Cashless Health Insurance in the UAE
Get the Best Insurance Plan that fits for Your Need
Introduction
Adopting valuable health insurance can protect you and your family from hefty medical charges. It includes coverage for treatments, hospital stays, and medicines. However, when you desire to claim your health insurance, there are certain steps you should follow to get the money back or to let the insurance company pay the bill directly to the hospital. To help you with this, this article includes everything related to cashless claims in health insurance in the UAE. It also includes the claiming process, benefits, importance, and much more.
What is a Cashless Health Insurance Claim?
Talking about a cashless insurance claim is a policy type where you don’t need to pay for the medical treatments upfront if you prefer a hospital that works under your insurance provider. This insurance allows your insurance company to directly pay the charges to the hospital.
With the integral approaches of cashless claims, you don’t need to worry if you have enough cash for emergency situations or not. The insurance company can take care of the payment. With the increasing rate of healthcare bills, cashless claims can be your biggest help in managing medical expenses when required.
How Does Cashless Health Insurance Work in the UAE?
Cashless health insurance policies have been significantly rooting their base in every part of the world, as in the UAE. Cashless claim in the UAE allows you to receive treatments at any network hospital without any upfront payment. While you visit an approved facility, the appointed professional will verify the coverage with the insurance company and bill them directly. You just have to carry your insurance card. There is no need for any lengthy paperwork or out-of-pocket charges.
Types of Cashless Health Insurance Plans
Let us go through some valuable types of health claims available in the UAE.
Family floater plans
This plan can protect your whole family with just one premium. This coverage can include your parents, spouse, and children.
Individual health insurance
This plan is curated for individuals and helps cover their medical expenses against any type of sudden health risks.
Senior citizen health insurance
This plan is specifically designed for older people and ensures the extra care they require with their age.
Maternity health insurance plan:
This plan can safeguard soon-to-be parents and covers all the charges related to pregnancy, delivery, and post-birth care.
Critical illness plans
This plan can be a safety factor for critical health risks like heart attacks and chronic diseases like cancer. The policy provides you with a lump sum to cover the treatment expenses for obstacle-free recovery.
Personal accident insurance
The following plan offers financial support in case of any sudden demise due to an accident or disability.
Eligibility and Requirements for Cashless Claims in the UAE
Let us get in-depth knowledge about the cashless claim settlement eligibility criteria and requirements.
Eligibility Criteria
You must prefer treatments from a hospital that is a part of your insurance company’s network. Through this, you can adopt cashless health insurance services.
The medical treatments you receive must be listed under your health insurance policy.
Your health insurance must be active and working with no due premium charges.
For getting planned hospitalisations, you should acquire pre-authorisation from your insurance company before the treatment.
Requirements:
Health insurance card
Doctor’s prescription
Proof of identity
Approval certificate from the insurance company
Hospital’s form
Medical papers
Insurance claim form.
How to Make a Cashless Claim in the UAE - Step-by-Step Process
Go through the detailed cashless insurance process in the UAE and claim it with confidence.
Prefer a networked hospital
Opt for a hospital that works under your insurance company. The following hospitals can offer you cashless treatment services.
Notify your insurance provider
Make sure to inform your insurance company about your hospitalisation process 3 to 4 days in advance. Further, share your hospital and policy details.
Get Pre-Approved
The insurer will verify your request and, accordingly, communicate with the hospital to review the treatments.
Confirmation of the coverage
Once the insurer approves your request, you will receive a confirmation text.
The insurance company covers the expenses
After you get the treatment, the insurance company will pay the hospital charges directly through your cashless medical claim.
Submit for reimbursement
Once you leave the hospital, if you get notified about other approved expenses, submit the bills to your insurance provider to get the money back.
What is covered under Cashless Health Insurance?
Here is the list of coverage you can get through a cashless health insurance policy:
Inpatient hospitalisation.
Outpatient consultation sessions with general doctors and physicians.
Diagnostic tests like blood tests, MRIs, and others.
Maternity and newborn care.
Emergency medical services.
Daycare procedures like minor surgeries do not require overnight stays.
Prescribed medications and related treatments.
Pre- and post-hospitalisation costs.
The ambulance service is listed in the policy.
Cost coverage for chronic disease treatments.
What is not covered under Cashless Health Insurance?
