In setting up an account, is there a required minimum or maximum number of employees?
There is neither minimum nor limit to the number of employees that can be enrolled.
Does the Card Have the Capability to Monitor the Expenses and Balances of Each Employee?
Yes, ESORSE Health Benefit Card acts as a debit card. It does not exceed the pre-determined amount set aside by the employer for their employees’ eligible health-related expenses.
What Prescription And Medical Services Are Considered Eligible?
The eligible prescription and medical services will be dependent on the agreed Plan Design, which is specifically customized for the employer and its employees. A Special Authorization Letter may be provided, at the employer’s discretion, for some drugs or medical services that are initially excluded from Plan Design.
How Long Does It Take To Process Each Submitted Claim?
All drug and dental claims will be processed and paid within 48 hours. Employees will be notified within 24 hours for any claims that did not pass the adjudication process due, but not limited, to the absence of original receipt, ineligibility of the medical/dental service or lack of supporting documents.
Does It Have Provision For Deductible and Co-payment?
Yes, it has provision for Deductible (the amount that will have to paid in a calendar year or policy year before any expenses becomes eligible for reimbursement) and Co-payment (ratio of the total reimbursable claims to be paid by the employee for each Claim Transaction)
Does the Card Expire When It Reaches Zero Balance?
Transactions may not be processed if the card does not have available funds. However, this does not deactivate the card. The member can still use the card as soon as funds are replenished.
Does It Support Coordination of Benefits?
ESORSE supports Coordination of Benefits for both public and privately administered plans. ESORSE can be a primary or a secondary payor. No conditions or order is necessary to determine whether ESORSE will act as primary or secondary payor. As a first payor, the pharmacist submits the claim electronically. Amount which will not be covered by ESORSE will be transmitted by the pharmacist to the second payor. As a secondary payor, it is assumed that the claim has already been adjudicated by another Drug Card. The paid amount is, then, transmitted to ESORSE. This difference between the original amount and the paid amount will be used as basis for ESORSE payment.
Can Payment Be Sent To Customers Directly?
Should the customers wish to be paid directly, they have to manually submit their Claims Form to ESORSE CORPORATION. By providing Bank Information and a voided cheque, payment can be deposited directly to the members’ accounts.
How Will Each Member Access Status and History of Claims?
ESORSE Corporation provides web application that will allow the member to view the status and history of reimbursements. This can be linked to website of the employer, TPA or agent.
Can the Employer View Its Employees’ Claims Transactions?
Acknowledging the employee’s right to privacy, employers can only access all transactions pertaining to the firm and not to individual employee.
How Does ESORSE Manage Its Funds?
To protect and safeguard the interest of its clients, financial assets are placed in a Trust Fund, administered by independent, impartial and highly competent Trustees.
ESORSE Corporation provides web application that will allow the member to view the status and history of reimbursements. This can be linked to website of the employer, TPA or agent.
Transactions may not be processed if the card does not have available funds. However, this does not deactivate the cardThe member can still use the card as soon as funds are replenished.
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