FAQ's Health

Faqs Faqs

Can I change my primary care provider?

Yes, if for any reason, you wish to change your primary care provider, you may contact us via healthcare@axamansard.com or call on 08141304026-27, 01 4606655 -01 4606659. Change will be effective in 24 hours.

Can I access care from any hospital of my choice outside your network providers?

Yes, you can access care from out of network providers especially in an emergency. Please contact the customer care for pre- authorization and to ensure adequate care provision.

How long do I have to wait to receive care from my health care provider?

Wait times vary at different providers and at certain times of the day. Most providers require that you schedule an appointment.  However, in an emergency you will be attended to immediately at your health provider.
 

Which bills do I pay for at my health care providers?

Members do not pay for covered services on their health plan. You may however need to pay for services not covered under your plan type or if you are out of cover. In the event of any doubt, always call the customer care center for assistance. On 01 4606655 – 014606659 or email healthcare@axamansard.com

How do you monitor the activities of the hospitals?

Our Providers services and quality assurance team carries out initialcredentialing and periodic monitoring of contracted health providers. Unscheduled visits are also made to these health facilities.

How do you guard against under treatment?

Providers on the AXA Mansard health network are required to adhere to approved treatment guidelines.

How do you ensure that only hospitals of high standards are on your network?

Our Providers services and quality assurance team carries out initially credentialing and periodic monitoring of contracted health providers according to approved health quality standards.

 

Can I choose other hospitals apart from those on your network?

No, you may choose your primary health provider within the AXA Mansard Health network. You may use an Out- of-Network hospital in an emergency or according to preference; please not however, that enrollee reimbursement will be at the provider’s rate for your plan type.

 

Can I register with more than one provider?

Yes, you can register with up to 2 in network provider on the Group and Employee plan.

How often can I visit the hospital?

You can visit the hospital anytime you need.

What happens if I need specialist care not available at my primary care provider?

You primary care provider will refer you for specialist care when required. Please contact customer care on 01 4606655-014606659 or email healthcare@axamansard.com for assistance.

Who is responsible for inter hospital transfer transport?

Your AXA Mansard Health plan benefit includes hospital to hospital and site of injury to hospital transportation.

Can the provider refuse me treatment because of past frequent visits?

No. While you are under cover, you can access care at your health care provider when needed.

 

Can I access care while travelling outside my usual area of residence?

Yes, you can access care while travelling within your health plan coverage area; you can visit any hospital on our provider network. You may also receive care at hospitals outside our network in an emergency or if there is no in- network hospital available.

A list of AXA Mansard Health providers is available on our website and from the customer care center.

You should contact the HMO within 72 hours of using an out- of- network hospital to ensure adequate care provision and as a requirement for out- of- pocket payment reimbursement.

Can new hospitals not yet listed by AXA Mansard be introduced to you?

Yes, we are expanding our network and contract with new health care providers who meet our credentialing standards.

What happens if my current healthcare provider is not on the AXA Mansard health network?

You will need to choose a health care provider on the AXA Mansard provider network and advice that your medical records be transferred there. However, for continuity of care you may use your current health care provider

Please note that all enrollee reimbursement will be at the contracted provider’s rate for your plan type.

Are there any restrictions as to how often a service can be performed?

Yes, there are plan dependent restrictions on some services on the AXA Mansard health plan e.g. Physiotherapy, Renal dialysis.

How will I know if the treatment I need will be covered?

A summary of benefits coverage for each plan type is available on our website. You should contact our customer care center for assistance.

 

Can I get reimbursed for prescription medications I bought from a pharmacy not on AXA Mansard health’s network?

No, you will not be reimbursed for medication purchased from a pharmacy not on AXA Mansard health’s network.

Are there any restrictions as to how often a service can be performed?

Yes, there are plan dependent sub limits on some services on the AXA Mansard health plan e.g. Physiotherapy, Renal dialysis.

How will I know if the treatment I need will be covered?

A summary of benefits coverage for each plan type is available on the AXA Mansard health website and in the health plan brochure. Please contact the Customer care center for assistance on 01 4606655 -01 4606659

Can I get reimbursed for prescription medications I bought from a pharmacy that is not in AXA Mansard's network?

No, you will not be reimbursed for medication purchased from an Out-of-Network pharmacy.

How can AXA Mansard help me give my baby a healthy start?

The AXA Mansard health plan provides care for newborns under the mother’s cover up to the plan specified limit. Babies should be registered soon after birth to receive care after the neonatal period.

Can I change my primary care provider?

Yes, you may change your health care provider. Contact us via healthcare@axamansard.com or call on 01 4606655 -01 4606659. There is a 2 week administrative wait period before access at the new health provider.

Can I access care while travelling outside my usual area of residence?

