Allianz Global Assistance

Simple. Safe. Smart.

Green Shield – University of Windsor Information Session

Presented by Allianz Global Assistance

January 14, 2014

2 / Title of Presentation © Copyright Allianz Global Assistance 26-Mar-12

Who We Are

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400,000 Service providers

worldwide

40 languages

Group offices

in 34

countries

Helping people,

anytime,

anywhere

mission Our

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Our Values

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A Worldwide Presence Designed to Help

Group offices

Branches

Commercial activity

Americas

Countries with

group offices

• Brazil

• Canada

• Mexico

• USA

Countries with

commercial activity

• Argentina

• Chile

• Columbia

Asia Pacific

Countries with

group offices

• Australia

• China

• India

• Japan

• Malaysia

• New Zealand

• Singapore

• Thailand

Countries with

commercial activity

• Indonesia

• Philippines

• South Korea

• Taiwan

• Vietnam

Europe Middle East Africa Countries with group offices

• Austria

• Belgium

• Czech Rep.

• Egypt

• France

• Germany

• Greece

• Ireland

• Italy

• Saudi Arabia

• Lebanon

Countries with commercial activity

• Bahrain

• Bosnia/Herzegovina

• Bulgaria

• Croatia

• Denmark

• Estonia

• Finland

• Hungary

• Kuwait

• Latvia

• Mauritius

• Poland

• Portugal

• Reunion Island

• Russia

• Spain

• Switzerland

• The Netherlands

• Turkey

• UAE

• UK

• Lithuanua

• Luxembourg

• Moldova

• Morocco

• Norway

• Oman

• Qatar

• Romania

• Serbia

• Slovak Rep.

• Slovenia

• Sweden

• Ukraine

• Uzbekistan

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Our Canadian Operations

• Established in 1988

• Head office in Kitchener, ON

• 24/7/365 emergency assistance

• 280+ Employees

• Over 8 million Canadians covered

• Trusted by top Canadian travel and

financial services brands

• Employee engagement score from

Global Employee Survey: 88%

• Average Net Promoter Score of

over 78%

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7 / Title of Presentation © Copyright Allianz Global Assistance 26-Mar-12 7 / Title of Presentation © Copyright Allianz Global Assistance 26-Mar-12

23 RN Case

Managers 60 call centre

agents

606,348 calls

received

68,181 assistance cases

opened

251,573 claims

processed

11 languages

In-House Support: Key Stats in 2012

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Selected Key Partners

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• ICMI’s 2012 Call Centre of the

Year Award

• ICMI 2012 Silver Award for Quality

• IQPC’s Best Contact Center

Learning, Development &

Recognition Program (2012)

• 2011 Finalist in the Insurance

Canada Technology Awards

(ICTA) for our Online Claims

Submission Tool

Award-Winning Service

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What We Do

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• Pre-Trip Assistance

• Emergency Message Centre

• Emergency Legal Referrals

• Emergency Translation Services

• Referrals

• Cashless Service

• Medical Case Management

• Medical Transportation

• Cost Containment

• Claims Payment

• GHIP Recovery

• Coordination of Benefits

Services Provided to Green

Shield Members

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• 25 years experience servicing Canadian travellers

• 8 million+ covered by assistance services

• Experienced in-house nursing team of 23 Registered Nurses

• Average over 10 years critical care experience per RN

• Exclusive partnership with five Emergency Physicians

Emergency Assistance Specialists

Areas of nursing expertise include:

• Emergency medicine

• Pediatrics

• Coronary and medical/surgical intensive care

• Utilization review

• Rehabilitation

• Oncology

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• Local presence around the world allows us to:

• Expedite delivery of medical information

• Confirm legitimacy of facility and appropriateness of care

• Identify cultural differences in medical care

• Enable billing arrangements from providers who otherwise would require

patient to pay prior to leaving hospital

Our International Reach

International network covering all countries…

• Selection, management and control of service providers by

dedicated international team

• 118 administrative and medical correspondents worldwide

• 400,000 service providers

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• Market leading quality-verification initiative

• Evaluations performed on-site by Allianz medical staff

• Results available to Canadian staff via intranet

• Regular provider re-evaluations

Proprietary Provider Rating Tool

1,716 hospitals…

542 cities…

137 countries…

15 / Title of Presentation © Copyright Allianz Global Assistance 26-Mar-12

Screen Capture: Hospital Search in Cuba

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Screen Capture: A Tale of Two Hospitals

Hospital A Hospital B

Rating: 1 out of 5 Stethoscopes Rating: 4 out of 5 Stethoscopes

Based on the information available, Allianz Global Assistance RNs are able to select the hospital with the appropriate facilities and standards of care.

