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

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Presentation on theme: "Alliance-NextCare New Generation of Health Insurance Products Health Insurance Products New Generation."— Presentation transcript:

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

3 Alliance-NextCare New Generation of Health Insurance Products Talents Coming Together Alliance Experience: Good name and market share Alliance Experience: Good name and market share First class well renowned reinsurers Arab Gulf Health Services (AGHS), the exclusive licensee of NextCare in UAE Arab Gulf Health Services (AGHS), the exclusive licensee of NextCare in UAE

4 Alliance-NextCare New Generation of Health Insurance Products Alliance Talent 10 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

5 Alliance-NextCare New Generation of Health Insurance Products First Class Reinsurers’ Talent General Cologne Re/Berkshire Hathaway Reinsurance Group GE Frankona/Employers Reinsurance Group Converium/Zurich Reinsurance Group Have entered into Risk Carrying Partnership with Alliance in relation with the New Generation of Health Insurance Products.

6 Alliance-NextCare New Generation of Health Insurance Products 1.Munich Reinsurance Group 2.Swiss Reinsurance Group 3.General Cologne Re/Berkshire Hathaway Reinsurance Group 4.GE Frankona/Employers Reinsurance Group 5.Hannover Reinsurance Group 6.Gerling Global Reinsurance Group 7.Lloyd’s 8.Allianz Reinsurance Group 9.SCOR Reinsurance Group 10.Converium/Zurich Reinsurance Group 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 REPORT TOP 20 REINSURANCE COMPANIES RANKED BY WRITTEN PREMIUM

7 Alliance-NextCare New Generation of Health Insurance Products 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

8 Alliance-NextCare New Generation of Health Insurance Products 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

9 Alliance-NextCare New Generation of Health Insurance Products Alliance New Generation Health Insurance Products New Identity

10 Alliance-NextCare New Generation of Health Insurance Products New Generation as of 1 st of July 2002 Global 1 Global 2 Global 3 Regional Plus Regional COBRA Extension

11 Alliance-NextCare New Generation of Health Insurance Products Global 1 AED 200/Night Up to 180 days Cash Benefit/Free of Charge Inpatient 100%Inpatient/Day Care AED 2.5 Million Aggregate Limit Worldwide Territorial Scope of Coverage New Generation Scope/Limits/Benefits

12 Alliance-NextCare New Generation of Health Insurance Products 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 New Generation Scope/Limits/Benefits

13 Alliance-NextCare New Generation of Health Insurance Products Global 2 AED 200/Night Up to 180 days Cash Benefit/Free of Charge Inpatient 100%Inpatient/Day Care AED 2.5 Million Aggregate Limit Worldwide excluding USA&Canada Territorial Scope of Coverage New Generation Scope/Limits/Benefits

14 Alliance-NextCare New Generation of Health Insurance Products Global 2 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 New Generation Scope/Limits/Benefits

15 Alliance-NextCare New Generation of Health Insurance Products Global 3 AED 200/Night Up to 180 days Cash Benefit/Free of Charge Inpatient 100%Inpatient/Day Care AED 2.5 Million Aggregate Limit UAE, Arab Countries, Sub-Asian Countries Territorial Scope of Coverage New Generation Scope/Limits/Benefits

16 Alliance-NextCare New Generation of Health Insurance Products Global 3 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 New Generation Scope/Limits/Benefits

17 Alliance-NextCare New Generation of Health Insurance Products Regional Plus AED 200/Night Up to 180 days Cash Benefit/Free of Charge Inpatient 100%Inpatient/Day Care 1000,000/500,000/ 250,000/125,000 Aggregate Limit/AED UAE, Arab Countries, Sub-Asian Countries, Territorial Scope of Coverage New Generation Scope/Limits/Benefits

18 Alliance-NextCare New Generation of Health Insurance Products Regional Plus Not ApplicableInternational Assistance 100% Worldwide ex.USA&Canada as per UAE Network Tariff Emergency AED 1,600 Chiropractic Treatment annual limit/ 100% 25/50/75/100/150/200 Out Patient Services Deductible per PC/AED New Generation Scope/Limits/Benefits

19 Alliance-NextCare New Generation of Health Insurance Products Regional AED 200/Night Up to 180 days Cash Benefit/Free of Charge Inpatient 100%Inpatient/Day Care 300,000/150,000/ 75,000/40,000 Aggregate Limit/AED UAE Territorial Scope of Coverage New Generation Scope/Limits/Benefits

20 Alliance-NextCare New Generation of Health Insurance Products 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 Out Patient Services Deductible per PC/AED New Generation Scope/Limits/Benefits

21 Alliance-NextCare New Generation of Health Insurance Products AED 1,000,000 Aggregate Annual Limit 100% Covered Accommodation for Accompanying Person 100% CoveredInpatient Treatment 100% Covered Air Transportation for the Patient and Accompanying Next of Kin 100% Covered Treatment Not Available in UAE New Generation Scope/Limits/Benefits Cobra Extension Cobra Extension

22 Alliance-NextCare New Generation of Health Insurance Products Major Standard Exclusions 1-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.

23 Alliance-NextCare New Generation of Health Insurance Products Major Network Providers Abu Dhabi : Ahlia Hospital Al Manarah Hospital Al Noor Hospital Al Salama Hospital Dar Al Shifa Hospital El Maghrabi Eye&Ear Hospital Hopital Franco-Emirien National Hospital New Medical Center Hospital

24 Alliance-NextCare New Generation of Health Insurance Products Dubai : Belhoul European Hospital International (Al Dowali) Private Hospital Iranian Hospital Neuro Spinal Hospital New Medical Center Hospital Welcare Hospital Sharjah : Al Zahra Hospital Central Private Hospital Zuleikha Hospital

25 Alliance-NextCare New Generation of Health Insurance Products How to Use the Benefits in UAE Emergency: Emergency: If possible, present the Alliance/NextCARE Health card and if possible call NextCARE Claims Center In-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

26 Alliance-NextCare New Generation of Health Insurance Products How 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 Network: Non Network: Pay and follow the Reimbursement Claim Procedure

27 Alliance-NextCare New Generation of Health Insurance Products Reimbursement 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

28 Alliance-NextCare New Generation of Health Insurance Products Inpatient/Same Day Procedures All In-patient admissions, procedures, surgeries, same day procedures and physiotherapy require pre-approval.

29 Alliance-NextCare New Generation of Health Insurance Products Outpatient Procedures Diagnostic Pharmaceuticals Consultation

30 Alliance-NextCare New Generation of Health Insurance Products Consultation Procedures Consultations do not require pre-approval except for: 1.Maternity 2.Dental

31 Alliance-NextCare New Generation of Health Insurance Products Pharmaceutical 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

32 Alliance-NextCare New Generation of Health Insurance Products Diagnostic 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

33 Alliance-NextCare New Generation of Health Insurance Products We are ready for your questions


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