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Health Insurance Products New Generation

Health Insurance Products New Generation. Talents Coming Together. Alliance Experience: Good name and market share First class well renowned reinsurers Arab Gulf Health Services (AGHS), the exclusive licensee of NextCare in UAE . Alliance Talent. 10 Years of Experience in Health Insurance

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Health Insurance Products New Generation

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  1. Health Insurance Products New Generation Alliance-NextCare New Generation of Health Insurance Products

  2. Talents Coming Together • Alliance Experience: Good name and market share • First class well renowned reinsurers • Arab Gulf Health Services (AGHS), the exclusive licensee of NextCare in UAE Alliance-NextCare New Generation of Health Insurance Products

  3. Alliance Talent • 10 Years of Experience in Health Insurance • 7 Years of Experience with PPP • One of the Leading Insurers in the UAE • One of the Largest Market Share in Private Health Insurance • In Charge of • Marketing • Underwriting • Premium Collection • Claims Payment Alliance-NextCare New Generation of Health Insurance Products

  4. First Class Reinsurers’ Talent • General Cologne Re/Berkshire Hathaway Reinsurance Group • GE Frankona/Employers Reinsurance Group • Converium/Zurich Reinsurance Group • Have entered into Risk Carrying Partnership with Alliance in relation with the New Generation of Health Insurance Products. Alliance-NextCare New Generation of Health Insurance Products

  5. Munich Reinsurance Group Swiss Reinsurance Group General Cologne Re/Berkshire Hathaway Reinsurance Group GE Frankona/Employers Reinsurance Group Hannover Reinsurance Group Gerling Global Reinsurance Group Lloyd’s Allianz Reinsurance Group SCOR Reinsurance Group Converium/Zurich Reinsurance Group Transatlantic Holding Inc. AXA Reinsurance Group Partner Reinsurance Group St. Paul Reinsurance Group Everest Reinsurance Group XL Re Group Korean Reinsurance Group CAN Reinsurance Group Toa Reinsurance Group Hartford Reinsurance Group STANDARD & POOR RATING REPORT • TOP 20 REINSURANCE COMPANIES RANKED BY WRITTEN PREMIUM Alliance-NextCare New Generation of Health Insurance Products

  6. AGHS/NextCare Talent • Provides Access to an Extended Network of Healthcare Providers on Direct Billing Basis… • Inpatient • Outpatient • Other benefits • with Preferred Tariff • in UAE and Abroad Alliance-NextCare New Generation of Health Insurance Products

  7. AGHS/NextCare Talent • 24/7 Claims Center Manned by Physicians to provide: • Directions for Network of Providers • Coverage Query • Authorizations for Medical Procedures • Claims Processing • Auditing of Claims • Medical Evaluation • Reporting Alliance-NextCare New Generation of Health Insurance Products

  8. Alliance New Generation Health Insurance ProductsNew Identity Alliance-NextCare New Generation of Health Insurance Products

  9. New Generation as of 1st of July 2002 • Global 1 • Global 2 • Global 3 • Regional Plus • Regional • COBRA Extension Alliance-NextCare New Generation of Health Insurance Products

  10. Scope/Limits/Benefits • New Generation • Territorial Scope of Coverage • Worldwide • Aggregate Limit • AED 2.5 Million • Inpatient/Day Care • 100% • Cash Benefit/Free of Charge Inpatient • AED 200/Night • Up to 180 days • Global 1 Alliance-NextCare New Generation of Health Insurance Products

  11. Scope/Limits/Benefits • New Generation • 100% • 50/75/100/150/200 • Out Patient Services • Deductible per PC/AED • Emergency • 100% Worldwide • Chiropractic Treatment and Osteopathy Annual Limit • AED 1,600 • International Assistance • Comprehensive covered by IPA • Global 1 Alliance-NextCare New Generation of Health Insurance Products

  12. Scope/Limits/Benefits • New Generation • Territorial Scope of Coverage • Worldwide excluding • USA&Canada • Aggregate Limit • AED 2.5 Million • Inpatient/Day Care • 100% • Cash Benefit/Free of Charge Inpatient • AED 200/Night • Up to 180 days • Global 2 Alliance-NextCare New Generation of Health Insurance Products

  13. Scope/Limits/Benefits • New Generation • 100% • 50/75/100/150/200 • Out Patient Services • Deductible per PC/AED • Emergency • 100% Worldwide • Chiropractic Treatment and Osteopathy Annual Limit • AED 1,600 • International Assistance • Comprehensive covered by IPA • Global 2 Alliance-NextCare New Generation of Health Insurance Products

  14. Scope/Limits/Benefits • New Generation • Global 3 • Territorial Scope of • Coverage • UAE, Arab Countries, • Sub-Asian Countries • Aggregate Limit • AED 2.5 Million • Inpatient/Day Care • 100% • Cash Benefit/Free of Charge Inpatient • AED 200/Night • Up to 180 days Alliance-NextCare New Generation of Health Insurance Products

  15. Scope/Limits/Benefits • New Generation • 100% • 50/75/100/150/200 • Out Patient Services • Deductible per PC/AED • Emergency • 100% Worldwide • Chiropractic Treatment and Osteopathy Annual Limit • AED 1,600 • International Assistance • Comprehensive covered by IPA • Global 3 Alliance-NextCare New Generation of Health Insurance Products

