Transcript No Slide Title

Health Insurance Products
New Generation
Alliance-NextCare New Generation of Health Insurance Products
Talents Coming Together
Alliance Experience: Good name and market
share
First class well renowned reinsurers
Arab Gulf Health Services (AGHS), the
exclusive licensee of NextCare in UAE
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
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.
Alliance-NextCare New Generation of Health Insurance Products
STANDARD & POOR RATING REPORT
TOP 20 REINSURANCE COMPANIES RANKED BY WRITTEN PREMIUM
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.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Transatlantic Holding Inc.
AXA Reinsurance Group
Partner Reinsurance Group
St. Paul Reinsurance Group
Everest Reinsurance Group
XL Re Group
Korean Reinsurance Group
CAN Reinsurance Group
Toa Reinsurance Group
Hartford Reinsurance Group
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
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
Alliance-NextCare New Generation of Health Insurance Products
Alliance
New Generation Health Insurance Products
New Identity
Alliance-NextCare New Generation of Health Insurance Products
New Generation as of 1st of July 2002
Global 1
Global 2
Global 3
Regional Plus
Regional
COBRA Extension
Alliance-NextCare New Generation of Health Insurance Products
Global 1
Scope/Limits/Benefits
Territorial Scope of
Coverage
Aggregate Limit
Inpatient/Day Care
Cash Benefit/Free of
Charge Inpatient
New Generation
Worldwide
AED 2.5 Million
100%
AED 200/Night
Up to 180 days
Alliance-NextCare New Generation of Health Insurance Products
Global 1
Scope/Limits/Benefits
New Generation
Out Patient Services
Deductible per PC/AED
100%
50/75/100/150/200
Emergency
100% Worldwide
Chiropractic Treatment
and Osteopathy Annual
Limit
AED 1,600
International Assistance
Comprehensive covered
by IPA
Alliance-NextCare New Generation of Health Insurance Products
Global 2
Scope/Limits/Benefits
Territorial Scope of
Coverage
Aggregate Limit
Inpatient/Day Care
Cash Benefit/Free of
Charge Inpatient
New Generation
Worldwide excluding
USA&Canada
AED 2.5 Million
100%
AED 200/Night
Up to 180 days
Alliance-NextCare New Generation of Health Insurance Products
Global 2
Scope/Limits/Benefits
Out Patient Services
Deductible per PC/AED
Emergency
New Generation
100%
50/75/100/150/200
100% Worldwide
Chiropractic Treatment
and Osteopathy Annual
Limit
AED 1,600
International Assistance
Comprehensive covered
by IPA
Alliance-NextCare New Generation of Health Insurance Products
Global 3
Scope/Limits/Benefits
New Generation
Territorial Scope of
Coverage
UAE, Arab Countries,
Sub-Asian Countries
Aggregate Limit
Inpatient/Day Care
Cash Benefit/Free of
Charge Inpatient
AED 2.5 Million
100%
AED 200/Night
Up to 180 days
Alliance-NextCare New Generation of Health Insurance Products
Global 3
Scope/Limits/Benefits
Out Patient Services
Deductible per PC/AED
Emergency
New Generation
100%
50/75/100/150/200
100% Worldwide
Chiropractic Treatment
and Osteopathy Annual
Limit
AED 1,600
International Assistance
Comprehensive covered
by IPA
Alliance-NextCare New Generation of Health Insurance Products
Regional Plus
Scope/Limits/Benefits
New Generation
Territorial Scope of
Coverage
UAE, Arab Countries,
Sub-Asian Countries,
Aggregate Limit/AED
Inpatient/Day Care
Cash Benefit/Free of
Charge Inpatient
1000,000/500,000/
250,000/125,000
100%
AED 200/Night
Up to 180 days
Alliance-NextCare New Generation of Health Insurance Products
Regional Plus
Scope/Limits/Benefits
Out Patient Services
Deductible per PC/AED
Chiropractic Treatment
annual limit/
Emergency
International Assistance
New Generation
100%
25/50/75/100/150/200
AED 1,600
100% Worldwide
ex.USA&Canada as per
UAE Network Tariff
Not Applicable
Alliance-NextCare New Generation of Health Insurance Products
Regional
Scope/Limits/Benefits
Territorial Scope of
Coverage
Aggregate Limit/AED
Inpatient/Day Care
Cash Benefit/Free of
Charge Inpatient
New Generation
UAE
300,000/150,000/
75,000/40,000
100%
AED 200/Night
Up to 180 days
Alliance-NextCare New Generation of Health Insurance Products
Regional
Scope/Limits/Benefits
New Generation
Out Patient Services
Deductible per PC/AED
Chiropractic Treatment
annual limit
100%
25/50/75/100/150/200
Emergency
International Assistance
AED 1,600
100% AGCC,AC,Asian
sub-cont as per
UAE Network Tariff
Not Applicable
Alliance-NextCare New Generation of Health Insurance Products
Cobra Extension
Scope/Limits/Benefits
New Generation
Treatment Not Available
in UAE
100% Covered
Air Transportation for the
Patient and Accompanying
Next of Kin
100% Covered
Inpatient Treatment
100% Covered
Accommodation for
Accompanying Person
100% Covered
Aggregate Annual Limit
AED 1,000,000
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.
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
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
Alliance-NextCare New Generation of Health Insurance Products
How to Use the Benefits in UAE
Emergency: If possible, present the Alliance/NextCARE
Health card and if possible call NextCARE Claims Center
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: Pay co-part or deductible.
Eligible expenses are billed directly to Alliance.
Non Network: Call NextCARE for inpatient, pay and
follow the Reimbursement Claim Procedure
Alliance-NextCare New Generation of Health Insurance Products
How to Use Your Benefits Outside the UAE
Emergency, Non-emergency : Call the number
presented on the back of your Access Card.
Non Network: Pay and follow the Reimbursement
Claim Procedure
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
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.
Alliance-NextCare New Generation of Health Insurance Products
Outpatient Procedures
Consultation
Diagnostic
Pharmaceuticals
Alliance-NextCare New Generation of Health Insurance Products
Consultation Procedures
Consultations do not require pre-approval except
for:
1. Maternity
2. Dental
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
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
Alliance-NextCare New Generation of Health Insurance Products
We are ready
for your
questions
Alliance-NextCare New Generation of Health Insurance Products