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Case Management

• 24/7 in-house RN support

• Real time monitoring and approval

of emergent medical treatment

• Advise patient / provider up front

regarding terms and conditions

• Pre-approval of all invasive

procedures

• Review patient medical history

• Liaise with physician, patient and

family

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Medical Transport

Providers are screened through RFP

process:

• Site visits to validate RFP submission

• Inspected for maintenance documentation

• Review protocols for medical transports

• Selection can be made based on

availability and price

Working relationship with medical desks at

commercial airlines

Advanced cardiac life support from certified

physicians, paramedics and nurses for

transport

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Claims Management

• $11.2M USD in averted costs (Case

Management)

• 80% adjudicated within 10 days

• 99% financial accuracy rate

• 98% procedural accuracy rate

• Require original itemized bills for GHIP

submissions

• Claims reviewed to ensure only pre-

approved treatments are paid

• System Check for duplicate and repeat

cases

• Bills over a specific dollar limit are

reviewed by RNs

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Government Health Insurance Plan (GHIP)

• Money recovered from member’s provincial insurance (e.g. OHIP)

Coordination of Benefits (COB)

• Payments made up front by Allianz

• Any money owed by other insurance (i.e. spouse’s coverage or purchased coverage for example) coordinated after the fact as per CHLIA guidelines

Subrogation

• Pursue if possibility of third party’s liability

Recoveries

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3 Points of Interest

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• Continue to see delays in some

provinces when attempting to find

receiving beds.

• Saw more willingness from Canadian

physicians to accept patients prior to their

surgery being done in the USA.

• Some Medical Facilities still requesting

deposits, a trend that the travel insurance

industry is working to combat.

• Increased presence of Collection

Agencies and/or 3rd Party Audit

companies acting on behalf of medical

providers

Industry Trends

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It is important to call when a medical

emergency arises, rather than just paying

for the treatment and submitting the claims.

• Allianz can direct member to

appropriate level of care with preferred

provider

• Allianz can arrange billing with medical

provider

• Allianz will monitor care to approve any

subsequent required treatment, tests,

etc.

• If member does not contact Allianz for

assistance within 48 hrs, the member

may be subject to a managed care

penalty

Points of Interest

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GHIP covers Canadians while travelling.

• The Government will cover a minor

portion of what is billed

• The US healthcare operates as a

business

• Transportation, Prescriptions, Trip

Interruption or Delay, Equipment, etc.

are not reimbursed by GHIP

• Not all provinces have interprovincial

agreements and patients may be asked

to pay for services up front

• Transportation is not covered by GHIP

• Only covered up to certain amounts and

treatments

Points of Interest

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Adequate health care is available in any travel

destination.

• This is true, for the most part, in the US

and Canada.

• This is not true in many foreign

countries.

• We have put measures in place and

have a worldwide presence to assist

members in getting to the most

appropriate level of care.

Points of Interest

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Allianz will immediately move the patient to

a medical provider of the patient’s choice.

• Medical appropriateness is the first priority of

Allianz

• Evacuation is arranged based on medical

necessity, not appearance of facility and

preference of patient/family.

• Cultural, geographical and economical

differences impact the amenities at a medical

provider, however, medical capability is

highest priority.

• A patient is required to be medically stable to

travel before Allianz arranges repatriation for

ongoing care.

• If member requires ongoing care as an

inpatient, a receiving bed must be available in

Canada (cannot drop in ER)

Points of Interest

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Does travel insurance guarantee that no

expenses will be incurred if you get sick

while travelling?

• In most cases, Allianz can arrange for

cashless service

• Allianz can engage local business units

to assist with billing challenges

• It is the right of medical provider to

request payment/deposit up front from

the patient

• Certain services are not available

cashless (PX, equipment, etc)

Points of Interest

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• All expenses will be covered in the event of

a medical emergency while travelling.

Reimbursement of eligible benefits for emergency services will be

made only if the services were required as a result of emergency

illness or injuries which occurred while you were vacationing or

travelling for other than health reasons.

Benefits will be eligible only if existing or pre-diagnosed conditions

are completely stable and you are fit to travel (in the opinion of

Green Shield Canada and/or our Assistance Medical Team) at the

time of departure from your province of residence.

• If medical care is no longer emergent,

continued treatment will not be covered.

• Policy benefits differ. It is important to

be aware of what benefits are covered.

• Some benefits may fall under extended

health care rather than emergency

travel assistance.

Points of Interest

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Travelling for the purpose of treatment.

• The policy covers pre-approved referral

treatment, should all options be

exhausted

• Approved referral benefits would cover

any charges above what the GHIP plan

would cover, as long as they are eligible

benefits under the plan

• Transfers from a Canadian facility to a

US facility are not considered eligible

benefits under this plan, as those

services should be covered by GHIP

• Technical benefits would not be eligible

under this circumstance

Point of Interest

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“Your staff & service were absolutely superb

in meeting every need of my unforeseen

medical emergency. Many thanks.”

“If everybody was treated the way you treated

me then the world would be perfect”

“The quality of the services Allianz Global

Assistance has provided to my wife and me

over the years has been absolutely superb.

The associates have been unfailingly

understanding, patient, and professional.

We are happiest when we don’t need your

services, and extremely grateful when we do

because we know that what Allianz Global

Assistance will provide will be first class.”

Customer Feedback

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“The receptionist at the clinic I had to go to was

very impressed with Allianz Global

Assistance. When I told her that Allianz Global

Assistance would look after my case, she was

really happy as she had just dealt with you the

week before. They are so good to work with”

was her comment”

“It felt like I was dealing with family”

“Fantastic service provided to a frantic mother

needing quick help for her newborn, every call

was answered by knowledgeable staff willing to

answer all my questions. Thank you for an

outstanding experience.”

Customer Feedback

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During this

presentation,

we assisted more

than 5,251 people.

Thank you!

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4 Questions?