Medical Service Provider Avega to Maxicare FAQs
Medical Service Provider Transition FAQsGeneral QuestionsWhat is happening with AXA's current medical service provider?AXA Philippines (AXA) will transition from its current medical service provider, Avega, to Maxicare Healthcare Corporation (Maxicare). Avega will still act as its third-party administrator (TPA) in processing your healthcare benefits and services until the transition is fully implemented.When will the change take effect?Starting March 3, 2025, Maxicare will become the official medical service provider for all AXA customers with health plans.What is a third-party administrator? Is it the same as a medical service provider?A third-party administrator or a TPA's role in an insurance company is to deliver and fulfill health insurance claims on behalf of the insurance policyholders. In this case, AXA's TPA assists AXA's health policyowners in managing their claims by facilitating the delivery and fulfillment of their plan's health benefits by providing access to its accredited network of hospitals, clinics, and health professionals. They are also referred to as health or medical service providers or partners.Why is AXA making a transition in its medical service provider?The transition aims to introduce improvements and new solutions focused on optimizing processes, enhancing service quality, and streamlining claims management to provide customers a convenient and hassle-free experience. Who will benefit from this change?AXA's health policyholders who own a Global Health Access/GHA, and Health Care Access/HCA plan, those who wish to process health claims, and new health policyholders will all benefit from Maxicare's medical services and expansive network.How will this change benefit the customers?Once the change takes effect on March 3, 2025, AXA health customers will have Maxicare as the new medical service provider for their AXA health plans. This means that customers filing a health claim will now rely on Maxicare to fulfill their healthcare benefits. Customers with ongoing health claims will continue to receive services from AVEGA until the transition is complete, after which Maxicare will take over.What key changes are expected with the change?As the new medical service provider, Maxicare will be AXA's new partner in delivering and fulfilling AXA's healthcare benefits when its health customers file for a claim. Enhancements include:- Faster turnaround time by receiving responses to inquiries and Letter of Authorization (LOG) request within 24 hours- Wider network of accredited facilities through access to Maxicare’s 34 primary care clinics and 5 exclusive wings, 20,000 doctors, 1,500 hospitals and clinics nationwide- 24/7 dedicated AXA Contact Center Hotline with round-the-clock support for all health-related inquiriesHow will customers be informed about the change?Customers will be notified of the change before it takes effect through an email announcement, and again on March 3, when the transition is complete. AXA Financial Advisors will update their clients, while customer care representatives will provide assistance through our AXA Contact Center Hotline.What can customers do to learn more about the change?Customers can refer to the emails sent, which contain all the necessary information on the transition. For inquiries on processes, services, and network facilities, they may contact AXA Contact Center Hotline or visit the AXA website to know more.How can I provide feedback about the transition?For any questions or inquiries about the transition, you can speak with your Financial Executive/FE or reach out to AXA Contact Center Hotline.Products and BenefitsIs there a process that customers need to do to switch to the new medical service provider?No action is required on your part to switch to the new medical service provider, as AXA will ensure a smooth, seamless transition experience to Maxicare.What benefits can customers expect from the new medical service provider?Customers can expect the same benefits and coverage, but with a better overall healthcare experience with Maxicare, such as- Faster turnaround time by receiving responses to inquiries and Letter of Authorization (LOG) request within 24 hours- Wider network of accredited facilities through access to Maxicare’s 34 primary care clinics and 5 exclusive wings, 20,000 doctors, 1,500 hospitals and clinics nationwide- 24/7 dedicated AXA Contact Center Hotline with round-the-clock support for all health-related inquiriesWill customers still have access to the same healthcare professionals as before?As long as they are part of Maxicare's network of accredited doctors and healthcare professionals, you can still access their services when you file for a health claim.What should customers do if their doctor is not part of the new network?You may check Maxicare's list of accredited doctors, hospitals, and clinics to look for an alternative healthcare specialist, service, or facility.Will there be any differences in coverage for preventive care services like health screenings and teleconsultation?Your coverage remains the same for all your benefits, as outlined in your plan.Are there any additional costs with the change to the new medical service provider?There are no additional costs needed to be paid during the transition. Benefits included in your health plan will remain the same.Will the change affect the benefits from the customers’ health plan?Customers who will file for a health claim from their GHA or HCA plans will have their coverage benefits fulfilled by Maxicare. This means AXA health customers will enjoy a smoother service experience and faster response times from its healthcare facilities when claiming their benefits. However, the transition to a new provider will not affect customers' premium rates.Will the change affect customers' ongoing claim benefits?Customers with ongoing health claims before the transition is completed on March 3, 2025 will continue to receive services from AVEGA. After this, Maxicare will take over.Will the change affect customers' premium rates?The transition to the new medical service provider will not affect customers' premium rates.Where can customers find a list of accredited network providers under the new plan?You can find this information via our website: www.axa.com.ph or download Emma by AXA app.Claims and Service ProcessesWhat should I do if I have ongoing treatments during the transition?If you have ongoing treatments being handled by AVEGA before the transition to Maxicare, you can continue with your scheduled appointment. We encourage you to reach out to our Customer Care Team for personalized assistance to ensure that the services you need remain uninterrupted throughout the transition. Claims filed after March 3, 2025 will be processed by Maxicare.What happens if a customer is currently getting treatment at an Avega-accredited facility?A sample scenario: A customer is hospitalized due to an illness before March 3 but is expected to be discharged after March 3. Customers with ongoing health claims before the transition is completed on March 3, 2025 will continue to receive services from Avega, then the case will be endorsed to Maxicare to take over until discharge. What happens if a customer is currently getting treatment at a facility or from a doctor that is Avega-accredited and not Maxicare-accredited?A sample scenario: A customer is hospitalized due to a chronic illness before March 3 with follow-up treatments required after March 3, but the attending physician is not accredited with Maxicare.Customers will be able to continue their treatments with no disruption through Avega. A 90-day grace period will be provided for follow-up consultations and