Member Information

Medical Service Access

a. Medical Service Access 

All in and outpatient services can only be obtained from our appointed Medical Service Providers. This list is subject to change from time to time.

  • Frontline List: Services can be accessed directly
  • Referral List: Services are on referral basis only by a frontline provider or a Resolution Health Care Manager. For a subsequent visit, authorization must be obtained from a Resolution Health Care Manager.
  • Members must present their Resolution Health Membership Card at the Medical Service Providers for identification
  • Member validity will be verified by the Medical Service Provider representative prior to service delivery
  • Members shall be required to sign the Resolution Health claim form at the Medical Service Provider 

b.      Hospital Admissions

All scheduled hospital admissions must be reported to Resolution Health at least 48 hours prior to admission, while Emergency admissions must be reported within 24 hours of admission. Please notify our care management team to obtain written authorizations for above medical services.

  • Members are not required to pay any deposits; Resolution Health will co-ordinate admissions vide our existing arrangements with the hospitals.
  • Daily cash is applicable after 3 days of admission up to a maximum of 180 days. For benefits with defined sub limits, the daily cash is payable within the sublimit except in cases of maternity and pregnancy related admission where it is not applicable. This benefit is only eligible to working adults.
  • Admission will also be strictly by doctors on our select panel as per our Medical Service Providers list.
  • Resolution Health shall pay all approved admissions bills less National Hospital Insurance Fund (NHIF) rebates.

c. Outpatient Service Access

There is co-payment levied on visits to particular Medical Service Providers. Outpatient covers for Corporate plans has an option of either co-payment or no co-payment

  • Authorization must be obtained in advance from Resolution Health in respect of chemotherapy, radiotherapy, MRI and CT scan, hospice care, haemodialysis, physiotherapy, dental, optical and annual well person checkups.
  • A Harmony out-patient plan can only be accessed if you have purchased a Harmony in-patient cover.
  • A Fortune out-patient plan can only be accessed if you have purchased a Fortune in-patient cover.