QLM Toll Free Qatar: 8000880   Oman: 80070202  Rest of the world: +97444533666  QLM Toll Free Qatar: 8000880   Oman: 80070202  Rest of the world: +97444533666  QLM Toll Free Qatar: 8000880   Oman: 80070202  Rest of the world: +97444533666  QLM Toll Free Qatar: 8000880   Oman: 80070202  Rest of the world: +97444533666  QLM Toll Free Qatar: 8000880   Oman: 80070202  Rest of the world: +97444533666

FAQs

Frequently Asked Questions

1. What is the process if I want to include my Dependents?

Please request your HR Department to include your spouse and child. An eligible child will be covered until the end of the contract year in which he/she reaches age 18 or 23 if a full time student. There is no age limit for a dependant who is physically or mentally handicapped and is unable to live independently.

2. How will I upgrade my insurance coverage into a higher plan?

Upgrading your plan is only allowed if you as a principal member have been promoted from your current post and is eligible for a higher plan according to the new designation. All dependents will be in the same category of the principal insured.

3. Can I get individual insurance coverage?

At present, we are offering Health insurance solutions to corporate customers only.

4. What if I want to include Maternity Coverage into my existing plan?

Maternity coverage is an optional cover that is opted for on the level of the plan/Group. If the plan you are affiliated to is having that additional coverage, automatically maternity will be added to all married insured females aging from 15 to 50 years old. If the benefit is not available for your current plan, if cannot be added later a on selection basis.

5. Can I add my parents to my health insurance policy?

Employee’s spouse and children are the only dependents that can be enrolled in the insurance policy.

6. Is there any age limit for Maternity age for Maternity Coverage?

Yes, from 15 to 50 years and the cover is applicable only for married females.

7. Is Caesarean Section covered?

Yes, if maternity benefit is included in your plan, Caesarean Section will be covered subject to the maternity sub-limit mentioned in the table of benefits.

8. Is Miscarriage covered?

Yes, if the maternity benefit is included in your plan, legal abortion will be covered subject to the maternity sub-limit mentioned in the Table Of Benefits.

9. Are Maternity complications covered?

Yes, if the maternity benefit is included in your plan, maternity complications will be covered subject to the maternity sub-limit mentioned in the Table Of Benefits.

10. If I want to deliver outside the plan’s geographical scope of cover, am I entitled to apply for re-imbursement of the incurred medical cost?

Delivery should be done only within the plan’s geographical scope of cover to be covered by the insurance policy.

11. Is pre-approval mandatory for availing medical treatment inside QLM providers’ network?

QLM approval must be obtained for certain medical procedures/treatments. Healthcare provider bears the responsibility to obtain the pre-approval from QLM. Following are some examples for services that require pre-approval:

  • All hospital admissions and surgical procedures
  • Some outpatient procedures such as: MRI, CT, Endoscopies, physiotherapy.
  • Optional benefits (dental, maternity and optical)

12. Is pre-approval mandatory for availing medical treatment outside QLM providers’ network?

Please ensure that any expenses for non-emergency “elective” inpatient treatment are agreed by QLM in writing i.e. either by fax/e-mail/letter before any planned treatment is undertaken. Planned inpatient treatment availed without pre-authorisation from QLM may not be eligible for a full refund in accordance with the policy terms and conditions.

13. How can I get a pre-approval?

Network Provider: Our service provider will arrange for the pre-approvals on your behalf.

Non-Network provider: Please contact our call centre and they will assist you with this.

14. If I plan to deliver outside Qatar, what is the procedure and the necessary documents required?

If the country where you are planning the delivery is covered within the geographical scope of cover, the arrangement shall be as follows:

  • Inside Network Provider: The arrangement shall be on cashless basis and the preapproval shall be taken by the Network Provider.
  • Outside Network provider: The claim shall be processed on cash reimbursement basis on submission of the following :
  1. Copy of QLM Health Insurance card
  2. Original Itemised Invoice with dates of services availed
  3. Original Receipt or Payment Proof
  4. Detailed Medical Report / Discharge Summary duly filled , signed and stamped by the attending Medical Practitioner
  5. Copy of Investigations’ results (Laboratory / Radiology / Endoscopies, etc.)
  6. Copy of the Prescription
  7. Copy of birth certificate (Maternity)
  8. Proof of availed treatment (Physiotherapy)
  9. QLM preapproval

15. What is the mode of payment for cash-reimbursement claim?

Based on your preference, payments can be made either through a cheque or through a bank transfer.

