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Overview | Out-Patient Procedure | In-Patient Procedure | Outreach Procedure | Claim Forms

In order to ensure that you receive the best possible claims service, the procedures noted below should be followed in the event of treatment being required by you or your dependant.

Should you have any difficulties with your claim submission or claim process, please contact us and the TTc team will be happy to assist you.



DEFINITION
We/Our/Us: Aetna Global Benefits
Aetna International Service Centre
(previously known as Medical Helpline)

All insured persons have access to our Aetna International Service Centre which is available 24 hours a day, 365 days a year and is staffed by multi-lingual operators who can arrange admission to hospital, ambulance transfers and air evacuation where necessary. To obtain medical assistance, please use the Aetna International Service Centre number stated below. You will need to provide your name, policy number, telephone and/or fax number, location and medical condition. In any given situation, if you are unsure what to do, contact the Aetna International Service Centre.

Tel:       +1 877 248 2197

Email:   helpline@talent-trust.com


Pre-Authorisation

The following types of planned treatment require pre-authorisation from Aetna or it may not be covered in full:
  • Planned in-patient or day-patient treatment (hospitalisation).
  • Any pregnancy or childbirth treatment.
  • Planned surgery.
  • Evacuation.
  • Psychiatric treatment - in-patient, day-patient and out-patient.
  • Home nursing charges.
  • Planned in-patient, day-patient or out-patient MRI, CT & PET scans.
PCMF and ROMIF

For all pre-authorisation, please contact the Aetna claims office in the same region as your location as listed below. Please ensure you have your Member ID/Cert. No. at hand if you need to call Aetna claims office, as this will be required to verify your cover.

Europe & Africa
Tel:     +44 870 429 6439
EMail: AIMedicalTeamEurope@aetna.com
Download: Pre-Certification Medical Form(PCMF-EU) - Your treating doctor would need to fill out the PCMF-EU and have the completed form (including a breakdown of the estimated treatment costs) submitted to AIMedicalTeamEurope@aetna.com for pre-authorisation

Asia Pacific
Tel:     +852 3071 5022
EMail: AIMedicalTeamHongKong@aetna.com
Download: Pre-Certification Medical Form(PCMF-Asia Pacific) - Your treating doctor would need to fill out the PCMF-Asia Pacific and have the completed form (including a breakdown of the estimated treatment costs) submitted to AIMedicalTeamHongKong@aetna.com for pre-authorisation.

Middle-East & India
Tel:     +971 4 324 0040
EMail: AIMedicalTeamMiddleEast@aetna.com
Download: Pre-Certification Medical Form(PCMF-UAE) - Your treating doctor would need to fill out the PCMF-UAE and have the completed form (including a breakdown of the estimated treatment costs) submitted to AIMedicalTeamMiddleEast@aetna.com for pre-authorisation.

Canada, Central & South America
Tel:     +1 877 248 2197
EMail: AetnaInternationalAmericasPrecert@aetna.com
Download: Pre-Certification Medical Form(PCMF-Americas) - Your treating doctor would need to fill out the PCMF-Americas and have the completed form (including a breakdown of the estimated treatment costs) submitted to AetnaInternationalAmericasPrecert@aetna.com for pre-authorisation.

USA
Tel:     +1 877 248 2197
EMail: AetnaCaseManagementAmericas@aetna.com
Download: Release of Medical Information Form(ROMIF) - You would need to fill out the ROMIF and have the completed form returned to AetnaCaseManagementAmericas@aetna.com so that AETNA will have your permission to obtain your medical records from the service providers in the USA for their assessment related to pre-authorisation.



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Pre-authorisation for Treatment Outside the USA

To obtain Aetna's pre-authorisation for treatment outside the USA, it is important that you arrange for your treating doctor to fill out the above PCMF(Pre-Certification Medical Form) and have the completed PCMF(including a breakdown of your estimated treatment costs) returned to the e-mail address for the designated Aetna Medical Team for your country of treatment, for their assessment. Once pre-authorisation is granted, Aetna will arrange a GOP(guarantee of payment) with the service provider for their direct payment of your eligible treatment costs.

Please note that Aetna's direct-settlement is subject to the service provider's agreement to Aetna's payment arrangement. For treatment outside the USA, our members are free to seek treatment from any service provider of their choice. However, not all service providers accept Aetna's GOP(guarantee of payment). If you would like help in finding a service provider that can accept Aetna's direct payment, please contact us by e-mail.

For outpatient treatment estimated to exceed US$1,000, you may request Aetna's assistance with the direct-settlement of your bill by following these procedures for pre-authorisation for treatment outside the USA.
Pre-authorisation for Treatment Inside the USA

Please note that all treatment in the USA must be received at a preferred provider facility. You can find the Provider Network facilities in the USA by clicking HERE or call Aetna International Service Centre (as printed on the membership card) for their assistance. To obtain Aetna's pre-authorisation for treatment within Aetna's preferred provider network in the USA, the service provider would need to submit the following info to Aetna Medical Team for their assessment.
  1. The service provider's pre-authorisation request and.

  2. Name of insured person, telephone, fax and address of facility, Referring Doctor, Treating Doctor, ICD-9 / diagnosis code, CPT / procedure code, Facility Tax ID, Supporting medical information. These are all common terms which a US service provider will be familiar with.
This info can be emailed to: AetnaCaseManagementAmericas@aetna.com
or fax to: +1 860-262-9111

It is important that you complete the above ROMIF(Release of Medical Information Form) and have the completed form returned as soon as possible to Aetna Medical Team's e-mail address AetnaCaseManagementAmericas@aetna.com so that they will have your permission to obtain your medical records from the service providers in the USA for their pre-authorisation. We will notify you as soon as possible if the medical condition or treatment required is not covered under the terms of your policy.




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Note

Should a member under a long-term program, i.e., Alpha or Omega, make a claim and receive reimbursement, their NCB discount will revert to a level two years below their current level at their next renewal. However, if the reimbursement exceeds US$10,000 (for claims within the USA) or US$25,000 (for claims outside the USA), the NCB discount will drop all the way down to the standard premium, i.e., no discount.
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