treatments with the same physician to ensure continuity of care. The attending physician will be referred for accreditation under Maxicare.Are there changes in how I can contact Customer Care if I encounter any issues with my claim?There are no major changes to how you can contact AXA Contact Center Hotline. You can continue to reach us via phone, email, or through the Emma by AXA PH app. Our team is ready to assist you with any claim-related concerns.Are there guides available for customers to assist them in filing a health claim?Yes! We will provide comprehensive guides and resources on our website and through the Emma by AXA PH app to help you navigate the claims process easily.Emma by AXA PH App and New EMV CardWhat new features will be available in the Emma by AXA PH app after the transition?After the transition to Maxicare, the Emma by AXA PH app will feature enhanced capabilities, including accessing health plan details, scheduling appointments, requesting for Letter of Guarantee (LOG), viewing the list of accredited medical network, and managing health information through a more user-friendly interface.Can I use the Maxicare app? Is it interchangeable with the Emma by AXA PH app?The Maxicare app will not be interchangeable with the Emma by AXA PH app. Once the transition is complete, we encourage you to use the Emma by AXA app for all your health service needs.How can the new app features help improve my experience in managing my health services?The new features are designed to provide convenience in managing the health services available for you. With the enhanced capabilities, it's now easier for you to access health plan details, schedule appointments, request for Letter of Authorization (LOA), view the list of accredited medical network, and manage your health information through a more user-friendly interface.Will I be receiving a new card?Yes! You will receive a new insurance card indicating your coverage under the new medical service provider. The interim card will be mailed to you and expected to be received on or before 3 March.I haven’t received my interim card, what should I do?You can use your eCard available via the Emma by AXA app to access Maxicare Primary Care Clinics and network facilities until you receive your physical cards.What can the new permanent card do?The permanent card to be sent and received on or before 2 June will have a significant upgrade from your current GHA/HCA card. It is now equipped with an EMV chip, offering enhanced access, improved security, and greater convenience. It will be recognized at all accredited facilities, ensuring seamless access to available services.I received my EMV card, what do I do with my interim card?You can already replace your interim card with the new EMV card you received to give you enhanced access, benefits, and security in all accredited Maxicare facilities.Distributor/Financial Advisor GuideWhat should I tell my clients about the transition to the new medical service provider?Reassure your health clients that the transition to the new medical service provider will be seamless, ensuring that they continue to receive high-quality healthcare. Inform them that detailed information about any changes will be provided, and our customer care team will remain readily available to address any questions they may have.How can I assist my clients in understanding their new coverage options?Encourage your clients to review their health plan with you and take the opportunity to walk them through the enhanced key features and benefits. Highlight any improvements compared to the previous provider to ensure they understand the added value. Remind them that they can reach out to you and our customer care team for any clarifications.What resources are available for me to help my clients during this transition?We will provide all the necessary information through cascade sessions, training materials, FAQs, and access to customer service representatives who can assist you when dealing with complex inquiries. Make sure to familiarize yourself with these resources so you can effectively support your clients.How will the change in medical service provider affect claims processing?Claims processing should remain efficient, though there may be minor adjustments during the transition. Make sure your health clients are aware that they can contact AXA for any support or guidance they need when filing claims.What should I advise my clients to do if their doctor is not part of the new network?Advise clients to contact AXA Customer Center Hotline for assistance in finding an alternative healthcare provider within Maxicare's network. We can help them understand their options and ensure that they continue to receive all the necessary services.Are there any specific benefits that clients can expect from the new provider?Clients can look forward to better access to Maxicare's expanded network of healthcare professionals, improved customer support, and potentially enhanced coverage options tailored to their needs.How can I explain the changes in preventive care services to clients?Inform clients that while preventive care services will remain covered, there may be updates in the process or enhancements of services under the new medical service provider. Encourage your clients to review their health plan with you for the details and remind them that we’re here to answer any questions.What should I do if a client has concerns about additional costs associated with the new provider?Reassure clients that there will be no additional costs on their end, and if anything, theit benefits will be enhanced compared to the current set-up.How will I be updated about the changes or developments during this transition?You will receive regular updates via email and through our internal communication channels, including cascades sessions, viber network, and training programs. Stay connected and participate in these events events to ensure you can accurately guide your clients.Can I directly assist clients in filing claims with the new provider?Yes, you can guide clients on how to file their claims. Encourage them to gather all the necessary documentation before filing to ensure seamless claims processing and servicing.How can I explain the changes in preventive care services to clients?Inform clients that while preventive care services will remain covered, there may be updates in the process or enhancements of services under the new medical service provider. Encourage your clients to review their health plan with you for the details and remind them that we’re here to answer any questions.What should I do if a client has concerns about additional costs associated with the new provider?Reassure clients that there will be no additional costs on their end, and if anything, theit benefits will be enhanced compared to the current set-up.How will I be updated about the changes or developments during this transition?You will receive regular updates via email and through our internal communication channels, including cascades sessions, viber network, and training programs. Stay connected and participate in these events events to ensure you can accurately guide your clients.Can I directly assist clients in filing claims with the new provider?Yes, you can guide clients on how to file their claims. Encourage them to gather all the necessary documentation before filing to ensure seamless claims processing and servicing.Contact InformationCustomer Care:Call these numbers anytime, for any health inquiries:(+632) 8 581-5292(+63) 917 170-9292 (Globe)(+63) 919 056-5292 (Smart)or email customer.service@axa.com.ph.Financial Advisor / Financial Executive:Talk to your advisor or bank executive for details about the change.
