FijiCare Insurance

Daycare, Inpatient Medivac

Hospitalisation Benefits

Includes daycare, hospitalisation, surgical and medical treatment locally and overseas. Provides you with the benefits of daycare i.e. pathology [blood tests], procedures, x-rays, CT scans, specialist consultations, prescription by specialists, pathology as required by your treating doctor or specialist, hospitalisation, surgery, and medical treatment locally and overseas.
For Medivac – the benefits include evacuation to a preferred hospital overseas for treatment which is not available in Fiji, treatment at a non-preferred hospital if treatment is not available at a preferred hospital and choice of receiving medical treatment overseas for the Gold plan only regardless of whether treatment/surgery is available locally or not.

What is covered?

Daycare and Local Hospitalisation

Overseas medical evacuation where the medical practitioner chosen by FijiCare certifies the need for a treatment, which is not available locally. FijiCare will arrange a preferred hospital.
FijiCare Insurance Limited will liaise directly with the Specialist for confirmation of coverage, the arrangement of payment and updated medical report.
If FijiCare Insurance Limited approves for the member to pay upfront, then the member must submit the following.
(i) Original receipts and invoices pertaining to your payment.
(ii) Detailed medical report.

*If further information is required – we will contact you. This information will be required based on the medical condition(s) on a case by case basis.

Limits

Bronze Plan

The maximum limit of benefits for daycare & Inpatient is F$10,000.00 per annum.
The maximum limit for prescribed medicine for any disability is F$500.00 per annum.
If treatment is provided privately in Fiji but not available in the public sector, requires a letter of confirmation from the Ministry of Health to confirm.
Refer to our Medical Plan for details on Silver and Gold Plans.

Funeral Benefit

Where a policyholder is fully paid up for both hospitalisation and outpatient plans, FijiCare will help you in your hour of need by making a F$500.00 cash payment in the event of the death of a Principal person.

In order to make a claim for Local Hospitalisation

The member is required to pay upfront for all costs medical incurred during admission or treatment at any Government Hospitals in Fiji, obtain all original receipts and update/detailed medical reports which should then be forwarded to us for assessment as per the terms and conditions of the policy.

Note: Please ensure that your premium is kept current and up to date, as we cannot process any claim where the premium is in arrears.

In order to make a claim for Overseas medical Evacuation (MEDIVAC)

The member must provide details such as the full name of Insured, claimant or dependent whichever is applicable with their EDP or FNPF Number and date of birth.
The member should first obtain a detailed current medical report from his/her treating doctor/specialist in Fiji certifying the need for treatment overseas and medical evacuation.
The medical report should be submitted with a completed “Claim Form for Medical Evacuation” which needs to be completed by the patient/claimant and his/her treating doctor in Fiji.
Additional Information – The onus is on the member to provide his Insurer with additional medical information such as x-rays, ultrasound scan results, laboratory results, ECG, Stress test results, current medications etc.
On receipt of the above information, these will be forwarded to PremiumCare for counselling / interview / a medical opinion.
Once a claim is notified to FijiCare and approved for overseas medical treatment, unless, the member opts to make his arrangements, FijiCare will reimburse the equivalent cost from our preferred hospitals in India for the Bronze and Silver plans. Whereas it is upto FJ$50,000.00 under the Gold plan.
When FijiCare makes all arrangements for a medical evacuation, then the overall maximum limit of benefits is FJ$90,000.00 per sickness under the Bronze plan, FJ$170,000.00 under the Silver plan and FJ$280,000.00 under the Gold plan.

Note: Excess may be applicable on certain sickness as per the terms and conditions of the policy

Repatriation of Body & Funeral Benefits
In the event of the death of an insured overseas under the provisions of this benefit, FijiCare will provide reimbursement for costs of embalming, coffin, transportation, or a contribution towards overseas funeral costs. Up to a maximum of FJ$6,000.00 but refer to your policy document

Important Notes

Please ensure that your premium is kept current and up to date, as we cannot process any claim where the premium is in arrears.
Daycare and local inpatient claims are assessed depending on the urgency as per the update medical report and all relevant information provided to us.
Overseas Treatment Claims are assessed as soon as an updated detailed medical report is received by FijiCare and a decision is advised based on the medical information provided to us, subject to premium status, and depending on the urgency of the case as per the current medical report and subject to an acceptance letter, appointment date, and estimate of costs from the overseas hospital, medical visa lodgment, and evacuation/travel which is then based on a visa decision. Reimbursement claims for departure taxes and taxi fares incurred overseas are assessed within 14 working days and subject to providing all relevant information initially.
Maximum limits stated are per sickness or disability.
Pre-existing conditions not covered – refer to your policy document.
Diagnostic tests overseas are not covered.
Routine tests are not covered.
Organ transplant including bone marrow transplant is not covered.
Congenital condition is not covered.
Palliative treatment is not covered.
Any sickness or illness which occurs while traveling outside the Geographical Limits of Fiji is not covered.

Note: The above terms and conditions apply as per different policies purchased by the client.