commencement date of the policy, as well as the treatment of an acute phase. We also pay for on-going maintenance of a Chronic condition up to an agreed sub-ceiling.

Q: Can we choose where to have our treatment ?

A: Yes, provided that treatment is received within MedCom contracted medical network. However, if you choose to visit a non-contracted provider, reimbursement of claims will be based on 80% of the contracted providers’ tariff (based on Misr International Hospital tariff) or 100% of the value of your invoices, whichever is lower.

Q: Can we have a Dental, Vision or Maternity Cover included in our Health Care Policy?

A: Yes, if you have these options clearly stated in your policy wording, you can be covered for Dental, Maternity or Vision according to each option’s sub-ceiling.

Q: By applying directly to the Insurance Company can we have a better quote than going through a Broker ?

A: No. Your insurance cost will be the same either directly to the insurance Company or through an intermediary.

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Q: How do we know if our doctor is in the medical network ?

A: You will receive with your enrollment the MedCom Network Booklet. If the name of your doctor is listed, then you can still visit your own doctor. If your doctor is not listed, then you will have to follow the “Out of Network” procedures as previously defined.

Q: What is the minimum number of insured to qualify for a corporate coverage plan?

A: we cover small, medium and large corporate plans starting from 10 insured and above as per the client volume.