  16. Scope/Limits/Benefits • New Generation • Territorial Scope of Coverage • UAE, Arab Countries, Sub-Asian Countries, • Aggregate Limit/AED • 1000,000/500,000/ • 250,000/125,000 • Inpatient/Day Care • 100% • Cash Benefit/Free of Charge Inpatient • AED 200/Night • Up to 180 days • Regional Plus Alliance-NextCare New Generation of Health Insurance Products

  17. Scope/Limits/Benefits • New Generation • Out Patient Services • Deductible per PC/AED • 100% • 25/50/75/100/150/200 • Chiropractic Treatment • annual limit/ • AED 1,600 • Emergency • 100% Worldwide ex.USA&Canada as per UAE Network Tariff • International Assistance • Not Applicable • Regional Plus Alliance-NextCare New Generation of Health Insurance Products

  18. Scope/Limits/Benefits • New Generation • Territorial Scope of Coverage • UAE • Aggregate Limit/AED • 300,000/150,000/ • 75,000/40,000 • Inpatient/Day Care • 100% • Cash Benefit/Free of Charge Inpatient • AED 200/Night • Up to 180 days • Regional Alliance-NextCare New Generation of Health Insurance Products

  19. Scope/Limits/Benefits • New Generation • Out Patient Services • Deductible per PC/AED • 100% • 25/50/75/100/150/200 • Chiropractic Treatment • annual limit • AED 1,600 • Emergency • 100% AGCC,AC,Asian • sub-cont as per • UAE Network Tariff • International Assistance • Not Applicable • Regional Alliance-NextCare New Generation of Health Insurance Products

  20. Scope/Limits/Benefits • New Generation • Cobra Extension • Treatment Not Available in UAE • 100% Covered • Air Transportation for the Patient and Accompanying Next of Kin • 100% Covered • Inpatient Treatment • 100% Covered • Accommodation for Accompanying Person • 100% Covered • Aggregate Annual Limit • AED 1,000,000 Alliance-NextCare New Generation of Health Insurance Products

  21. Major Standard Exclusions • 1-Congenital Diseases with a WP of 365 days. • 2-Infertility related cases. • 3-Psychiatric illness,mental retardation,developmental delays. • 4-Contraception and termination of pregnancy. • 5-Organ Donation. • 6-Plastic and cosmetic surgery and treatment. • 7-Gum and dental treatment unless resulting from an accident. • 8-Preventive Care, check-up. • 9-Work related injury and accident. • 10-Durable medical equipment for home use. • 11-Alternative medicine and therapy except chiropractory and osteopathy. Alliance-NextCare New Generation of Health Insurance Products

  22. Major Network Providers • Abu Dhabi : • Ahlia Hospital • Al Manarah Hospital • Al Noor Hospital • Al Salama Hospital • Dar Al Shifa Hospital • El Maghrabi Eye&Ear Hospital • Hopital Franco-Emirien • National Hospital • New Medical Center Hospital Alliance-NextCare New Generation of Health Insurance Products

  23. Dubai : • Belhoul European Hospital • International (Al Dowali) Private Hospital • Iranian Hospital • Neuro Spinal Hospital • New Medical Center Hospital • Welcare Hospital • Sharjah : • Al Zahra Hospital • Central Private Hospital • Zuleikha Hospital Alliance-NextCare New Generation of Health Insurance Products

  24. How to Use the Benefits in UAE • Emergency: If possible, present the Alliance/NextCARE Health card and if possible call NextCARE Claims Center • In-patient Non-emergency: Call Claims Center in advance for in-patient care at Network providers. Authorization shall be provided for Covered Cases and eligible expenses are billed directly to Alliance. • Outpatient Non-Emergency: Pay co-part or deductible. Eligible expenses are billed directly to Alliance. • Non Network: Call NextCARE for inpatient, pay and follow the Reimbursement Claim Procedure Alliance-NextCare New Generation of Health Insurance Products

  25. How to Use Your Benefits Outside the UAE • Emergency, Non-emergency : Call the number presented on the back of your Access Card. • Non Network: Pay and follow the Reimbursement Claim Procedure Alliance-NextCare New Generation of Health Insurance Products

  26. Reimbursement Procedures • Call us before you leave the provider if hospitalized • Settle the invoiced amounts • Get itemized bill, detailed medical reports & results • Submit complete claim to Alliance Alliance-NextCare New Generation of Health Insurance Products

  27. Inpatient/Same Day Procedures AllIn-patient admissions, procedures, surgeries, same day procedures and physiotherapy require pre-approval. Alliance-NextCare New Generation of Health Insurance Products

  28. Pharmaceuticals Diagnostic Outpatient Procedures Consultation Alliance-NextCare New Generation of Health Insurance Products

  29. Consultation Procedures Consultations do not require pre-approval except for: • Maternity • Dental Alliance-NextCare New Generation of Health Insurance Products

  30. Pharmaceutical Products do not require pre-approval except for: Pharmaceutical Procedures • Maternity medications or supplements • More than one box of each medication (exc. Antibiotics) • Vitamins, minerals and supplements • Prescriptions with more than one antibiotic • Dental prescriptions Alliance-NextCare New Generation of Health Insurance Products

  31. Diagnostic Procedures/Tests do not require pre-approval except for: Diagnostic Procedures • Any kind of special investigation (EEG, Endoscopies, CT Scans, MRIs, all contrast studies, angiographies etc.) • Maternity related procedures/ tests. • Dental and/ or Gum related tests and procedures. • Allergy Testing Alliance-NextCare New Generation of Health Insurance Products

  32. We are ready for your questions Alliance-NextCare New Generation of Health Insurance Products

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