Medical Insurance
Medical insurance is available to all full time team members that have completed their 90-day probationary period. The team member cost is $12 each week with the company picking up the rest of the cost on their behalf. (This works out to team members paying 40% of the monthly premium and the company paying 60%.)
How do I Enrol?
To enrol in the medical insurance program it is important that you complete the enrolment forms prior to the end of your 90-day probationary period. Doing this allows you an auto-enrolment that does not require you to answer detailed medical questions. To start the enrolment process, check with the office.
How Does the $12 Get Paid?
Your portion of the monthly premium is deducted from your pay check each week. This is the only way to pay the weekly premium.
How Does the Insurance Work?
Simply put, once you have had out-of-pocket medical expenses of more than $250 in a calendar year, the insurance will begin to pay 80% of any additional medical costs. This $250 is called your "deductible". It is important that you file the appropriate forms (see below) for ALL medical expenses so the insurance company knows when have met your deductible.
There are some things that are covered at a higher or lower rate than this 80%, but for the most part medical costs will be covered at 80%. You can see the detailed Schedule of Benefits here.
How Do I File a Claim?
To file a claim you need to complete and submit a Medical Claim Form. It is important that you get the medical provider to complete sections 16 through 30 (as applicable). It is best to do this during your visit, or else you will need to go back. You will also need to attach and invoices, receipts, and prescriptions to the form. Once the form is complete you can turn it into the office, or email it to belizelocalclaims@sagicor.com.
Download Form
What Happens After I File a Claim?
Within 10 business days you will receive an email from the insurance company. This will typically be one of two responses. They may contact you asking for more information or to complete something missing on the Claim Form. The other response could be an EOB (Explanation of Benefits). This will detail what they insurance will cover from your claim and how it will be paid.
Can I Get Medical Treatment in Mexico or Guatemala?
Yes, the coverage on our plan extends to Mexico, Guatemala and beyond. Keep in mind that the insurance will pay 80% of the typical cost for your treatment had you received it in Belize. In most cases though the costs are similar or cheaper in those countries.
It is best to have a referring doctor complete a Out of County Request Form at least 10 days prior to receiving treatment. This will speed up the processing of your claims and ensure you get the best coverage for the medical costs. Coverage is extended to the nearest country where treatment is available.
If you are traveling and need emergency care, this is available without preauthorisation. Coverage can be verified with the phone numbers listed on the back of your insurance card.
What if I Need to Stay in the Hospital?
Hospital stays are covered under the plan. You will need to submit a Hospital Insurance Form in order for benefits to be paid.
What is the Card I Received For?
The medical insurance card can be used at medical providers that have the Sagicor credit card machine. The provider will scan the card, and the machine will tell them how much the insurance will cover, and how much you need to pay for the treatment (taking your deductible into account). No filing of forms will required when the card is scanned.
Us this website to find a location that supports the card: https://eservice.sagicorlife.com/groupwebsli/ProviderList.aspx
What about Preventative Care?
Our plan covers one preventive care visit per year to be covered by the insurance. The preventative care includes:
Medical Examination
Complete Urinalysis
Blood Profile, including:
Fasting Blood Sugar Test
Total Blood Cholesterol
HDL
LDL
Triglycerides
Haemoglobin
Estimated Sedimentation Rate (ESR) Test
Electrocardiogram for employees over 40 or older
Proctology / Prostate exam for males over 40 or older
Mammogram for females 40 or older
GYN and Pap Smear test for all females
There is limit to what the insurance will pay for this visit:
Males under 40 - $140
Males 40 or over - $200
Females under 40 - $190
Females 40 or over - $270
If you choose to use your doctor rather than one of the plan's approved medical centers keep in mind the max the insurance will pay for the preventative visit from the table above, add you will need to pay for the physical and then make a claim to be reimbursed. Approved medical centers are:
If you choose to not use an approved medical center, check with the office to collect the forms you will need to take with you to your doctor. These forms tell the doctor which tests to complete.