Individual Medical Insurance : FAQ

  • Why do I need Health Insurance??

    As medical care advances and treatments increase, health care costs also increase. The purpose of health insurance is to protect you and your family financially in the event of an unexpected serious illness or injury that could be very expensive.

    You need health insurance because you cannot predict what your medical bills will be. In some years, your costs may be low. In other years, you may have very high medical expenses. If you have health insurance, you will have peace of mind in knowing that you are protected from most of these costs.

  • What does health insurance cover??

    Health insurance generally covers the cost of doctors or emergency room visits, medicines, laboratory & other diagnostic tests for medical conditions other that specific exclusions.

    Depending on the type of insurance coverage you have, you may need to pay a portion of the expenses in addition to the premium you pay for general coverage.

    You can also purchase extra cover that includes services that are generally not provided such as services for pregnancy and child birth / dental treatments/optical care/vaccinations  e.t.c

  • Is there any assistance provided for medical emergencies arising while insured members are travelling abroad??

    Yes, they are provided the required support via Mondial Assistance/Assist America.

  • How is the deductible applied??

    Deductible is the amount the insured has to pay the deductible is a fixed amount or percentage of expenses that must be paid by the insured before an insurer will pay any medical expenses 

    The higher the deductible, the lower the premium you pay. This is an advantage for the employers to provide health insurance to their employees in a cost efficient way.

    The insurer would pay the amount over and above the deductible. So you should check the possibilities of deductibles if it is within you budget to pay for minor ailments out of your pocket as it could substantially lower your annual premium.

  • On the medical card it is mentioned 20% co-insurance on all outpatient services. What does this mean??

    The coinsurance/copay is any amount specified on the DNIRC medical card that should be paid by the insured directly to the health care provider on all covered /eligible medical services rendered. In this case 20% of the total expenses rendered has to be borne by the insured.

    Coinsurance helps reduce the premium to be paid

  • Will I be covered for any pre-existing and chronic conditions??

    For individual covers medical conditions for any medical or related conditions for which you have received treatment, had symptoms of, existed to the best of your knowledge or you sought advice for “prior” to your date of entry are excluded from coverage.

    For group insurance pre-existing conditions shall be covered, however major medical conditions if any has to be declared and the insurer will decide the outcome, on the merit of each case.

  • What should be done if an insurer does not carry his medical card to avail a medical service at a health care provider??

    The expenses incurred in this case shall be on reimbursement basis subject to policy terms & conditions. The member shall pay cash for medical treatment /services and medications and submit the original invoices and completed reimbursements claim form from the treating doctor with supplementary documents to DNIRC.

  • Is NEXtCARE/Mednet an Insurance Company??

    No, they are leading Third Party Administrators in the UAE who works closely with insurance companies and provide administrative, network and claims management support.

  • Can I visit a non network provider??

    Yes you can. You have to pay the charges in full and file a reimbursement claim for eligible expenses. Check your contract if it allows for reimbursement.