In Dubai, where advanced and accessible healthcare is a given, health insurance plays a crucial role in residents' lives. It not only offers financial protection during illness or injury but also covers the costs of treatments, medications, and essential medical procedures. However, knowing how to effectively file a health insurance claim is vital to fully benefit from this coverage. This comprehensive guide will take you through the process step-by-step, from understanding the types of claims to submitting the required documents.
What is a Health Insurance Claim?
A health insurance claim is a request submitted to the insurance company to cover medical expenses incurred by the insured due to an accident, illness, or injury. These claims can generally be made within a specified period.
Types of Health Insurance Claims in Dubai
There are two main types of health insurance claims that an individual can initiate:
- Cashless Claims or Direct Billing Within the Network Claim
In this type of claim, the insurance company directly pays the medical bills to the network hospital on your behalf. You don’t need to worry about paying for medical treatments or handling bills. Your insurance provider will directly settle the costs with network clinics, pharmacies, diagnostics, and hospitals for the services you use. Simply present your Emirates ID card at the network facilities of your choice to enjoy the benefits of your insurance plan without hassle.
- Reimbursement Claims or Reimbursement Outside the Network Claim
With a reimbursement claim, you initially pay for your medical treatment out of pocket. You then submit the bill to your insurance provider, and once they verify the details, they will reimburse you for the covered expenses.
Eligibility for Reimbursement Claims Outside the Network
Before submitting a reimbursement claim, ensure that your insurance plan covers it. Basic insurance plans usually only cover emergencies and life-threatening conditions, so it’s important to double-check your policy terms before filing a claim.
Emergency treatment generally refers to urgent medical care needed due to a sudden critical condition or a serious injury that requires immediate attention. If you face such a situation, notify your insurance provider’s customer service within 24 hours to ensure eligibility for claim reimbursement. It is essential to inform them promptly about the incident.
How to File a Health Insurance Claim in Dubai Using Shory
You can log on to Shory's website or app (available for Android and iOS). or contact our customer support center to initiate a reimbursement claim request. Our dedicated service team is here to assist you every step of the way, ensuring a smooth and easy process.
When filing a claim, gather all the necessary information and medical reports. The usual documents required for filing a claim include:
-
A completed reimbursement claim form signed by the doctor. Be sure to update and include your bank account details in the form.
-
Medical reports and discharge summary from the treating doctor.
-
Copies of invoices or receipts showing the services received and proof of payment.
-
Copies of test results and prescriptions from your doctor.
You can upload scanned copies of these documents to our app or website. In some cases, if the treatment cost exceeds a certain amount, you can file a health insurance claim in one of the following ways:
-
If your health insurance card was issued through your company, you can submit the claim via the Human Resources department.
-
If your health insurance was issued through a broker, you can submit the claim via the broker.
-
If you have individual health insurance, you can submit the claim at one of your insurance company's branches.
-
Claims along with original documents can also be mailed to your insurance company.
What is the Deadline for Submitting a Claim?
It's crucial to be aware that health insurance claims must typically be submitted within about 60 days, although this timeframe can vary depending on your insurance plan. To ensure you receive reimbursement, make sure to submit your claim within this period.
How Long Does It Take to Process a Claim?
After you submit all the required documents, it generally takes 15 to 21 working days for the insurance company to review your claim. During this time, they will assess whether your claim qualifies for reimbursement. If approved, the reimbursement will be directly deposited into your bank account. To facilitate this, ensure you provide your bank details when submitting your claim.
How Much Will Be Refunded?
Understanding the specifics of your insurance plan, including deductibles, co-pays, and Usual Customary and Reasonable (UCR) rates, is essential for managing your health insurance claims in the UAE. Different plans come with varying deductibles and co-pays.
What are Deductibles, Co-Pays, and Usual Customary and Reasonable (UCR) Rates?
Deductibles: This is the amount you need to pay out of pocket before your insurance coverage kicks in. For instance, if your deductible is AED 300 and your medical bill is AED 3,000, you will pay the first AED 300, and your insurance will cover the remaining AED 2,700.
Co-Pays: This is a fixed percentage you pay for a service, such as a doctor's visit. If your co-pay is 20% for a visit that costs AED 200, you will pay AED 40, and the insurance will cover the remaining AED 160. The percentage of co-pay remains constant irrespective of the service cost.
Usual Customary and Reasonable (UCR) Rates: If you have coinsurance, the insurance company will reimburse you based on standard rates for the service, or the network rates you have chosen. For example, if your network covers up to AED 300 for a doctor's visit, but the actual cost is AED 500, the insurance will reimburse you AED 300, subtracting any applicable coinsurance or deductibles.
Conclusion
Filing a health insurance claim in Dubai is not complicated if you gather all the required documents and follow the steps mentioned in this guide. You can ensure you receive the due compensation and cover the necessary medical costs. Remember to read your insurance policy benefits carefully and contact your insurance company for any details before starting the health insurance claim process.
