How to File Health Insurance Claims in UAE?

Health Insurance Claim: At a Glimpse

• A health insurance claim is a formal request you make to your insurer to help you cover your medical expenses. 
• These expenses include doctor consultations, treatments, hospitalisation, diagnostic tests, pharmaceutical drugs, and more. 
• In the UAE, you can file both cashless and reimbursement claims. 
• Cashless facilities are the most common, as they apply to all network hospitals covered under your health policy. 
• You can request claims for inpatient services as well as outpatient services. 

What are the Types of Health Insurance Claims in the UAE?

There are 2 categories of health insurance claims in the Emirates: cashless and reimbursement. 

• Choosing the cashless facility means a seamless claim experience. This is because you don’t have to pay your medical bills up front. The hospital directly settles your bills with the insurer post-treatment.  
• Reimbursement claims generally apply to treatments that occur in an out-of-network hospital. You need to file the claim with the insurer post-treatment.

How to Claim Your Health Insurance in the UAE?

Let’s understand how you can claim medical insurance–

Source- This image is AI-generated. 

Cashless Claims

STEP 1- Check Your Hospital Network 

Read your policy document to know your provider’s hospital networks. Select your preferred hospital. 

STEP 2- Visit the Hospital 

Visit the hospital’s insurance helpdesk to inform the dedicated official regarding the claim you want to make. Present your health card to the concerned authorities. 

STEP 3- Get Pre-approval 

The hospital will send a request for pre-approval from your provider. 

STEP 4- Proceed With the Treatment 

Upon approval, your treatment starts. 

STEP 5- Claim Settlement 

Once your treatment is complete, the hospital will directly settle the bill with your insurance provider. 

Source- This image is AI-generated. 

Reimbursement Claims

STEP 1- Seek Treatment

After the treatment, pay the bill to the clinic/hospital. 

STEP 2- Gather Documents 

Keep the required original documents handy. These usually include medical reports, invoices, and others (depending on your insurer’s requirements) 

STEP 3- Download and Submit Claim Form 

Download the claim form from your insurer’s official portal. Complete the form and attach the necessary documents. 

STEP 4- Tracking of Claim 

Once you submit the form with the documents, a claim reference number will be sent to your registered email ID or contact number. 

STEP 5- Receive the Amount

Your claim will be approved, and the money will be transferred to the mentioned bank account. 

How Does Policybazaar.ae Help You In Filing Health Insurance Claims?

Get quick assistance for health insurance claim support via Policybazaar UAE. Under our PB Advantage program, we offer quick claim assistance within 30 minutes, along with perks like auto recharge benefit. Know what all privileges PB Advantage gives you. 

Besides, you can also check out our website and head out to the “Claims” section, where our TPAs are listed. Choose your TPA and get all the necessary information. 

What Documents Do You Need to Claim Medical Insurance?

Given below is a list of general documents required to claim your health insurance in the UAE–

Note- Your insurer may require additional documents. 

What Happens If Your Health Insurance Claim Gets Rejected?

In case your medical insurance claim gets rejected by the insurer, you will have to pay the entire amount upfront to the hospital. This applies to cashless claims. Likewise, for reimbursement claim rejections, the respective provider will not reimburse you for the medical bill amount. 

If your claim is rejected, you need to understand the reasons to get more clarity. Here are the reasons why your claim may be rejected– 

• Filing claims for treatments that are excluded from your policy
• Incorrect or incomplete documentation
• Seeking treatment from non-network hospitals without pre-approval (for specific treatments/ surgeries) 
• Not disclosing your PED
• Seeking treatment during the waiting period 

How to Ensure Your Health Insurance Claim is not Rejected?

We understand that filing claims can be mentally draining at times, especially if they get rejected. So, to ensure your claims are approved, follow the practical tips stated below–

Make Timely Claims

For reimbursement claims, ensure you submit the claim request within the timeframe mentioned in your policy. The time period varies for each insurer. With some providers, you may be able to file your claim within 90 days from the date of your medical treatment, while others may provide you with a tenure of 30 or 60 days. 

Provide Accurate Details

Complete the claims form with the correct details and signature. Any wrong information can result in claim delays or rejections. Make sure you attach all the documents required to process your claim. 

Stay Updated on Policy Terms and Conditions

Keeping yourself regularly updated with your policy details helps you avoid hassles during claims. Stay updated with the inclusions, their coverage limits, exclusions, and the claim process. 

Know Your Coverage

Always check the coverage limit for the treatment you are prescribed. Adequate coverage eliminates your out-of-pocket expenses at the time of filing your claim. 

Prioritise Cashless Claims

Choosing a hospital within your provider’s network list is the best option. This helps you access cashless treatment, meaning zero hassle of paying your bills upfront. 

Pre-authorise Your Claim Request

If you’ve already planned a treatment and chosen a hospital, pre-authorise your claim request from the hospital. By doing this, you can align your claim process on time. 

In a Nutshell

Health insurance claim becomes much easier when you understand the process, requirements, and your policy coverage thoroughly. Whether opting for cashless treatment or reimbursement, timely communication, proper documentation, and choosing network providers ease the claims experience. 

While claim rejections or delays may occur, they are often manageable with the right follow-ups and clarity. Always stay up to date on exclusions, waiting periods, and insurer guidelines.