Members can submit a completed health claim form and original receipt directly to the insurer or they may submit their claims to Gallagher Insurance Brokers. Claims can also be submitted electronically by email to Gallagher. We encourage members to ensure that the claim form is thoroughly completed including their name, policy number, diagnosis and signature with receipt attached.

Pre-Authorization is the written approval granted by the insurer confirming that they will undertake payment of a specific medical procedure. A quotation is usually submitted to the insurer by a provider seeking authorization of said procedure and the amount the insurer would reimburse.

This is the maximum amount that the insurer will pay for any one surgery, including surgeon fees, assistant surgeon & anaesthetist. The insurer will apply the reasonable and customary charges up to a maximum of $1,500,000 per surgery. This has been implemented to assist with the sustainability of the health plan.

This is an abbreviation of Reasonable & Customary charges, which is applied by each Insurance Company primarily to surgical, hospitalization & major medical charges. It refers to a charge for medical care which is considered reasonable and customary to the extent that it does not exceed the general level of charges being made by others of similar standing in the locality where the charge is incurred when furnishing comparable treatment or services, to individuals of the same sex and comparable age, for a similar disease or injury.

This means that your comprehensive health plan typically covers 80% of most medical expenses and the insured is responsible for the balance of 20%. However for Prescription drugs, the plan will pay a co-insurance of 60%-40% when in major medical.

This is the initial amount which you must pay after benefits have been exhausted under the basic plan, thereby making you eligible for benefits under Major Medical. This may be a one-time payment or an accumulation of payments over the policy year. The deductible is paid to the provider during the normal course of accessing services, should as prescription drugs or diagnostic services.

The abbreviation ‘MM’ stands for Major Medical – Major Medical is the provision of additional protection to meet the expenses of serious illnesses and accidents. These benefits are combined with the basic plan benefits to offer a more comprehensive coverage for major illnesses and accidents without which an insured would incur significant out of pocket expenses. Major Medical extends to coverage of all reasonable medical expenses and operates on a coinsurance basis, with the plan covering 80% of costs and the insured meeting the balance of 20% in some benefits of the plan.

The member will be transferred to the next age band category at the policy renewal / anniversary date and premium adjusted accordingly.

Regrettably, you will be taken off the scheme and can only be reinstated subject to proof of insurability. It is very important to ensure payments are made on time and kept up-to-date.

Premiums are payable quarterly, semi-annually or annually basis. There are several options to remit premium payments. Payments can be made at Gallagher Insurance Brokers Ja. Ltd, Paymaster Ltd or online bank transfer. We accept debit/credit cards, cheque or cash.

Premiums become due on the following dates, however members can remit premiums prior to the due date: