In response to the increased popularity of new technologies and communication channels used by plan members, Cruz del Sur is investing in technologies, information service points and new mechanisms that allow it to receive and process reimbursement requests faster, more conveniently, and more efficiently.
In response to the increased popularity of new technologies and communication channels used by plan members, Cruz del Sur is investing in technologies, information service points and new mechanisms that allow it to receive and process reimbursement requests faster, more conveniently, and more efficiently.
Santiago-based Cruz del Sur has set up three mechanisms for settling health claims for plan members easily and efficiently. These allow the Network Partner to bring a positive experience of insurance closer to insurance plan members, making it more tangible and appreciated by reducing reimbursement waiting times.
Speed up reimbursement time
This new mechanism allows members to receive cash reimbursements for their health expenses directly at their nearest Cruz del Sul branch, avoiding the need to go to a bank to fill in forms (the traditional process takes about five days). This service is made possible through the provision of benefits settlement software at Cruz del Sul branches, enabling users to access information on the policies covering these services, control their cash flow, and receive printed receipts along with their reimbursements.
An example of the express reimbursement: Client BHP Billiton has several mining operations located in various parts of the Atacama Desert, however the plan members who are the actual consumers of the health services insured live in different towns far from the operations. With this service, plan members can receive the reimbursement in a much shorter time with less effort.
As much cashless as possible
Cruz del Sur has also entered into agreements with major pharmacy groups that allow plan members to receive discounts when they purchase prescription medicines. These discounts are equivalent to the reimbursement the members would have received if they had applied in the traditional way. The agreements incorporate controls to prevent misuse, for example, online lists of products authorised for reimbursement, and maximum reimbursements per purchase.
The insurer provides the information on the policies associated with this service, and the percentage and amount limits, which are used at the points of sale in the pharmacies.
Direct deduction of reimbursement
Cruz del Sur has also set up an online discount service called Imed that allows plan members to deduct from the amount due for a private clinic medical consultation or examination the reimbursement payable for the service.
This has led to an increase in the use of institutions working with the Imed agreement, and up to 50% lower operating expenses for the insurer. The mechanism works by consulting the settlement databases at Cruz del Sur using digital fingerprint recognition.
The success of these technology-based mechanisms indicates that their use will increase, and Cruz del Sur is planning further innovations in the services it offers in order to continue delivering more satisfying experiences for plan members.