Medical Insurance

Visiting a provider that is not under AlKoot Network:

When visiting a provider that is not under AlKoot Network, you have the option of receiving treatment, paying the provider up front, and then claiming reimbursement.

Submitting the claim for reimbursement is simple but please ensure that you follow the below procedure for a hassle-free processing of your claim.

Step 1: Claim Form

Before submitting any claim on a reimbursement basis to AlKoot Insurance, it is very important to ensure that all of the sections of the claim form have been completed, stamped and signed.

Step 2: Requirements

Members must submit all requirements including but not limited to:

● Original invoices with an itemized breakdown of services and proof of payment/receipts.

● Deposits and/or advance payments are not eligible for reimbursement

● Physician prescriptions & referrals

● Investigation results

● Medical reports

● Discharge summary (if hospitalization), and

● Documentation relating to any medical service that the member has paid for.

Step 3: Original Documents

Claims up to a specific amount agreed between AlKoot Insurance and the company/member will be accepted as scanned copies without submitting original documents, any amounts above this limit should be submitted with original documents. You must retain all of the originals as AlKoot Insurance retains the right to request these on a periodic basis for further assessment.

Please refer to your table of benefits, reimbursement process, and important information section to understand the amount limit applicable to your policy.

Step 4: Timeline

Ensure that your claim is submitted within the allowed time frame from the date of treatment. Please refer to your table of benefits, and reimbursement level benefits where a specific claim submission timeline is defined.

Step 5: Bank Account Details

Ensure your bank account details are updated on our mobile app or Member Portal. All eligible reimbursement claims will be paid to the nominated bank account. It is important to note that claim payments can be processed only to the Principal’s bank account.

Step 6: Submit

Once ready, submit your claim via any selected reporting channels.

Step 7: Receive Claim Reference Number

Upon successful registration of the claim, you will be provided with a claim reference number for future correspondence.

Claim Processing: Our claims team will initiate the processing of your claim promptly upon receipt of all necessary information. Regular updates on the status of your claim will be provided in writing. Incomplete Claim form and/or supporting documentation could result in the claim being returned to you for completion (shortfall) which may delay the processing of the claim.

The date of receipt of all complete documents required to substantiate, assess and validate the claim, will be treated as the initial date of receipt of the claim for administration purposes. It is, therefore, in your interest to ensure that all requirements are fully met to minimize any delay.

Once the claim is assessed, we will work towards a fair and efficient resolution and/or any necessary settlements. Policyholders will be informed of the final decision and any actions required on their part via mobile app, Member Portal and/or to the registered email ID.