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Explore a variety of available resources to help you get the most out of your health insurance benefits. Find forms; learn about prescription drug benefits and NetCare’s guidelines and policies.

Member ID Cards

NetCare provides member identification cards for employees and dependents enrolled in the Plan. The Member Identification Card indicates the following:
  • Member’s Name
  • NetCare Unique Identification Number
  • Plan Benefit Type
The back side of the card has a magnetic strip that enables medical providers to swipe the card to obtain eligibility and benefit coverage information such as co-payments and co-insurance and benefit limitations.

Your member identification card must be presented to the provider at the time of service. To replace a lost or stolen card, please contact our Customer Service Department at 472-3610 or log onto our website at www.netcarelifeandhealth.com to make an express request for a replacement card. There will be a $2.00 charge for each replacement card. The replacement fee will be charged even if the member is not responsible for the lost or stolen card.

Explanation of Benefits

An Explanation of Benefits (EOB) will be mailed to you after your claim has been processed or you may also obtain an electronic copy of your EOB via our website at www.netcarelifeandhealth.com and logging into the Member portal. The EOB tells you how we processed the claim, including the services performed, the amount charged, our eligible charge, the amount we paid and the amount, if any, that you owe as a member. If we denied the claim or any part of it, the EOB will provide an explanation of the reason for the denial.

Please be sure to retain your EOB for filing with your secondary insurance carrier when applicable.

If you have any questions about your EOB, or think that we may have made an error in paying a claim, please contact or write to our Customer Service Department providing details as to why you feel the claim was processed in error. If, after contacting the Customer Service Department, you are not satisfied and think that we made an error in determining benefits or paying your claim, you may request a formal review by writing to us within 180 days of the date the claim was paid.

Off-Island Referral

As a PPO member, you are not required to get an approved referral from NetCare to seek specialist care either on-island or off-island. Under the POS Plan, off-island referral approval is required from NetCare.

We encourage members to contact our Customer Service Department so we may assist you with arrangements and making appointments for medical care off-island. NetCare has a Medical Liaison Office in Manila to help coordinate your care while in the Philippines.

By allowing us to assist you, we can verify provider status and benefit coverage. It is important to note that when self-referring off-island, you must ensure that the facility and provider, or attending physician or laboratory etc.. are all in the participating provider network in order to avoid additional out-of-pocket expenses for services rendered by a non-participating provider.

For services in Hawaii through Straub Clinic and Kapiolani Medical Center, you must contact our customer service department for appointment assistance and coordination with the Hawaii Pacific Health’s Liaison Office. Please allow 2 to 4 weeks for appointment scheduling.

NetCare has contracted with FirstHealth Group Network to access providers in the Continental United States with over 450,000 providers throughout the U.S. In addition, we also have direct provider agreements with several medical facilities in the Los Angeles area including Good Samaritan Hospital, White Memorial Medical Center, Anaheim Memorial Medical Center and Pacific Cardiovascular Associates. We also have direct agreements with the following Philippine providers including St. Luke’s Medical Center, Makati Medical Center, Asian Hospital & Medical Center, The Medical City Medical Center, Cardinal Santos Medical Center and Philippines Heart Center.

Locating a Provider

As a NetCare member, you have access to a wide variety of participating providers on Guam, CMNI, Hawaii, Philippines, Asia and throughout the Continental United States depending on the benefit plan you are enrolled under.

We encourage you to choose your physician from our extensive network of participating providers to serve as the foundation for your health needs and to help reduce your health care costs in the long run.

Finding one is simple. Search through our Netcare PPO Provider Directory, Advantage Plan Provider Directory, CNMI Plans Provider Directory to find a physician or clinic that is convenient for you and your family.

Your benefits are meant to be used within the service area. However, we do recognize that you may also prefer to seek treatment outside of the service area. Therefore, we do have a contractual arrangement with participating providers off-island should you desire or need urgent or emergency care while outside of the service area.

You may also log on to www.firsthealth.com to access and locate a U.S. Mainland Participating Provider.

For assistance with off-island referrals, please contact NetCare’s Customer Service Department at 472-3610.

2017 Provider Directory

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How to Change my Primary Care Physician (PCP)

NetCare requires members enrolled under the Point of Service (POS) and HMO Plans to select a Primary Care Physician (PCP) for each member of the family. Your primary care physician will be the doctor you access for all of your day to day healthcare needs. Through regular screenings and wellness education, your PCP can prevent or manage health problems and coordinate referrals to specialists when necessary. A good relationship with your PCP can help ensure continuity of care and peace of mind for you and your family.

You may select an independent physician or a medical clinic from the Participating Provider Directory. You may not select a specialist as your PCP. If you select a clinic, you may see any primary care physician in that clinic, but if you see a specialist within the clinic, the specialist co-payment will apply.

Effective March 1, 2010 NetCare will allow members enrolled under our Advantage POS and HMO plans to make PCP changes anytime within the month to be effective the same day of your PCP election or incurred service.

Changes can be made through written request, telephone or email with our Customer Service Department or with your Marketing Representative. PCP change requests will be made effective the same day of the request. Requests for retroactive PCP changes will not be accepted however.

Members who are authorized to make PCP changes include the subscriber or any adult dependent. A subscriber may make changes for self and dependents. Dependent spouse may make changes for self and children. Overage dependent children (ages 18-22 years) may make changes for self only.

Primary Care is defined as general practice; family practice; pediatrics; internal medicine.
   
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