1. Introduction
Whether you live in Qatar or are travelling abroad, you can be sure that, should anything happen to you or your family by way of an illness or injury, you have access to the best possible medical care.While abroad, you might find that:
> The standards of healthcare that we take for granted aren’t always available elsewhere.
> Local hospitals may be unable to undertake the treatment you need or
> To arrange transportation to the nearest available healthcare\facility in an emergency.
> Some countries do not have state healthcare facilities and even if they do, as a visitor, it is quite likely that you’ll be entitled to nothing more than basic care
Did you know?
> Al Koot has more than 100,000 customers
> Al Koot has more than 80% satisfied customers
> Al Koot/AXA has a high standard of cover and excellent support
to its members
> Al Koot/AXA provides personal care and attention
> Al Koot/AXA is able to offer plans authorized by all GCC health regulators
2. Cover
Out and in patient treatment, in addition to other optional benefits (depends on your employer's choice), such as, dental cover, pregnancy and maternity cover, optical cover, emergency evacuation and repatriation cover.
3. Members Information
Welcome to the members section. Thank you for choosing Al Koot as your healthcare insurance provider. You can rest assured that, whatever the year brings, we will give you access to the best available care. In order to communicate with you efficiently, we have included some useful information on this page.
4. Claims
Prior Approval
Al Koot/AXA Insurance requires prior authorization for some treatments. The reason is to protect you from unexpected costs.
When issuing confirmation of cover in this way, we confirm the following;
· Planned treatment is eligible under your policy
· The planned treatment is medically necessary
· The planned treatment is within the reasonable and customary costs
· The planned treatment falls within the remaining benefit of your plan.
Our agreement with you requires you to seek authorization for the following treatment and services:
In-patient & Daycare
· All in-patient and daycare admissions
· Diagnostics, treatment, surgery and other medical services.
· All in-patient maternity services
· All in-patient dental services
Out-patient
· Non-emergency MRI, CT, PET and Gait scans and internal diagnostics such as but not limited to endoscopy, colonoscopy, gastroscopy etc.
· Physiotherapy services
· Prescriptions covering consumables for 30 days or more
· All out-patient dental services received on a direct billing basis
· All out-patient services costing or exceeding QR 1,000
When do I need to contact Al Koot/AXA for pre-approval?
In the network shown for your plan When you visit a hospital/clinic in the network shown for your plan, the hospital/clinic representative will contact us directly in order to pre-authorize any appointment or medical treatment needed (including in an emergency) Outside the network shown for your plan If you are visiting a hospital/clinic outside the network shown for your plan for out-patient treatment, then there is no need to pre-authorize with us, you will follow the reimbursement process. If you need to be hospitalized for a planned treatment then you will need to contact us at least 5 days prior to your treatment taking place.
Planning an admission to a hospital Why do I need to contact al Koot/AXA?
If you need to go to the hospital for the day or to stay overnight for eligible medical treatment and this is planned, contact us at least 48 hours before your admission so that we can discuss this with you.
The reason for this is so that Al Koot/AXA can:
· If necessary, advise you of hospitals in your area
· Confirm that you are covered for the planned treatment
· Confirm how much we will pay for the planned treatment
· Confirm how long we will pay for you to stay in hospital
· Confirm whether we will be able to settle directly your hospital bills or not
· And if you are travelling we will be able to help you with your admission.
Going into a network hospital covered by your planWhat do I need to do?
First things first…
· Bring your current/valid Al Koot/AXA medical card and another form of identification, such as your passport or local ID AND the claim form which is included in your health plan pack or print one from our web site
· Show these documents to the clinic/hospital representative before you see a Medical Practitioner. Remember to…
· Remind the hospital that you are insured with Al Koot/AXA Insurance and ask them to confirm they have received authorization for your stay and treatment. You should check what our authorization says as you may have to pay for anything not shown on that authorization before you leave the hospital. Please contact us before admission if you have any concerns.
· The hospital will ask you to complete an Admission Form. Make sure that this includes your insurance details before you sign it.
· The hospital will probably ask you for a credit card. This may be used to collect payment, from you, for anything that is not covered by your plan or for which the hospital has not received authorization from us.
While in hospital…
While you are in the hospital, if you have any doubts about what you are being told or if you do not understand something, please do not hesitate to contact us for advice. If you are not able to contact us yourself we will be happy to talk to someone else with your permission. Working with us to manage your care while in hospital reduces the risk that you will have to pay for all or any part of the cost.
Leaving the hospital…
Before leaving the hospital you will be asked to pay for anything not covered by your policy and not included in our authorization. If this is the case please keep all receipts for future reference. If you need any advice following your discharge from hospital please contact us.
Visit to Clinic’s/Hospitals & Dentists What do I need to do when I visit a Clinic/Hospital or Dentist in the network shown for my plan?
First things first…
· Bring your current/valid Al Koot/AXA medical card and another form of identification such as your passport or local ID.
· Show these documents to the clinic/hospital representative before you see a Medical Practitioner.
· See the Medical Practitioner, who will give you the treatment you need, any prescription you might need or refer you for further investigation.
· At the end of this consultation you and the Medical Practitioner should complete and sign the claim form (the hospital/clinic will provide this).
NB. Do not sign an empty, incomplete or incorrect claim form; it is against rules and regulations to do so.
Don't forget your deductible…
· If your plan requires you to pay a deductible you must pay it before leaving the clinic/hospital. Details of this are given on your Al Koot/AXA medical card. Now your medication…
· If you have been prescribed any medications you will have been given the pink copy of your claim form. Take this along with the prescription to a network pharmacy (this may be inside the clinic/hospital itself). If not please refer to the Pharmacy Network shown for your plan.
· If you wish to use a pharmacy outside the network take the prescription with you to a non-network pharmacy, collect your medication and a receipt. You will need to send the receipt and the pink copy of your claim form to us as shown in the Section “Reimbursement”.
What if the clinic/hospital or dentist is not in the network shown for my plan?
· Bring your current/valid Al Koot/AXA Medical card and another form of identification such as your passport or local ID AND the claim form which is included in your health plan pack or print one from our web site www.alkoot.com.qa. Show these documents to the clinic/hospital representative before you see a Medical Practitioner. Don't forget to take the claim form in with you when you go to see the Medical Practitioner…
· See the Medical Practitioner, who will give you the treatment you need, any prescription you might need or refer you for further investigation.
· At the end of this consultation you and the Medical Practitioner must complete, sign and date the claim form (the hospital/clinic will normally not provide this). Do not sign an empty, incomplete or incorrect claim form! If the doctor does not wish to complete the claim form please remind them that, if they do not do so, you will not be able to make a claim.
· You will need to pay the clinic/hospital for your consultation. Keep the receipt for this as you will need to send this, the completed claim form and any other related bills to us for payment.
· If you have been prescribed any medications you will have been given a prescription. Pay for any medication and collect a receipt. You will need to send the receipt, together with the receipt for your consultation and any investigations plus your fully completed claim form to us.
5. Contact Us
Who can I contact to answer my queries?
Our Customer Service Team and Medical Board are available 24 hours a day,
When do I contact my Human Resources Department?
Your HR team can provide a full list of exclusions under your Al Koot/AXA policy and clarifications required relating to the benefits under your policy. In addition if you have any queries regarding your membership addition and deletion of members under the scheme) or your cover under the employee policy they can help.
