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Medical Insurance Guide - QLM - 2021

This document provides information about medical insurance coverage through QLM Life & Medical Insurance Company. The insurance provides coverage for medical expenses in Qatar and other countries. Insured individuals can use designated hospitals and clinics where bills will be directly submitted to QLM. For care received outside the network, individuals pay upfront and can be reimbursed 80% of reasonable costs. The insurance covers inpatient and outpatient hospital care, diagnostic tests, prescription drugs, and other services while excluding vision and dental. Claims submission procedures and benefits are also outlined.

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469 views12 pages

Medical Insurance Guide - QLM - 2021

This document provides information about medical insurance coverage through QLM Life & Medical Insurance Company. The insurance provides coverage for medical expenses in Qatar and other countries. Insured individuals can use designated hospitals and clinics where bills will be directly submitted to QLM. For care received outside the network, individuals pay upfront and can be reimbursed 80% of reasonable costs. The insurance covers inpatient and outpatient hospital care, diagnostic tests, prescription drugs, and other services while excluding vision and dental. Claims submission procedures and benefits are also outlined.

Uploaded by

Murthy Vvn
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Medical Insurance

SPIE OIL & GAS SERVICES EQUATION FOR PERFORMANCE


QLM Life & Medical Insurance Company

SPIE OIL & GAS SERVICES EQUATION FOR PERFORMANCE


Scope of Coverage

Qatar
&
Country of Origin

SPIE OIL & GAS SERVICES EQUATION FOR PERFORMANCE SPIE, sharing a vision for the future
Mode of Coverage
• Direct Billing
From the appointed Clinics/Hospitals within the Network.

• Reimbursement
All eligible claims incurred outside the designed network shall be settled at 80% based
on reasonable and customary charges of appointed network in Qatar.

Note: Al Ahli Hospital is excluded from the network and as such, not eligible for cash
reimbursement as well.

SPIE OIL & GAS SERVICES EQUATION FOR PERFORMANCE


Where Can I Use My Card?

You can present the e-card or insurance card in those health care facilities where QLM has an agreement.

Included Hospitals in Qatar are:

• Al Emadi Hospital
• American Hospital
• Doha Clinic Hospital
• Turkish Hospital
• Aster Hospital
• Hamad Hospital & Primary Health Care Centers

Please check the network list for the detailed list of health care facilities where direct billing is permitted.

SPIE OIL & GAS SERVICES EQUATION FOR PERFORMANCE


Claim Process

SPIE OIL & GAS SERVICES EQUATION FOR PERFORMANCE


How to contact QLM?

QLM Website
QLM Mobile App.
www.qlm-online.com

Qatar Toll Free:

How to each QLM? 8000 880

Outside Qatar:
+974 4453 3666

The above contact details are


indicated on the back side of your
insurance card.

SPIE OIL & GAS SERVICES EQUATION FOR PERFORMANCE


QLM Mobile App
You can use QLM Mobile Application for:

• Claim Submission
• Claim Tracking
• Pre-Approval Tracking
• Table of Benefits under the plan
• Hospitals/Clinics (search by country ,city etc.)

SPIE OIL & GAS SERVICES EQUATION FOR PERFORMANCE


Claim Process
Reimbursement (How to claim outside QLM network)
How to be reimbursed?

• You will have to pay the full amount upfront.


• The following original supporting documents (written in English) are required for each claim:

 A completed Medical Expenses Claim Form.


 Doctor's report/ Medical report
 Original invoice
 Prescriptions
 Discharge summary
 Pharmacy bill, detailing drugs and cost of prescribed drug.
 Diagnostic investigations (Laboratory investigation, X-Ray etc..) reports and invoices.
 Surgeon's Report for inpatient cases.
 In Hospital detailed invoice, in case of Hospitalization.

Continuation in next slide

SPIE OIL & GAS SERVICES EQUATION FOR PERFORMANCE


Claim Process
Reimbursement (How to claim outside QLM network)

• For claims less than 1500 QAR, submission to be through QLM mobile App.

• For claims equal or more than 1500 QAR, original documents are to be submitted to the HR focal point in Doha
for completing the claim process.

• In case of substantial amount to pay or elective IP cases (where the cost will be higher than the OP), it is
strongly recommended to avail pre-certification (prior approval ) from QLM.

SPIE OIL & GAS SERVICES EQUATION FOR PERFORMANCE


My Benefits

 25 QAR only deductible for every consultation visit.


 100% coverage for In-patient and Out-patient Hospitalization.
 100% for diagnosis (lab test, X-ray, MRI)
 100% coverage on prescription drugs.
 80% coverage outside the network
 Outpatient physiotherapy.
 Herbal medicines and vitamins on deficiency
 Enhanced network
 Toll free number (24/7 service)
 Local provider.

SPIE OIL & GAS SERVICES EQUATION FOR PERFORMANCE


Not Covered

× Vision: consultation, eye test, refraction and optical expenses


× Dental: preventive and surgical treatment

SPIE OIL & GAS SERVICES EQUATION FOR PERFORMANCE

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