No, Mediplus is a TPA (Third Party Administrator) that manages Health Insurance for Insurers and Self-funding Plans for companies.
The network of providers includes Doctors, hospitals, clinics, diagnostic centers and other health facilities or clinical services with which Medihealth has or will enter into a service agreement, with the aim of ensuring assistance of insured members within the scope of the agreed services. Medihealth may provide different types of Networks according to the constitution of specific products according to the maturity and needs of the market. Entities and their employees that are part of the provider network are fully independent and autonomous.
Information from the provider network is available on the Medihealth website (http://www.medihealth.co.mz/providers), where it is possible to have the providers' geographical location (GPS) and contacts. In order to have access to the assistance of the network of providers, the member should go to the provider and present the health card accompanied by the Identity Card.
If you lose the card, you must inform the insurer / company about the cancellation of the lost card and issuance of the new card.
Reimbursement requests can be submitted directly to the Medihealth website by following the steps below: - Completing the claim form; - Attach digital copies of the proof (invoices, receipts, medical prescriptions or medical reports); - After the above steps, click on "Submit" to send the request; - Wait for notifications via email;
If you have lost or forgotten the card and need service from a network provider, you can go to the provider and present the identification document and inform that you are the beneficiary of the Insurance Company. The provider will contact the call center to provide a "Token", which will allow the member to have assistance.
Pre-authorization is a request made by e-mail by the provider, where all the supporting documents for examinations, treatments or surgeries are attached and sent to Mediheatlh's medical team for analysis and evaluation.
Pre-authorization requests have an average SLA (Response Time) of less than 1 hour if the documentation is complete.