health_insurance_alfred

    google-2 4.9/5 Rating 49_star_google_rating (8000+ Reviews)

    HEALTH INSURANCE

    FREQUENTLY ASKED QUESTIONS

    What are the typical components included in health insurance?

    1. MAXIMUM CLAIM LIMIT – this is the total indemnity amount for the specific term or insured period. In most cases, the higher the amount that the policy is set to cover, the higher the premium will be. If one does not really have a known health risk or conditions, it would practically help manage the premium to go for a low or mid-range amount of claim limit. Otherwise, for a more comprehensive extent of cover, a higher claim limit would be the best option in such cases.

    2. NETWORK – the level or category of the medical facilities that would accept the insured members for medical treatments and procedures. This includes a wide range of clinics, medical centers, different levels of hospitals, care units, diagnostic centers, laboratories, radiology facilities, dental offices, pharmacies, rehabilitation and other medical units. There are different levels of network, but generally, as the level of network increases through the hierarchy, more contracted facilities will be open to accept the insured members, hence the premium gets higher as well. The network is a very good factor to consider for a practical decision in getting a health policy. It helps to bear in mind that most of the time, network levels differ only in terms of the hospitality and physical structure, but is not an outright justification that lower networks cannot be as equally good or even better than those at the top.

    3. WELLNESS BENEFITS – these are specific benefits that are considered as “extra” than the usual medical cover. This includes Vaccinations, Dental, Vision, and Hearing that usually can be provided through a separate plan. Once included in the same medical policy, premium can increase and would extend only a particular sub-limit of cover.

    4. GENDER AND AGE SPECIFIC RISK COVERS – these are part of the benefits that are specially made for specific age and/or gender group such as well-man, well-child, well-woman, PAP Smear / Testicular Exams, Diabetes and cover for other specific medical conditions. Inclusion of these benefits would pull up the premium. Hence, if not needed or may not be applicable as per age or even by choice, members can request these to be excluded in order to manage the price of the health insurance.

    5. MATERNITY – a special cover to assist in gestation or pregnancy, delivery and post-natal period. Obviously, with the inclusion of this cover, the price of the health insurance can certainly increase. In some cases, this is a standard benefit for married females that cannot be removed from the plan. Nevertheless, one can choose a plan with lower maternity cover in order to decrease the premium as well – especially those who may not be planning for pregnancy yet.

    6. REIMBURSEMENT FACILITY – It is the provision of the plan to cover members outside of the network, or where a service is received in a facility that is not contracted with the insurer for the specific plan involved. Note that not all health policies allow reimbursement, and if at all will be allowed, it is subject to the policy terms. Normally, reimbursement is not in full and will not be based on the actual cost.

    The insurer may accept the reimbursement but will process it based on their usual and customary rates, applying only a specific percentage and any involved cost-sharing options. Hence, it is best and advisable to stick with the network for any medical treatment.
     

    What can I do in a medical emergency?

    In case of emergency
    Your health and safety is of course the most important thing to us, and is thus the priority. Make sure you or whoever’s hurt is being looked after first, we can sort everything out with the insurance companies later.

    The emergency services in the UAE are contactable on 999.

    After you’ve bought your medical insurance with Alfred, make sure you’re aware which hospitals are in your network, and then go to the closest one! If the injury is not life-threatening, it might well be quicker getting a taxi than waiting for an ambulance. Taxis are used to this, but make sure they understand your need for urgency!

    Here are some emergency numbers:

    Dubai Hospital 042195000
    Rashid Hospital 042192000
    Al Wasl Hospital 042193000

    When everything is under control, let us help you sort out your claim effectively and efficiently.
     

    What are the type of cost sharing options in health insurance?

    COST SHARING OPTIONS are terms in which a member pays a portion, specific amount,or percentage of the medical costs. These schemes can affect the price of the health insurance policy on the basis that the higher the member shares in the liability, premium lowers. On the other hand, full coverage without cost sharing terms would cost higher premium. The following are the different types of cost sharing options:

    a. Deductible – a specific amount that the insured member needs to pay from the pocket for a specific period before the insurance kicks in. In most countries, this is referred to Plan-Year or Calendar-Year Deductible; whereas, in Dubai or UAE, deductible is taken as a maximum amount that the member needs to pay for the treatment before the rest will be covered by the policy terms.

    b. Copay or Copayment – a specific amount, which is usually lower than the deductible, that the insured needs to pay before the insurance policy cover a articular treatment or procedure.

    c. Coinsurance – is usually a percentage of the cost that the member needs to pay, and the rest will be paid by the insurer. This scheme can be used in combination with either deductible or copay, or sometimes both.

    d. Maximum Out-of-Pocket – the total amount or aggregate limit that the insured member needs to reach before the policy pays in full. Soon as this is satisfied and where the plan has a provision that all of the other cost sharing options contribute to this, all treatments as per the policy benefits can be fully covered up to the maximum claim limit.
     

    What does covered place of service mean?

    COVERED PLACE OF SERVICE (POS) pertains to the area of a medical facility where a service is rendered. Covered POS sets the flexibility of the plan in extending the level of care that a member can get from the health policy. POS of the plan can include the following:

    a. Outpatient – also known as Outpatient Department (OPD) where the member is treated for a number of hours, without the need of staying beyond 24 hours, and would usually be sent out after the consultation, test, or treatment. This place of service can cover consultations, diagnostic procedures, ambulatory or day surgery.

    b. Inpatient – where a member is considered as a “patient” that needs to stay in the medical facility for at least more than 24 hours while the treatment is ongoing.

    c. Emergency Department – a more flexible place of service that is typically covered by the policy in full since the member would not have a choice as to which medical facility s/he can be brought to.

    However, a clear investigation of the incident is normally being
    carried out by the insurer in such cases.

    d. GP Office – this includes clinics or private offices of physicians and consultants where check-up and diagnosis can be initiated prior to endorsement for further treatments.
     

    Am I eligible for medical insurance?

    Medical insurance is very delicate. Naturally, the older the client is, the more likely he is to use the UAE’s medical services, and this is reflected in the cost.

    Due to the complicated nature of the Abu Dhabi/Al Ain healthcare system, insurancemarket.ae will not be able to quote for these areas.
    We also ask that applicants are:

    – under 65 years of age (although in some cases, cover can be designed for those over 65)

    – holder of a valid residence visa in the UAE

    – if a child and applying alone, one or both of the parents must have existing healthcare arrangements

    Those with pre-existing conditions will still be eligible for cover for other symptoms, providing conditions are declared upon application. From our experience, we have seen very strict penalties imposed on applicants caught filling out their application incorrectly or inadequately.

     
    What are some of the medical exclusions?

    Because medical insurance is so complicated, each policy has their own set of exclusions and conditions.

    A brief overview is given here, but make sure the topic is discussed when you chat with one of the InsuranceMarket.ae team.

    – most, if not all, medical insurers have a waiting period for maternity cover. This means if you’re currently pregnant and apply for medical insurance, costs arising from the pregnancy will not be covered. After all, you will pay the insurer probably about 4,000 Dhs, and then they will have to pay nearly ten times this!

    – cover for dental is generally excluded too, apart from on the more expensive policies.

    – treatment in relation to sexually transmitted diseases

    – items like hair products, sanitary items, antiseptics, dental care products, milk, nutritional and dietary products

    – hearing aids

    – contraception, birth controls

    – vitamins and minerals

    – bandages, crepes, etc.