FAQs – Health

Health
Is individual health insurance available through AIB?
My company has a Group Health Plan brokered by AIB, how do I or my dependants enroll?
Who are eligible dependants?
I am covered under my spouse’s health plan; can I still enroll on my company’s health plan?
Is there a time period an employee can claim on a health plan?
What is the reimbursement percentage?
What is a Pre-Existing Condition?
What are Eligible Expenses?
What are Reasonable and Customary Charges?
How to Claim?
Are referrals required for Specialists’ visits?
Why aren’t all drugs prescribed by doctor’s covered?
Are visits by chiropractors, chiropodists, podiatrists etc… covered?
What services are not covered by most health plans?
Is it necessary to submit original receipts when claiming?
In addition to the annual benefit, what are some of the most common limitations on Vision Care Benefits?
Does my Dental Care Benefit extend to cosmetic services like teeth whitening and implants?
Is individual health insurance available through AIB?

Yes. Upon submission of your Date of Birth, we can provide quotes from two leading insurers. We also provide access to international $USD individual plans

My company has a Group Health Plan brokered by AIB, how do I or my dependants enroll?

An Employee enrolls in the Plan by completing an Enrollment Form for him/her and for his/her eligible dependants at the time of enrollment. This Employee and his/her dependants are guaranteed automatic enrollment unto the health plan on the basis that this form is submitted to Agostini Insurance Brokers within 31 days of his/her employment confirmation date.

For Employees who acquire new dependants while covered on the Plan, he/she will apply by completing the necessary Enrollment Form in respect of such new dependant and submit same to Agostini Insurance Brokers within 31 days of acquiring these dependants.

Please note that all late enrollments will have to be accompanied by a Declaration of Insurability Form and will be subject to the Insurer’s underwriting practices in place at such time.

Who are eligible dependants?

The eligible dependants of an Employee are-

  • the Employee’s legal wife or husband, (but not including spouses who are legally separated from the Employee) or
  • the person living with the Employee in a recognized husband and wife relationship, who is registered as such in the records of the Company, and
  • the Employee’s unmarried children, step-children and children legally adopted who are under nineteen (19) years of age and living in the Employee’s household and have the same permanent residence as the Employee or absent therefrom only to attend school. Such children must be registered as dependants in the records of the Company.

The Employee’s children who are over nineteen (19) years of age but under the age of twenty-two (22) years shall only be eligible if they have the same permanent residence as the Employee and if they are full-time students at an accredited college or university and coverage under the Plan was effected prior to such children attaining nineteen (19) years of age. Proof of attendance must be submitted to the Company annually.

I am covered under my spouse’s health plan; can I still enroll on my company’s health plan?

You are still eligible to join the plan even if your spouse is covered under another plan. The benefits to be derived from your plan shall be co-ordinated with the other plan’s benefits in accordance with the following:

  • On submission of each claim form, Co-ordination of Benefits section must be completed for persons who have duplicate coverage
  • Claims for you are to be submitted first through your plan
  • Claims for children are to be submitted first through the plan covering the male spouse
  • Claims for your spouse are to be submitted first through his/her plan

The initial payment would be made by the plan covering the member as an employee and the other plan pays the difference up to the plan’s limit.

Is there a time period an employee can claim on a health plan?

All Employees/dependants being transferred from the former health plan can claim immediately for Medical, Dental and Vision benefits.

Any other Employee/dependant can claim for Medical benefits from the first day they are effectively enrolled in the Plan.  However, Dental and Vision coverage becomes effective only three months after enrolling in the Plan.

What is the reimbursement percentage?

The Plan will reimburse the percentage stipulated in the Schedule of Benefits for Medical, Dental Care and Vision Care expenses incurred by enrolled Employees.  The insured Employee is responsible for the difference of the expenses.

What is a Pre-Existing Condition?

Upon joining a Group Health Plan, if an Employee within the three months prior to the effective date of participation was under a medical practitioner’s care or received any type of medical treatment or advice because of a medical disability or ailment, that condition is considered a pre-existing condition and expenses incurred by an Employee are not covered by the Plan over a particular period or indefinitely.

What are Eligible Expenses?

‘Eligible Expenses’ shall mean the actual expenses and charges incurred by an insured Employee enrolled in the Plan, which are reasonable and customary for necessary Medical, Dental or Vision Care and services administered by or ordered by a physician licensed to practice medicine.

What are Reasonable and Customary Charges?

‘Reasonable and Customary Charges’ shall refer to charges for Medical, Dental or Vision Care and services administered. Charges are considered reasonable and customary to the extent that it does not exceed the general level of charges being made in the area where the charge is incurred.

How to Claim?
STEP 1

At the end of each visit to the relevant medical practitioner, that practitioner should be requested to make an appropriate entry in the ‘Doctor’s Visits Section’ of the ‘Attending Physician’s Statement’ on the Claim Form and, if necessary, retain the form in his files. (Employee should avoid awaiting the completion of a course of treatment before requesting the doctor to complete the Claim Form).

STEP 2

On completion of a course of treatment, you should:

  • Fill in the Employee’s Statement portion of the Claim Form.
  • ATTACH ALL SUPPORTING ORIGINAL ITEMIZED BILLS AND RECEIPTS:
  • Hospital bills should state the number of days spent and the charge for each day, as well as itemized charges for other hospital services. Receipts for Surgeon’s and Anesthetist’s Fees are to be included and specifically stated.
  • Drug bills should show the date of purchase, name of patient, name of prescribing doctor, prescription number, the name and quantity of the drugs itemised if there is more than one with corresponding charges.
  • Bills for X-rays/Lab tests and other diagnostic tests should show the date, name of patient, the name and cost of each test done.

Insufficient information on your bills may cause a delay in settlement of your claim.

STEP 3

Deposit your form and supporting documents to your company’s Plan Administrator and the documents will be forwarded to AIB.

Are referrals required for Specialists’ visits?

Yes, with the exception of Gynecologist and Pediatric

Why aren’t all drugs prescribed by doctor’s covered?

Insurance plans only pay for controlled drugs (antibiotics, narcotics, injections)

Are visits by chiropractors, chiropodists, podiatrists etc… covered?

Generally No. Only doctors that are registered with the Medical Board of Trinidad and Tobago will be considered for reimbursement however some plans do sell the benefit

What services are not covered by most health plans?
  • Cosmetic services, supplies or treatment
  • Experimental Services
  • Charges in excess of benefit maximums
  • Services determined not to be medically appropriate and/or necessary
  • Infertility nor Birth Control
  • AIDS
In addition to the annual benefit, what are some of the most common limitations on Vision Care Benefits?

12 consecutive months for lenses and exams and 24 consecutive months for frames.

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