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QATAR CARE : PLAN SUMMARY

Right and responsibilities:

  • The contract : The plan is a contract between the sponsoring organization (who is named on the insurance policy) and QIC, The contract consists of:
    • a Group Membership Guide; And
    • an insurance policy and any exclusions or limitations in treatment or benefits that are specific to the member and his/her dependants included in the           membership.
    • If the wording of these is different, the insurance policy applies first, followed by  the Membership Guide.
  • Membership eligibility: This rules apply to members and their dependants:
    • you must be under 65 years old at the date you join in order to be covered under this group scheme.
    • Your dependants must be covered under the same plan benefits you have as the insured person.
    • We must receive premiums before the start date or due date of your cover.
  • Renewing your cover: This plan is a one-year contract that the sponsoring organization can renew, each year on the anniversary of the start date (the premium rates in force at the time you renew, and any changes we have given you notice of in writing, will apply). We will renew the plan when the sponsoring organization pays us the premium.
  • Ending your cover: We may end cover for the insured person and his/her dependants in the following situations. If the insured person, sponsoring organization or their dependants:
    • Withhold relevant information
    • Gives us incorrect information in the application form.
    • Makes any false or fraudulent claim.
    • Fail to provide any reasonable information we have asked for.
    • The sponsoring organization confirms that the insured person is no longer eligible for group membership or fails to pay the premium due on or before the anniversary date of the contract (or as agreed).
  • The sponsoring organization is responsible for telling the member immediately if insurance cover has been cancelled.
    ? We may decide to discontinue the plan or any part of it, or if the plan no longer meets current legislation. We have reserved the right to alter the terms of membership and the contract at any time.
NOTES ON BENEFITS:
  • As with any insurance contracts, there are conditions attached to claiming benefits, so please look carefully at the Benefits Table and notes.
  • We cannot pay any benefits if the plan is not in force or the premiums are not paid up to date at the time the member has his/her treatment.
  • There is an overall maximum benefits for each and insured person in each policy period as set forth in the schedule of the policy benefits.
  • We will work out the benefits in the same currency in which your premium is paid (that is, Qatari reiyal).
  • Benefits are limited to the usual and reasonable charges in the State of Qatar or in the area within the territorial scope of cover where the treatment is provided.
  • Before you are admitted to a hospital for planned in-patient treatment, you must get QIC pre-authorization/ prior approval before.
  • We may make reasonable request for information or proof to support your claim. You must supply any such information or proof of claim.

EXCLUSIONS:

The following services, medical conditions, activities, and their related expenses are not benefits that we cover under this plan.

  1. All Pre-existing conditions, unless agreed otherwise in your Schedule of benefits.
  2. Services, accommodation or treatment charges incurred in health hydrous, spas, nature cure clinics, rest homes or any similar place even if it is registered as a hospital. Residential stay in a hospital or any similar institution arranged wholly or partly for domestic reasons and which is not directly related to treatment, or beyond the period required for recovery from treatment.
  3. Routine medical examinations or check-ups, routine eye and ear examination, optometric examinations (vision tests) spectacles, contact lenses and correction of vision, vaccinations, inoculations, medical certificates and examination for residence, employment or travel. Dental and/or orthodontic treatment unless listed in the Table of Benefits.
  4. Elective/Cosmetic treatment or circumcision unless medically necessary and pre-authorized by the Insurers.
  5. Tests or treatment related to contraception, or sterilization, infertility, impotence, sexual dysfunction, or any similar condition.
  6. Birth defects, congenital illness or hereditary conditions, maternity examinations/complications and any treatment/condition related to or caused by pregnancy and childbirth, unless listed in the Table of Benefits.
  7. Hormone treatment therapy (HRT), unless carried out as part of, or immediately after a surgical procedure which is covered under the Table of Benefits to this plan.
  8. Any treatment or test, second or subsequent opinion for which the required Insurer’s pre-authorization is not obtained.
  9. Benefits recoverable under Workmen’s Compensation Act Insurance.
  10. Kidney Dialysis other than in the case of acute reversible kidney failure.
  11. Claims directly or indirectly. Occasioned by, happening through, or in consequence of, aviation, other than as a fare paying passenger in a fully certified passenger carrying aircraft, flown in the course of licensed operation for the transportation of passengers by properly licensed crew.
  12. Treatment of speech and voice problems.
    Loss of hearing unless caused by a medical condition covered under the policy, hearing aids, ear and body piercing.
  13. Any medical prescription relative to a special diet, weight control, children’s food, baby supplies or vitamin/mineral supplements.
  14. All Maternity related benefits unless provided for under the plan and listed in the Table of Benefits.
  15. All dental related services or treatment other than those covered under the eligible expenses and not occasioned by violent external means, Dental charges relating to prosthesis and false teeth are excluded howsoever caused,
  16. Experimental unproven treatment or drug therapy.
  17. Kidney dialysis, Pap smear and mammogram.
  18. Treatment for anorexia, anxiety, insomnia, homesickness, loss of appetite,
  19. Medical Practitioner fees for the completion of a claim form or other administration charges.
  20. Investigations into and treatment of obesity, Acne, Acne form eruptions, Alopecia, wigs and/or toupee.
  21. Sex change operations and related treatments.
  22. Expenses incurred as a result alcohol or drug abuse.
  23. Expenses incurred because of complications directly caused by an illness, injury or treatment for which cover is excluded or limited under your plan.
  24. Treatment of Mental Illness and Psychiatric and Development disorder.
  25. Any treatment or test for Acquired Immune Deficiency Syndrome (AIDS) and AIDS / HIV related conditions; or sexually transmitted diseases, self inflicted injury, suicide, alcohol or drug addiction/abuse.
  26. Treatments resulting from racing of any form other than on foot and professional participation in hazardous Sports.
  27. Treatment for any illnesses, diseases or injuries resulting from Active Participation in war, riots, civil disturbances, terrorism, acts against any foreign hostility, whether war has been declared or not treatment for any medical conditions arising directly or indirectly from chemical contamination, Radioactivity or any Nuclear Material whatsoever, including the combustion of Nuclear Fuel.
  28. Unless otherwise provided for under the plan and listed in the Table of Benefits, treatment of Chronic conditions including palliative treatment. However the Insurers will pay for the initial consultation and investigations that may be required to diagnose the condition and for the stabilization of acute exacerbations of the Chronic Condition.
  29. All vaccinations and routine or preventive medical examinations including routine follow up consultations.
  30. Treatment received outside the territorial limits described in the Table of Benefits and/or expenses incurred where the Insured has traveled against medical advice.
  31. Costs incurred in connection with locating or the acquisition of a replacement organ/tissues or any costs incurred for removal of the organ from the donor, transportation costs of same and all associated administration costs.
  32. Prosthesis, Corrective devices and medical appliances that are not surgically required, including hearing aids and/or any substance not considered a medicine such as, but not limited to vitamins, tonics, slimming pills, scalp and hair lotions and shampoos.
  33. Complementary medicine applications such as Chiropractic and Osteopathy, unless recommended by a medical practitioner and subject to prior approval of the Insurers.
  34. Treatment of any allergic condition or disorder. However, the initial visit to diagnose an allergy will be covered.

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