NHF’s QMS is ISO – 9001:2015 Certified · Government of Jamaica

An agency of the Ministry of Health & Wellness

NHF Signs 2nd Contract To Facilitate Automatic Co-ordination Of Health Benefits With Local Health Insurance Company

NHF Signs 2nd Contract To Facilitate Automatic Co-ordination Of Health Benefits With Local Health Insurance Company

– Enabling reduction of out-of-pocket payments for cardholders

National Health Fund, NHF has signed a Coordination of Benefits (COB) Contract with Guardian Life for their MedeCus Health product. The agreement became effective on January 3, 2011 and is the second such contract signed by the NHF to facilitate the automatic co-ordination of health benefits for NHF beneficiaries who also hold other health insurance cards. A similar agreement has been in place with Sagicor since June 2008.

These agreements enable NHF beneficiaries to maximize their health insurance benefits and reduce further their out-of-pocket payments. NHF beneficiaries who have health cards from both MedeCus and Sagicor and who are filling prescription from the NHF Drug List, present only one of their cards at the NHF participating pharmacy. This pharmacy must also be participating in the COB programme. The pharmacist only needs to swipe a single card from the NHF, Sagicor or Medecus to adjudicate the claim. The NHF beneficiary is therefore now able to cover his/her drug bill from all three cards.

NHF beneficiaries with MedeCus and Sagicor Health Cards who wish to participate in COB programme must provide their private health carrier with their respective Tax Registration Number (TRN). The TRN is the unique identifier used to connect the health plans.

Mr. Hugh Lawson, CEO of the NHF says “The NHF COB mechanism was developed in an effort to make it easier for NHF pharmacy providers to efficiently process prescriptions using multiple health cards from various carriers.” He says “While many pharmacies currently accept more than one health card when processing claims for NHF card holders, it is often a burdensome, time consuming task, plagued with customer dissatisfaction on both sides. This mechanism therefore significantly relieves the concerns of the pharmacy provider.”

Pharmacy providers participating in the programme send claims to the NHF so there is only one payor rather than several claims sent to various Carriers. The mechanism will significantly reduce the need for paper claims, improve the auditing of claims, and reduce the total payout for claims thereby benefiting the companies providing health insurance for their staff.

Mr. Lawson is encouraging pharmacies to engage their software providers to upgrade their computer solutions, so they can be a part of this worthwhile programme, which will ensure a distinctive advantage to those pharmacies that participate.

The development of this product, which facilitates the automatic adjudication of pharmacy claims across several plans with the swipe of a single health card, was a collaborative effort between the NHF and Advanced Integrated Systems Limited (AIS).

For further information contact:
Rosemarie Lee, Tel. 906-1106
Shermaine Robotham, Tel. 322- 0809

An agency of the Ministry of Health & Wellness
NHF’s QMS is ISO – 9001:2015 Certified

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