Sukoon TPA – Connecting People to Care!

Role and Responsibilities of Sukoon TPA

The key responsibilities of Sukoon TPA are given below — 

1. ✅ Approvals for treatment – Sukoon TPA reviews and approves medical procedures, tests and surgeries based on your insurance coverage.
2. 🏥 Managing hospital and clinic networks – They maintain a wide network of healthcare providers so members can access the right care without delay.
3. 💳 Direct billing coordination – They work directly with hospitals and clinics, so you don’t have to pay upfront for approved treatments.
4. 📑 Claims and reimbursements – If you’ve paid for treatment, Sukoon TPA checks the documents and processes your claim for repayment.
5. 📞 Customer support – Their team helps members with questions about coverage, approvals and claims.
6. 📋 Ensuring compliance – Sukoon TPA follows UAE health authority rules and makes sure everything runs fairly and transparently.

Top Sukoon Health Insurance Plans

Sukoon Insurance offers different plans for various needs. Below is a detailed comparison of key coverage and benefits under each plan —

Note: These details are a simplified summary. Always check the full policy document for exact coverage, terms, and conditions.

What Networks Are Under Sukoon TPA?

Sukoon TPA manages access to healthcare by organising networks of hospitals, clinics and pharmacies. These networks are grouped into different tiers based on the plan type and the level of services offered. Each network offers a wide range of medical facilities across the UAE — from top hospitals in Dubai to family clinics in remote areas.

Below are the main networks managed by Sukoon TPA — 

Signature Network

This is one of Sukoon’s most comprehensive networks. It includes high-end hospitals, specialised clinics and premium healthcare providers. It is usually linked to the Ultimate and Elite plans.

• Offers access to major private hospitals in the UAE
• Includes specialists, diagnostic centres and outpatient facilities
• Ideal for those seeking advanced or international-level care

Premium Network

The Premium Network covers well-known multi-speciality hospitals and clinics. It offers a balance between broad access and affordability, which makes it suitable for plans like Premier.

• Good for people who want strong coverage without going over budget
• Includes top-tier UAE facilities with a good mix of inpatient and outpatient services

Vital Network

This network includes a wide range of trusted hospitals, clinics and pharmacies across all emirates. It is ideal for those who prefer a cost-effective plan with dependable coverage, like the Select plan.

• Provides essential healthcare services with good access across the UAE
• Covers general practitioners, specialists, diagnostics, and pharmacies

Vital Eco Network

This is a budget-friendly network designed for entry-level plans. It’s meant to give essential coverage while keeping premiums low.

• Offers core health services including GP visits, outpatient care and emergency treatment
• Great for individuals or employers looking for affordable insurance options

Advance Network

This network includes mid-range hospitals, polyclinics and general medical providers. It's suited for wider employee coverage while balancing cost and quality.

Edge Network

Edge is another cost-effective network that includes a good number of clinics and general hospitals. It’s built for practical everyday medical needs.

Signature Network Medcare

This is a specific version of the Signature Network that focuses on Medcare hospitals and clinics under the Aster DM umbrella. It ensures access to a trusted chain of healthcare providers.

Lists of Hospitals and Clinics Under Sukoon TPA

Sukoon TPA gives its members access to a wide network of hospitals and clinics across the UAE. Each plan is linked to a specific network — some offer premium care and private hospitals, while others focus on affordable, essential services.

Below are the top healthcare providers under each Sukoon network — 

Signature Network

• ALD Medical Clinic – Yas Group
• AMC Medical Clinic – Yas Group
• AMH Medical Clinic – Yas Group
• Abu Al Abyad Island Clinic – Seha
• Acacia Advanced Medical Centre
• Aster Clinic – Bur Dubai
• American Hospital Dubai
• Mediclinic City Hospital
• Al Zahra Hospital – Dubai
• HealthBay Polyclinic

Premium Network

• Das Medical Centre
• Abu Dhabi Medical Centre
• Acacia Advanced Medical Centre
• Abu Dhabi Blood Bank – Seha
• AMC Medical Clinic – Yas Group
• Mediclinic Al Noor Hospital
• Universal Hospital
• Medeor Hospital
• Burjeel Hospital – Abu Dhabi
• NMC Specialty Hospital – Dubai

Vital Network

• NMC Royal Hospital – Khalifa City
• Burjeel Hospital – Abu Dhabi
• Thumbay Hospital – Ajman
• LLH Hospital – Musaffah
• Zulekha Hospital – Sharjah
• Aster Hospital – Mankhool
• NMC Specialty Hospital – Al Nahda
• Mediclinic Al Noor – Abu Dhabi
• Medeor 24x7 Hospital – Dubai
• Canadian Specialist Hospital – Dubai

Vital Eco Network

• Al Qadi Medical Center – Abu Dhabi
• Al Noor Polyclinic – Dubai
• Aster Clinic – Rolla, Sharjah
• Thumbay Clinic – Ajman
• Al Shifa Al Khaleeji Medical Center – Dubai
• Aster Clinic – Al Nahda
• Al Maher Medical Center – Abu Dhabi
• Rafah Polyclinic – Dubai
• Al Kamal Medical Center – Sharjah
• Life Medical Center – Abu Dhabi

Advance Network

• Al Garhoud Private Hospital – Dubai
• Adam Vital Hospital – Dubai
• Prime Hospital – Dubai
• Canadian Specialist Hospital – Dubai
• Al Zahra Hospital – Sharjah
• Aster Hospital – Qusais
• Thumbay Hospital – Fujairah
• NMC Medical Centre – Al Ain
• Zulekha Hospital – Dubai
• Burjeel Specialty Hospital – Sharjah