Here is the list of things that are not covered under your cashless health insurance:
Cosmetic surgeries.
Treatments at non-networked hospitals.
Pre-existing conditions that are not covered under the policy.
Non-prescribed medications.
Infertility treatments.
Injuries from substance abuse or self-harm.
Charges beyond policy limits.
Unapproved treatments.
Benefits of Cashless Claims over Reimbursement Claims
After a thorough knowledge of what is a cashless claim in health insurance, let us understand its benefits over reimbursement claims.
No worries about money
As you don’t need to rush for quick money, focus on taking care of yourself and your loved ones during emergency situations.
Quick medical treatments
During emergency or planned treatments, you can get quick care without worrying about arranging money.
Simple processing
The paperwork and the process remain extremely easy and simple, as you don’t have to ask for money back or wait for an approval period.
Lots of hospital options
Insurance companies mainly work with multiple hospitals. So, you have a number of options to choose from as per your requirements.
Difference between cashless and reimbursement
Let us thoroughly understand the difference between cashless and reimbursement claims.
| Cashless Claim | Reimbursement Claim |
|---|---|
| The networked hospital sends the treatment expenses directly to the insurance company. | You pay at the hospital first and then claim the money back from your insurance provider. |
| The process remains easy and simple as the hospital gets advanced approval. | You have to submit the bills to your insurance company after the treatment. |
| You might have to pay a certain small amount, like a co-payment. | You need to pay the full bill upfront to get reimbursed. |
| Remains easy and seamless during emergency cases. | You need to fill out the form and wait for the proceeding of reimbursement. |
| The process remains faster as the insurer handles the payment directly. | This process takes longer as you have to wait for the money after submitting your bills. |
These are some of the critical points when discussing the cashless vs. reimbursement process.
What to do if your Cashless Claim is Denied?
Now that you understand what is a cashless claim, you should also know what to do when it gets denied or rejected. Here, you can go through some valuable tips to avoid them.
Common reasons for claim rejection:
Lack of pre-authorisation steps.
When individuals prefer treatments from non-networked hospitals.
Get policy exclusion treatments like cosmetic surgeries.
When the insurance policy expired.
Claims that have exceeded the policy limits.
Incorrect or fraudulent documentation.
Tips to avoid cashless insurance claim rejection:
Make sure to choose a networked hospital for your treatment.
To acquire the best cashless health insurance, inform your insurance provider in advance.
Keep your insurance ID and card always ready and active.
Before the incorporation of the treatment, verify the policy coverage.
Maintain necessary medical documents.
Frequently Asked Questions about Cashless Health Insurance Claims in UAE
Is pre-authorisation always required for cashless claims?
Talking about cashless claims, you generally need pre-authorisation when you go for planned treatments. However, in cases of emergencies, the treatment will be initiated faster in the networked hospitals.
What if I need treatment in a non-network hospital?
If you are going to non-networked hospitals for your treatment, you have to pay the upfront bill and later file for reimbursement. The cashless claims are only applicable to networked hospitals.
How long does it take for a cashless claim to be approved?
You can get your cashless claims approved within 2 to 5 hours. However, it completely depends on your insurance company, hospitals, and the type of treatments you require. Emergency situations are approved comparatively faster.
Can I upgrade my room during cashless hospitalisation?
Yes, you can upgrade your room during cashless hospitalisation. However, if the upgrade cost exceeds the policy limit, you have to pay the extra charge out of your pocket. So, you must communicate with your insurer before making such changes.
What is the role of a TPA in cashless claims?
A TPA or a Third Party Administrator works as a communication link between you, the insurance company, and the opted hospital. They manage approvals and process claims to ensure seamless cashless treatments.
Are OPD treatments covered under cashless?
OPD treatments will only be covered under the cashless claims if it is listed in your policy and covered in a networked hospital. To be assured about it, you should always verify it with your insurer beforehand and ask them about OPD coverage and limits.
How can I find hospitals or clinics that accept cashless insurance in the UAE?
You can simply find the hospitals or clinics that adopt cashless insurance in the UAE by asking your insurance provider. You can also check the list on the insurance provider’s official website or just call their customer service.
Is dental or maternity care covered under cashless health insurance in the UAE?
Maternity is mainly covered in cashless health insurance. However, for dental care, you have to ask your insurance provider. Verify if these treatments are listed in your plans.