Yes, if you need to access care while travelling within your health plan coverage area, you can visit any hospital on our provider network. You may also receive care at hospitals outside our network in an emergency or if there is no in- network hospital available.

A list of AXA Mansard health providers is available on our website and from the customer care center.

You should contact the HMO within 48 hours of using an out- of- network hospital to ensure adequate care provision and as a requirement for out- of- pocket payment reimbursement.

When will I have to make out of pocket payment?

When the condition being treated is not covered under your plan type, or if you visit a hospital out of AXA Mansards Health’s provider network without prior authorization.

 

What do I need to process a reimbursement?

To process reimbursement for services provided outside the AXA Mansard Health provider network, you should contact the HMO within 72 hours, and provide within 1 week:

  • comprehensive medical report from the attending doctor
  • original invoices
  • original receipt of payment
  • a completed reimbursement form

Please note that prior authorization is required for processing reimbursement.

Can I access care without my Identification card?

Yes, you can access care without your identification card, a letter of introduction to the hospital would be mailed to you prior to the delivery of your HMO card Please contact our customer care center for assistance.

If I lose my card, what should I do?

Contact us via healthcare@axamansard.com or call on 01 4606655 -01 4606659 within 24 hours of the loss.

Where do I send my complaints?

You send in your complaints by calling our customer care representative on 01 4606655 -01 4606659 or sending an e-mail to healthcare@axamansard.com

What should I do if I want to give feedback or report any concerns?

You may contact us through email healthcare@axamansard.com or call on 01 4606655 -01 4606659.

Can I change my plan type?

A change of plan type can only be done at the renewal of your policy which is annually.

I am on the bronze plan, for how long am I covered for intensive care services?

You are covered for intensive care services in an emergency.

I just bought a Personal and Family plan. Can I access maternity services immediately?

On the Personal and Family plan, maternity services are covered after 2 years after enrollment on the health plan. 

When will I have to make out of pocket payment.

When the condition being treated is not covered under your plan type, or if you visit a hospital out of AXA Mansard’s health’s provider network without prior authorization.

What do I need to process a reimbursement?

For enrollee reimbursement for services provided outside the AXA Mansard health provider network, you should contact the HMO within 48 hours, and provide within 1week:

  • comprehensive medical report from the attending doctor
  • original invoices
  • original receipt of payment
  • a completed reimbursement form

Please note that prior authorization is required for processing a reimbursement.

How do I file for a reimbursement?

You can send in your completed reimbursement forms and the accompanying documents to our offices or welcome centers. To process a reimbursement you will require;

  • comprehensive medical report from the attending doctor
  • original invoices
  • original receipt of payment
  • a completed reimbursement form

Please note that prior authorization is required for processing a reimbursement.

How soon can I access care after registration on the health plan?

There is an administrative wait period of 14 days before care delivery starts. Members can access care 14 days after enrollment.

If I pay for service after I send in my registration forms before my policy start date. How do I process a reimbursement?

Your AXA Mansard health cover begins on your policy start date. AXA Mansard health will not reimburse for services utilized before the policy start date.

How can I check the status of my reimbursement?

You can send your enquires to healthcare@axamansard.com or call 01 4606655 – 014606659

What services is my baby covered for on the AXA Mansard health Plan?

Newborn babies on the AXA Mansard health plan receive care under the mother’s cover up to the specified limit for each plan type. Babies should be registered soon after birth to receive care after the neonatal period.

In addition to their benefits coverage, babies on the AXA Mansard health plan received immunization, well-baby checks at their primary care provider.

What pediatric services are provided under the AXA Mansard health Plan?

Medical care for children is provided by the general practitioner, children requiring specialist care will be referred to the appropriate specialist pediatrician.

 

What about adolescent services?

Adolescents are children between the age of 13- 18. Their services are provided for by the general practitioner with referrals made to the appropriate specialist pediatrician as required.

Will my plan cover cosmetic surgery?

No, the health plans do not cover cosmetic surgery.

Where can I find out what my coverage will be for certain procedures?

Details of your health plan coverage are available on the benefits summary table on our website and on the member brochure. Please contact our customer care center for any assistance.

Does my health plan cover for pre-existing conditions?

Yes, your AXA Mansard health covers for pre-existing conditions; you must disclose your condition at the commencement of the health plan to benefit from these services.

Where can I get a summary of my benefits?

The AXA Mansard health plan benefits summary table is available on the resources tab on our website; this is also sent to your e-mail.

 

How do I get pre-authorization?

Contact our customer care center for pre-authorization. 

Can I be denied pre-authorization for my condition?

Yes, pre – authorizations are only given for covered services.

Where can I find the reimbursement forms?

The reimbursement forms are available on the AXA Mansard health website and at our Welcome centers nationwide.