Edge Network

• Al Saha Al Shifa Hospital – Sharjah
• Thumbay Hospital – Dubai
• Aster Hospital – Muhaisnah
• Zulekha Medical Center – Dubai
• Right Health Clinic – Sonapur
• Access Clinic – Al Quoz
• Aster Clinic – Discovery Gardens
• NMC Medical Centre – Deira
• Medeor 24x7 Hospital – Sharjah
• Al Lulu Medical Centre – Ajman

Signature Network Medcare

• Medcare Hospital – Dubai
• Medcare Orthopaedics & Spine Hospital
• Medcare Women & Children Hospital
• Medcare Medical Centre – Jumeirah
• Medcare Eye Centre – Sheikh Zayed Rd
• Medcare Clinic – Mirdif
• Medcare Clinic – Sharjah
• Medcare Medical Centre – Al Barsha
• Medcare Medical Centre – Discovery Gardens
• Medcare Paediatric Specialty Centre

🔎 Disclaimer: This is a selected list of top providers under each network, based on the official Sukoon website. For the full and most updated list, please refer to Sukoon’s provider directory or use the Facility Finder tool. 

How Sukoon TPA Processes Direct Billing?

One of the key conveniences offered by Sukoon TPA is direct billing — where you don't have to pay out-of-pocket for medical treatment at approved hospitals or clinics. Instead, the provider bills Sukoon directly, saving you from the hassle of reimbursement claims.

Here’s how it works, step-by-step — 

1. Visit a Network Provider: Go to a hospital, clinic, or pharmacy that’s part of your Sukoon-approved network (like Signature, Vital, etc.).
2. Present Your Insurance Card: Show your Sukoon insurance card at the reception. The provider will verify your policy details with the TPA portal.
3. Eligibility & Coverage Check: The provider sends a treatment request to Sukoon TPA’s system for approval. This checks if the procedure is covered under your plan.
4. Authorisation Issued: If the treatment is covered, Sukoon TPA issues a pre-approval (also called pre-authorisation) to the provider.
5. Treatment is Provided: Once approval is granted, the healthcare provider will proceed with treatment — no upfront payment needed for covered services.
6. Claim Settlement: The hospital/clinic sends the bill directly to Sukoon TPA for settlement. You may only need to pay co-insurance or any non-covered charges (as per your policy).

📌 Things to Keep in Mind

1. Not all treatments require pre-approval (e.g. GP consultations might not).
2. Always check your network eligibility before visiting a hospital.
3. Some medications, diagnostic tests or second opinions may still require pre-approval.
4. Emergency treatments are usually covered, but you should notify Sukoon within 24 hours.

How Sukoon TPA Processes Reimbursement Billing?

Sometimes, you may receive medical treatment at a clinic or hospital that’s outside your network or in a location where direct billing isn't available, such as while travelling. In these cases, Sukoon TPA allows you to claim back your expenses through reimbursement.

Here’s how the process works —

1. Pay First, Claim Later: You pay the full cost of treatment directly to the healthcare provider at the time of service.
2. Collect All Required Documents: After your visit, you need to collect and keep:
   • Original payment receipts and invoices
   • Medical reports or diagnoses
   • Doctor’s prescription (if medicines were purchased)
   • Discharge summary (if admitted)
   • Your Emirates ID and insurance card copy
   • Completed claim form (from Sukoon website or TPA portal)
3. Submit Your Claim: You can submit your claim online through:
   • Sukoon’s member portal
   • Email (if allowed)
   • Through courier or by visiting their office
4. Claim Review by TPA Team: Sukoon TPA reviews all documents and checks:
   • Whether the treatment is covered under your policy
   • If costs are reasonable and valid
   • If any documents or details are missing
5. Reimbursement Decision: If approved, the amount (minus any co-insurance or uncovered items) will be reimbursed directly to your bank account.
6. Timeline: Reimbursement is processed within 15–21 working days, depending on the complexity of the case and document completeness.

How Does Sukoon TPA’s Partnership with Bupa Global Work?

Sukoon Insurance has partnered with Bupa Global, one of the world’s leading international health insurance providers. This partnership is a game-changer for frequent travellers, live internationally or simply want access to world-class medical care.

Here’s how this collaboration works —

1. Global Reach, Local Support: Sukoon handles your plan locally in the UAE, while Bupa Global provides international access to healthcare in over 190 countries. You get the best of both worlds.
2. Unified Member Experience: Despite the two companies being involved, your experience is seamless. Whether you're in Dubai or London, you use the same insurance card and have access to global helplines, portals and services.
3. Shared Networks: Through Bupa Global, you can access premium international hospitals and clinics — including in the UK, Europe, Asia, and North America. Back in the UAE, Sukoon’s strong local network keeps you covered.

🌐 Services You Get Through Bupa Global

1. 24/7 multilingual helpline for support wherever you are
2. Access to international second medical opinion services
3. Emergency medical evacuation if needed during travel
4. Support for pre-authorisation and direct billing abroad
5. Global online portal for claims, policy details and documents

📌 Important Things to Know

1. This international access is available under the Ultimate and Elite plans. It may not be included in basic or budget-friendly plans.
2. You don’t need to coordinate between Sukoon and Bupa — the system is integrated.
3. Before seeking treatment abroad, it’s always smart to contact the helpline to check eligibility and get pre-authorisation if needed.

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