16. What is the maximum time limit to submit my cash claims/invoices?

Claims should be submitted within 30 days from the date of treatment.

17. When can I receive the payment of the processed claims?

Payment for cash reimbursement of processed claim can be availed within 5 working days from the date of receiving complete claims documents.

18. How can I get a claim form?

You may download QLM Reimbursement Claim Form from QLM’s website.

19. In what currency do I get paid?

All cash reimbursements are made in Qatari Riyals.

20. How can I access QLM’s e-service online facility?

Please visit www.qlm-online.com and click on “Member” tab and enter your Qatari ID# or Membership# which is mentioned on your membership card. This will enable you to get access to all our online services.

21. What should I do in case of a medical emergency?

You can seek medical care immediately or speak to our 24/7 call centre to assist you with any queries you may have. You would have to notify us within 24 hours of admission to the hospital. Should you be on a trip outside Qatar, you must immediately call the international call centre number printed at the back of your card.

22. Do I need a referral to see a specialist or consultant?

You can access a specialist or consultant directly.

23. What is covered under Dental Benefit?

Please visit our website and click on Dental “Sub-benefit”to view the Dental benefits.

24. Is dental filling covered?

Please visit our website and click on Dental “Sub-benefit”to view the Dental benefits.

25. Do I need a referral to see an orthodontist?

No need as long you are covered for orthodontics.

26. Is replacement of missing teeth, dentures, bridges and implants covered?

Please visit our website and click on Dental “Sub-benefit”to view the Dental benefits.

27. How will I know if the treatment prescribed for me is covered or not?

You can always contact us for any clarifications or assistance; enquiry and voice message options are enabled through our Mobile App. Alternatively you can contact our call centre at:

E-mail: qlm_medical@qlm.com.qa
TOLL FREE: 800 0880
Outside Qatar: +974 44533666

You can also view the covered benefits in our website.

28. Can I check my plan benefits online?

Certainly, please access our online facility using your Qatari ID # or Membership#.

29. Can I get discount for uncovered services from your network provider?

You may contact our call centre and they will assist you accordingly.

30. Do I have to pay for any out-of-pocket expenses at the Provider?

The Insured will have to pay the deductible, co-payment and co-insurance (if any) as has been mentioned in the membership card. For more information, please refer to the Table Of Benefits.

31. What is the difference between co-payment, deductible & co-insurance?

Deductible is the amount of a claim which has to be borne by the Insured before the relevant benefits are payable under the Policy apart from the optional
benefits.

  • Co-payment is the percentage of costs the Insured must pay related to Dental, Optical & Maternity related treatments.
  • Co-insurance is the percentage of patient share applicable for Cash reimbursement claims or specific service provider. Kindly refer to the Table Of Benefits for details.

32. What should I do if I lose my membership card?

You will need to notify your HR department to ask for a replacement. A replacement fee will be levied.

33. Is vaccination covered?

Please refer to your Table of Benefits.

34. Is health check-up covered?

Please refer to your Table of Benefits.

35. Are vitamins covered?

Please refer to your Table of Benefits.

36. Does my policy cover chronic treatment/medication?

Please refer to your Table of Benefits.

37. Does my policy cover preventive treatment/services?

The sole purpose of this policy is to treat and cure existing medical conditions; hence preventive measures are not covered.

38. If I do not utilise my policy limit this year, can I use it in the next policy year?

Policy limit of the previous policy year cannot be carried over for the next policy year.

39. Can I continue availing treatment from my existing doctor if he is not a part of your preferred network?

Yes you can. Please submit the claim for cash reimbursement.

40. How can I find the nearest hospital or specialists?

You can use “Find Provider” feature in QLM Mobile App.

41. Does my membership card provide guarantee of cover?

Your membership card is purely a way to identify you and the payment capability is subject to the coverage of the policy.