Individual Medical Insurance : Claims Procedure
For submitting claims related to services received without direct billing basis, please follow the instructions :
- Claims to be submitted through his Company within 60 days if claim incurred in UAE & 90 days outside UAE of receiving treatment/ incurring medical expenditure
- The reimbursement claim form needs to be completed by the treating doctor with his/ her seal/stamp. Failure to obtain the same might disqualify the claim unless otherwise considered by the insurer at its discretion.
- Please make sure to complete all pertinent information particularly the name of insured, card no. and those relating to diagnosis and medical services rendered. DNIR will not be able to process claims if the Reimbursement Claim Form is incomplete or lacks proper documentation.
- All the documentation including invoices (originals) and medical reports (originals or copies) should be provided and should be either in English or Arabic.
- For All MedNet Cardholders, Reimbursement claim submissions are now through ONLINE by clicking on the link mentioned below:
The following documents to be attached to the duly filled Reimbursement claim form.
Please retain copies of receipts and documents enclosed with your claim, as DNIR will retain original documents.
- Copy of health card
- Original itemized bills invoices / receipts (dated)
- Original prescription for medication prescribed by the treating doctor.
- Original/copy of Investigation results/ reports like laboratory tests x-rays, etc.
- For In patient Hospitalization cases - Medical Report/ Discharge Summary stamped & signed by the treating Doctor.
Claims Lacking Supporting Documents/Reports Are Returned:
Claims lacking in any supportive documentation will be registered and sent back/intimated for reconciliation and resubmission. The member will provide such missing documents to Insurer within 15 days after receiving the intimation. After elapse of 15 days the Insurer will remunerate only those services that have all requirements submitted. Other services lacking requirements, and for which the member has been notified will be rejected without reconciliation. Even after submission of all requirements in case of doubtful claims additional documents will be requested for.
- Claim(s) falling in the excluded category are not paid and the Insured is accordingly communicated in writing. Denial sheets will be scanned and sent to respective contact person/policy holder.
- Settlement of valid medical insurance claim is effected by the issuance of an account payee cheque in the name of the claimant or company (to be decided at policy inception and shall be common for all members in a policy) within 21working days from the date of submission of all requirements.
Any Claims shall be considered in accordance with the terms and conditions of the original Policy.