Precertification
Precertification is a determination of medical necessity for proposed treatment or services.

Your plan contains specific services and treatment that require precertification.

You may initiate your precertification by contacting the Utilization Management and Review Coordinator as indicated on your identification card. Precertification may also be initiated by the doctor, the hospital administrator or relative.

Pursuant to your plan provisions, the following treatments and services must be precertified in order to avoid a reduction in benefits:

•Inpatient Treatment
•Surgery or Surgical Procedure
•Care in an Extended Care Facility
•Home Nursing Care
•Durable Medical Equipment
•Artificial Limb
•Maternity
•All Covered Transplant Treatment

Please note: Precertification is only a determination of medical necessity not an assurance of cover, verification of benefits or guarantee of payments.

Verification of Benefits
Verification of benefits is the process of verifying general cover and available benefits under the plan. You may do this by contacting Customer Care as indicated on your identification card. Verification of benefits is not a guarantee of payment nor assurance of cover. All medical expenses must meet eligible payment guidelines in accordance with the terms and conditions of the plan.

Claims Procedures
Verification of benefits is the process of verifying general cover and available benefits under the plan. You may do this by contacting Customer Care as indicated on your identification card. Verification of benefits is not a guarantee of payment nor assurance of cover. All medical expenses must meet eligible payment guidelines in accordance with the terms and conditions of the plan.

Claim Filing
Claims incurred within the U.A.E. and surrounding territories:

Claims inside of NAS Network - Within the NAS network, providers will submit claims as an accommodation on behalf of the insured for direct payment of eligible medical expenses. To have a claim paid in this manner, a claim form must be submitted with an itemized bill. The insured member may be responsible for direct payment of deductible, coinsurance and non-eligible expenses and charges, if applicable.

Claims outside of NAS Network - Non-network providers and insured members must submit claims to AWNIC using the appropriate claim form within 90 days of service along with the original itemized bills and paid receipts.

Claims incurred outside of the U.A.E. and surrounding territories:
All claims incurred outside of the U.A.E. and surrounding territories will be submitted to IMG as the plan administrator.

For direct payment of eligible medical expenses, IMG will work with the hospital or provider on your behalf where possible. To have a claim paid in this manner, a claim form must be submitted with an itemized bill. The insured member may be responsible for direct payment of deductible, coinsurance and non-eligible expenses and charges, if applicable.

Insured member reimbursement – For reimbursement of out-of-pocket medical expenses, please complete the appropriate claim form. Along with the claim form, need to be submitted original itemized bills and paid receipts within 90 days. Eligible medical expenses will be reimbursed after applying the deductible and coinsurance, subject to the terms of the plan.

Eligibility
MediGlobal Health Insurance is available to individuals, families and groups who are residents of the U.A.E. Persons older than 99 years of age are not eligible.

Renewal of Cover
Subject to the terms of the plan, MediGlobal Health Insurance is annually renewable and cover is continuous when renewed. Prior to the end of each period of cover (12 months) you will receive a renewal form. You must continue to meet the eligibility requirements outlined above in order to renew. There are no additional medical questions at renewal. Please select your deductible carefully, as you will be unable to select a lower deductible when you renew your cover.

How to Apply
To apply for individual cover under MediGlobal Health Insurance , simply complete and return the application. If you are applying as a family, you may include yourself, your spouse and dependents on one application. If you are 19 years of age or older, you must complete your own application.

For group cover, the employer will complete a group application and each employee needs to complete an enrolment form.

All questions outlined in the application must be accurately completed in order to be considered for cover. An attending physician statement may be required depending upon your answers to the medical questions, and the Company reserves the right to request additional medical information.

When we receive your completed application with premium, we will process it as quickly as possible. Once accepted, you will be mailed a fulfillment kit which includes an identification card, declaration of insurance and a Policy of Insurance (containing a complete description of benefits, exclusions and terms of the plan), claim filing information, and claim forms. You are required to notify the Company, as required by the terms of the plan, if you or any family member suffers from or is treated for any illness, injury or other medical condition between the time of your application and the issuance of the policy.

MediGlobal Health Insurance was designed with your specific needs in mind and provides the cover needed for you, your family or group inside and outside of U.A.E. Once you are accepted in the plan, we are confident that you will be pleased with the full terms of cover and we are available to assist you in the best way possible.