Services - Fijicare

Frequently Asked Questions (FAQs)

1. What does FijiCare do?

FijiCare Insurance Ltd a general insurance company licensed to write all forms of general insurance, specialising in medical & short term group & individual term life insurance. We have ventured into Worker's Compensation, Marine Insurance & Motor Vechile.FijiCare holds majority of the market share in the medical insurance in the Fiji islands and the Pacific.

2. What is the difference between Outpatient Nominated and Outpatient reimbursement plans?

Outpatient Nominated is a capitation scheme in which we issue you with a valid photo ID card which you present to a nominated doctor of your choice and pay $2.00 for consultation. This does NOT cater for after hours and weekend consultations. For emergency cases, members are to call FijiCare Medical Centre who will advise where you should go, whereby you will pay upfront, and submit receipts to FijiCare for reimbursement to a maximum limit of $10.00. Members that nominate FijiCare Medical Centre will be exempt from paying the $2.00 excess fee. Emergency phone number is 9298603. Using the same ID card, you may obtain your prescribed medication from one of our panel of pharmacies on payment of a $1.00 fee. Drugs outside our recommended list are NOT covered.

Outpatient Reimbursement is a reimbursement scheme in which you visit any general practitioner of your choice (24 hours aday/7 days a week) and pay for the full consultation. You may obtain your prescribed medication from any registered pharmacy and pay for the prescriptions. Always obtain receipts for consultations and prescriptions and submit to our office for reimbursement. Reimbursement percentage will depend upon the level of cover you have purchased from us.

3. What is the difference between Bronze, Silver and Gold medicare plans?

These are the 3 levels of coverage that a proposer may purchase from us. Whether it is for inpatient/medivac, outpatient reimbursement, optical or dental plans they all depend on the limitation of benefits, i.e. the higher the premium, the more your benefits will be i.e. compared to the lesser plan e.g. Bronze and Silver or Silver and Gold and so on. For detailed information, you may contact our Sales & Marketing Unit who would be more than happy to assist you.

4. Does FijiCare provide Overseas Medical Treatment and can members choose the country of Treatment if they are not satisfied with FijiCare’s current arrangement? i.e. First option for treatment being NZ?

If FijiCare approves the medical treatment overseas, we will make arrangements with our providers. However if the Insured member is dissatisfied with our arrangement and opt to have the treatment done at a hospital of his/her choice, FijiCare will not be making any arrangement. In this case, the member will have to pay for all his/her bills and upon return, submit to FijiCare and we will assess based on the terms and conditions of the policy. In this case, the limit(s) will be reduced.

5. Are Suva Private Doctors covered under the FijiCare Outpatient Nominated Benefit and why not?

Suva Private Hospital is not in agreement with FijiCare’s Nominated terms and conditions, therefore does not cater for members covered under this plan. For all other Outpatient plans, they cater for our Insured members.

6. Why are popular doctors - Dr De Asa, Dr Theresa Yee Chief and Dr John Fatiaki not part of the capitation plan?

These doctors were not in agreement with FijiCare’s Nominated terms and conditions, therefore do not cater for those under this plan, However for all other Outpatient plans, they cater for our Insured members.

7. What other groups or companies are insured with FijiCare Insurance Limited?

• Banking firms
• Unions & Associations (Sugar & Finance sector)
• Lending institutions
• Shipping industry
• Regional Secretariats/organizations
• Tourism industry
• Civil Aviation industry
• Higher learning/tertiary institutions
• Post and Telecommunications industry
• Forestry industry
• Media firms
• Manufacturing cigarette industry
• Government institutions
• Local municipality councils
• Healthplus group scheme

8. In emergency situations, does FijiCare carry out immediate evacuation overseas? What types of services are provided by FijiCare in emergencies? (road ambulance, stretchers, oxygen tanks)?

Yes but this is subject to the medical condition of the patient and the acceptance/availability of overseas providers, airline schedules, immigration services etc. Part of our emergency services includes road ambulance, stretchers, oxygen tanks in airplanes during travel. If medically necessary, we will also cater for a support person or a medical attendant to travel with the patient.

9. Why is FijiCare Insurance Ltd no longer providing the option of bulk billing arrangement to its members?

FijiCare ceased its Outpatient bulkbill scheme mainly due to the abuse of services provided; by not only the Insured members but the providers as well; in addition to these are the escalating costs of its administration/operations.

10. Will India be considered as an option for medical treatment of members?

The option of having India as an overseas provider is currently being negotiated and once finalized, we will keep our customers/visitors informed via this site and our official publications.

11. Can members have two doctors under the Outpatient Nominated arrangement (Capitation)?

Yes but members will have to pay for 2 separate premiums to cater for 2 providers under this plan.

12. What happens if a member's family doctor is not on the Outpatient Nominated doctors listing?

They may opt to have another Outpatient Reimbursement plan, however the other plans are only provided to members who have Executive Gold Medicare.

13. Can members be insured for a period of less than twelve months?

Yes, however the Insured will have to pay for a whole year's premium and we will terminate cover on the desired date. We will charge for time on risk and 20% administration cost and will refund the balance to the Insured. However if there has been a claim for the policy during the current insurance period, there will be no refund at all.

14. Why are some drugs not covered on the current FijiCare drug list? And why must they only be generic drugs?

The current FijiCare drug list was recommended and approved after consultation with the Ministry of Health, panel of Pharmacists and the Fiji Council of General Practitioners and covers 90% of drugs prescribed daily (for common illnesses). Generic drugs are not inferior as they have the same effect as branded drugs, only they are cost-effective.