Posted:
February 21, 2013
As a reminder, all American Maritime Officers Medical Plan participants are required to obtain prior authorization before receiving certain types of health care. The health care services and treatment types that require prior authorization are detailed in the Schedule of Benefits contained in the AMO Medical Plan Summary Plan Description, which has been distributed in print to Plan participants and is available for reference on the AMO Plans website.
Please note: failure to obtain authorization as required may result in benefits being reduced or denied. Prior authorization does not guarantee benefit payment. Benefits are subject to AMO Medical Plan provisions.
Non-Compliance Penalty
As detailed in the Schedule of Benefits, a Non-Compliance Penalty of $250 will apply for failure to obtain prior authorization for certain types of health care. For participants who fail to obtain prior authorization, specific treatment will be reviewed when a claim is received.
If it is determined to be a covered expense, benefits that are otherwise payable will be reduced or not covered at all, as shown in the Schedule of Benefits under Non-Compliance Penalty (Failure to Obtain Prior Authorization). The penalty may be taken from any charges relating to the treatment. The penalty is taken before subtracting any deductible and coinsurance. The penalty is not applied to the out-of-pocket limit. The first penalty per covered person per lifetime will be waived.
If the treatment is not a covered expense, no benefits will be payable under the Plan.
AMO Medical Plan reminder: prior authorization required for certain types of health care; Non-Compliance Penalty applies
As a reminder, all American Maritime Officers Medical Plan participants are required to obtain prior authorization before receiving certain types of health care. The health care services and treatment types that require prior authorization are detailed in the Schedule of Benefits contained in the AMO Medical Plan Summary Plan Description, which has been distributed in print to Plan participants and is available for reference on the AMO Plans website.
Please note: failure to obtain authorization as required may result in benefits being reduced or denied. Prior authorization does not guarantee benefit payment. Benefits are subject to AMO Medical Plan provisions.
Non-Compliance Penalty
As detailed in the Schedule of Benefits, a Non-Compliance Penalty of $250 will apply for failure to obtain prior authorization for certain types of health care. For participants who fail to obtain prior authorization, specific treatment will be reviewed when a claim is received.
If it is determined to be a covered expense, benefits that are otherwise payable will be reduced or not covered at all, as shown in the Schedule of Benefits under Non-Compliance Penalty (Failure to Obtain Prior Authorization). The penalty may be taken from any charges relating to the treatment. The penalty is taken before subtracting any deductible and coinsurance. The penalty is not applied to the out-of-pocket limit. The first penalty per covered person per lifetime will be waived.
If the treatment is not a covered expense, no benefits will be payable under the Plan.