TECU Members’ Health Plan

Coverage will vary based on the selected division; however, coverage options include:

• Medical
• Maternity
• Major Surgeries
• General Practitioners and Specialists Visits
• Prescription Drugs
• Diagnostic Services
• Preventative Care
• Chemotherapy & Radiotherapy
• Dialysis
• Dental
• Vision

Cost saving initiatives

Guardian Life will cover 95% of the cost of approved Generic drugs. Additionally, insureds who are on repeat prescriptions or major treatment have the option to order and purchase chronic and high value drugs through pharmaceutical distributors which is usually at a lower cost than the pharmacies.

Colombia Hospital Network

Guardian Life of the Caribbean, in partnership with Coomeva Medicina Prepagada, offer an exclusive hospital network in Colombia as an affordable option for overseas medical treatment from highly qualified Physicians (no Visa requirements).

Health card discount

Your Health card allows you to qualify for discounts available at Guardian General on one of the following policies:

• Private Motor Insureds purchasing a fully Comprehensive policy or renewing (including Private use pickups) will enjoy a 20% discount.
• Private Dwellings and General Contents policyholders will receive a 10% discount on new policies only.

Pink Hibiscus

Guardian Life has finalized an arrangement with Pink Hibiscus Breast Health Specialists whereby all eligible Plan members over age 40 would be able to receive a Preventative Care Screening Package for just $100.00 including:

• Risk Assessment
• Clinical Physical Examination
• Breast Ultrasound
• Mammogram

Medical Concierge Services

Guardian Life of the Caribbean’s highly trained professional team assists you in times of medical trauma. Services include:

• Accident & Emergency Case Management for all Guardian Life Health Insureds
• Comprehensive Listing of hospitals and medical clinics
• Ambulance Contact Numbers for fast response
• Personalized QR Code for easy access to your plan information
• Coverage Confirmation for hospitals to streamline the admissions process
• Co-Pay Estimates to assist patients and hospitals
• Pre-Certification Assistance for both scheduled and unscheduled procedures

VIP perks summary includes:

• 24/7/365 Toll-Free Assistance
• Guaranteed Access via Approved Provider Listings
• Minimal Deposits for Outpatient & Inpatient Care
• Simplified Claims Processing with minimal paperwork
• Dedicated Case Management Support

For any queries, and or clarification, please call contact the Medical Concierge Team:

Hotline: at 877-2636

Email: GLOCPPOServiceDesk@myguardiangroup.com

Aragon Agency

In the event of a medical emergency during your travel, you are required to contact Aragon Agency using the following:

FOR EMERGENCY OVERSEAS TREATMENT

Contact: Aragon Agency for Guardian Life of the Caribbean Ltd

Phone: 305-443-2700 / 305-443-4200

Fax 305-443-2800

The above contact information is also available on your health e-card.

Aragon Agency will assist you with any medical emergencies outside of the Caribbean, arranging seamless admission using one of our Providers/Facility within our extensive Overseas Provider Network.

The network in the US has over 300 providers, and through the Axa Group we have access to over 40,000 International medical providers in approximately 200 countries. They also provide a wide range of services from interactive medical management to cost control.

A gentle reminder, Guardian Life of the Caribbean Ltd should be notified of all medical emergencies within two (2) business days.

Access your electonic ID card

To request your electronic ID card, register with Guardian via the Easi Connect portal.

Using your electronic ID card

Each insured person is issued an electronic ID card with a unique QR code.

Persons are invited to scan their card at any organization that is a provider network.

Once the card has been presented with a valid photo ID, the service provider will advise you on what portion of the claim the insurer will cover and how much you will need to pay. You will also obtain a statement, showing a breakdown of how the claim has been processed.

Using your electonic ID card for referrals to a specialist

Based on how the provider enters the code on the system, claims can be distinguished as having been based on a referral.

Submitting your claim

Claims can be scanned and submitted via the Claims portal on the TISL website for processing.

Submitting at out of network providers

Outside of the network, a physical claim form will need to be completed and submitted for processing along with associated receipts to our Insurance Team, via admin@tisltt.com.

Submitting following referral

Based on how the provider enters the code on the system, claims can be distinguished as having been based on a referral.

Submitting while traveling abroad

If travelling and there is an emergency, you can complete the claim documents and submit one of two ways, (1) to the Aragon Agency, the information is available on the back of your E Card. Alternatively, we can forward this information to you. (2) or kindly email us all the documents via admin@tisltt.com

Sending a claim to your secondary insurer

Once the claim information for the Secondary insurer is noted on the submitted claim form, the Primary insurer is responsible for sending the claim to the secondary provider.

After having completed the claim process, an explanation of benefits (EOB) statement is generated and given to you, showing how the claim was processed. With this statement, complete the claim form for the secondary insurer and attach the receipt for the difference in payment, and any additional information relevant to the claim and forward a copy either via email or physical submission to the Plan administration or insurer. This will be based on the secondary insurer submission policy.

We also advise members to keep a copy of the claim with their explanation of benefits (EOB) statement to follow up on the payment process.

Multiple health plan insurers

Persons can have more than one Insurers even if they are with the same insurance company.

Primary or secondary health plan insurer

Order of coverage will be based on the effective date of the plan.

Sending a claim to your secondary insurer

Once the claim information for the Secondary insurer is noted on the submitted claim form, the Primary insurer is responsible for sending the claim to the secondary provider.

After having completed the claim process, an explanation of benefits (EOB) statement is generated and given to you, showing how the claim was processed. With this statement, complete the claim form for the secondary insurer and attach the receipt for the difference in payment, and any additional information relevant to the claim and forward a copy either via email or physical submission to the Plan administration or insurer. This will be based on the secondary insurer submission policy.

We also advise members to keep a copy of the claim with their explanation of benefits (EOB) statement to follow up on the payment process.