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

Alliance-NextCare New Generation of Health Insurance Products

Health Insurance Products New Generation


Talents Coming TogetherAlliance Experience: Good name and market sh

are

First class well renowned reinsurers

Arab Gulf Health Services (AGHS), the exclusive licensee of NextCare in UAE


Alliance Talent10 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


First Class Reinsurers’ Talent

General Cologne Re/Berkshire Hathaway Reinsurance Group

GE Frankona/Employers Reinsurance Group

Converium/Zurich Reinsurance GroupHave entered into Risk Carrying Partnership with

Alliance in relation with the New Generation of Health Insurance Products.


1. Munich Reinsurance Group

2. Swiss Reinsurance Group

3.3. General Cologne Re/Berkshire General Cologne Re/Berkshire Hathaway Reinsurance GroupHathaway Reinsurance Group

4.4. GE Frankona/Employers GE Frankona/Employers Reinsurance GroupReinsurance Group

5. Hannover Reinsurance Group

6. Gerling Global Reinsurance Group

7. Lloyd’s

8. Allianz Reinsurance Group

9. SCOR Reinsurance Group

10.10. Converium/Zurich Reinsurance Converium/Zurich Reinsurance GroupGroup

11. Transatlantic Holding Inc.

12. AXA Reinsurance Group

13. Partner Reinsurance Group

14. St. Paul Reinsurance Group

15. Everest Reinsurance Group

16. XL Re Group

17. Korean Reinsurance Group

18. CAN Reinsurance Group

19. Toa Reinsurance Group

20. Hartford Reinsurance Group

STANDARD & POOR RATING REPORTSTANDARD & POOR RATING REPORTTOP 20 REINSURANCE COMPANIES RANKED BY WRITTEN PREMIUMTOP 20 REINSURANCE COMPANIES RANKED BY WRITTEN PREMIUM


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


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


AllianceAlliance New Generation Health Insurance Products New Generation Health Insurance Products

New IdentityNew Identity


New Generation as of 1st of July 2002

Global 1

Global 2

Global 3

Regional Plus

Regional

COBRA Extension


Global 1

AED 200/Night

Up to 180 daysCash Benefit/Free of Charge Inpatient

100%Inpatient/Day Care

AED 2.5 MillionAggregate Limit

Worldwide Territorial Scope of Coverage

New GenerationNew GenerationScope/Limits/BenefitsScope/Limits/Benefits


Global 1

Comprehensive covered by IPA

International Assistance

AED 1,600

Chiropractic Treatment and Osteopathy Annual Limit

100% WorldwideEmergency

100% 50/75/100/150/200

Out Patient Services

Deductible per PC/AED



Global 2

AED 200/Night

Up to 180 days

Cash Benefit/Free of Charge Inpatient



Worldwide excluding

USA&Canada Territorial Scope of Coverage



Global 2



AED 1,600



100%50/75/100/150/200





Global 3

AED 200/Night




UAE, Arab Countries,

Sub-Asian Countries

Territorial Scope of

Coverage



Global 3



AED 1,600



100%50/75/100/150/200





Regional Plus

AED 200/Night



1000,000/500,000/ 250,000/125,000Aggregate Limit/AED

UAE, Arab Countries, Sub-Asian Countries,

Territorial Scope of Coverage



Regional Plus

Not ApplicableInternational Assistance

100% Worldwide ex.USA&Canada as per

UAE Network TariffEmergency

AED 1,600Chiropractic Treatment

annual limit/

100% 25/50/75/100/150/200





Regional

AED 200/Night



300,000/150,000/75,000/40,000 Aggregate Limit/AED

UAE Territorial Scope of Coverage



Regional

Not ApplicableInternational Assistance

100% AGCC,AC,Asian

sub-cont as per

UAE Network Tariff

Emergency

AED 1,600 Chiropractic Treatment

annual limit

100%25/50/75/100/150/200





AED 1,000,000Aggregate Annual Limit

100% CoveredAccommodation for Accompanying Person

100% CoveredInpatient Treatment

100% CoveredAir Transportation for the Patient and Accompanying Next of Kin

100% CoveredTreatment Not Available in UAE


Cobra ExtensionCobra Extension


Major Standard Exclusions1-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.


Major Network Providers

Abu Dhabi :Ahlia Hospital Al Manarah Hospital Al Noor Hospital Al Salama HospitalDar Al Shifa HospitalEl Maghrabi Eye&Ear HospitalHopital Franco-EmirienNational HospitalNew Medical Center Hospital


Dubai :Belhoul European HospitalInternational (Al Dowali) Private HospitalIranian HospitalNeuro Spinal HospitalNew Medical Center HospitalWelcare Hospital

Sharjah :Al Zahra HospitalCentral Private HospitalZuleikha Hospital


How to Use the Benefits in UAEHow to Use the Benefits in UAEEmergency:Emergency: If possible, present the Alliance/NextCARE Health card and if possible call NextCARE Claims CenterIn-patient Non-emergency: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:Outpatient Non-Emergency: Pay co-part or deductible. Eligible expenses are billed directly to Alliance.Non Network:Non Network: Call NextCARE for inpatient, pay and follow the Reimbursement Claim Procedure


How to Use Your Benefits Outside the UAEHow to Use Your Benefits Outside the UAE

Emergency, Non-emergency :Emergency, Non-emergency : Call the number presented on the back of your Access Card.

Non NetworkNon Network:: Pay and follow the Reimbursement Claim Procedure


Reimbursement ProceduresReimbursement 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


Inpatient/Same Day ProceduresInpatient/Same Day Procedures

All In-patient admissions, procedures, surgeries, same day procedures and physiotherapy require

pre-approval.


Outpatient ProceduresOutpatient Procedures

DiagnosticDiagnostic

PharmaceuticalsPharmaceuticals

ConsultationConsultation


Consultation ProceduresConsultation Procedures

Consultations do not require pre-approval except for:

1. Maternity2. Dental


Pharmaceutical ProceduresPharmaceutical Procedures

Pharmaceutical Products do not require pre-approval except for:

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


Diagnostic ProceduresDiagnostic Procedures

Diagnostic Procedures/Tests do not require pre-approval except for:

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


We are ready We are ready for your for your questionsquestions

Date post:	23-Dec-2015
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