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

FAQ’s

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. No age limit for a dependant who is physically or mentally handicapped and 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 has 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 only offering Health insurance solutions to corporate.

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

Maternity coverage is an optional cover that is opted 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 female aging from 15 to 50 years old. If the benefit is not available for your current plan if can’t be added 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 old applicable only for married females.

7. Is Caesarean Section covered?

Yes, if the 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 in 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 preapproval from QLM. Following are some examples for services that require preapproval:

  • 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 in-patient” treatment are approved by QLM before any planned treatment is undertaken. Planned inpatient treatment availed without pre-authorization from QLM may not be eligible for a full refund in accordance with the policy terms and conditions, hence, seeking a prior approval from QLM is recommended to know whether or not the planned treatment is covered and how much will be covered.

13. How can I get a pre-approval?

Answer:

    • Network provider: Our service provider will arrange for the preapprovals on your behalf.
    • Non network provider: Send all the medical reports to QLM via “Claims/Preapproval Submission” section of this application or through e-mail.

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 “subject to remaining maternity balance” and preapproval shall be taken care of by the network provider.
  • Outside Network provider: the claim shall be processed on cash reimbursement basis.

15. What are the required documents to submit a cash-reimbursement claim?

  1. Copy of QLM Health Insurance card
  2. Original Itemized Invoice with dates of services availed
  3. Original Receipt or Payment Proof
  4. Detailed Medical Report / Discharge Summary duly filled out, 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 (elective in-patient services only”

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

Payments can be made either through a cheque or bank transfer based on your preference.

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

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

18. When can I receive the payment of the cash claim?

Payment for cash reimbursement claim will be made within 5 working days from the date of receiving a complete claim documents.

19. How can I get a claim form?

You may download QLM Reimbursement Claim Form through QLM website.

20. In what currency do I get paid?

Qatari Riyals

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

Our website is www.qlm-online.com. You will need to click on “Member” and then enter your Qatari ID# or MEM# which is mentioned on your membership card. That will enable you to get access to all our online services.

22. What should I do in case of medical emergency?

You can seek medical care immediately or speak to our 24/7 call centre to assist you. Wherever possible, please notify us within 24 hours from hospital admission.

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

No. You can visit a specialist or consultant directly.

24. What is covered under Dental Benefit?

Please visit the “Policy” section of the mobile app or visit our online portal and click on “Benefit Limits / Dental Benefit / Sub-benefits”

25. Is dental filling covered?

Please visit the “Policy” section of the mobile app or visit our online portal and click on “Benefit Limits / Dental Benefit / Sub-benefits”

26. Do I need a referral to orthodontist?

No need as long you are covered for orthodontics “except for some policies”

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

Please visit the “Policy” section of the mobile app or visit our online portal and click on “Benefit Limits / Dental Benefit / Sub-benefits”

28. How would I know if the prescribed treatment is covered?

You can always contact us for any clarifications or assistance via “Chat” section of this mobile app or you can contact our call centre on:

  • E-mail: qlm_medical@qlm.com.qa
  • Qatar Toll Free: 800 0880
  • Oman Toll Free: 80070202
  • Outside Qatar: +974 44533666

You can also view the covered benefits through “Policy” section of this app or visit our online portal.

29. Can I get some 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 any out-of-pocket money at the network provider?

An insured has to pay the deductible, co-payment and co-insurance mentioned in the membership card (if any), 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 out of a claim which has to be borne by the Insured person before the relevant benefits are payable under the Policy away from 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 applicable on specific service provider. Kindly refer to the table of benefits for details.

32. What should I do if I lost 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/medications?

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 did not utilize my policy limit this year, can I avail it next policy year?

No. Policy and benefit limits of the previous policy year can’t be carried over for the next policy year.

39. Will I be able to continue availing treatment with my existing doctor if he is not part of QLM preferred network?

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

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

You can visit “Provider” section of this app

41. Does my membership card provide guarantee of cover?

Your membership card is purely a way to identify you, coverage is subject to policy terms.

42. How can I file a complaint?

You can call our call center directly or submit your complaint through this application “Chat Section”. Please go to “About QLM” section for more details.

Chat

You can easily have a real-time chat with QLM team wherever you are. You can check your eligibility, coverage details, balances, claim or preapproval status. Simply speaking, QLM services have become at your fingertips. Interacting with QLM team has never been easier! In few seconds, you can voice your thoughts, file complaints, report abuse activities, or schedule an appointment with your preferred healthcare provider.

Policy

You can easily know the covered benefits, sub-benefits, treatments and exclusions. Moreover, you will come to know the remaining balance in each benefit. Travelling? Download the health certificate for you and your family members. Lost your card? You can show the electronic version of your card to the network provider instantly till you replace it shortly after.

Claims

You are now one click away from submitting and tracking your claims. You just have to shoot your invoices, upload the photos and submit them directly to QLM Claims Department. Money will be deposited into your account within few days! Undergoing an elective in-patient treatment outside QLM providers Network? Spare few minutes to submit a pre-approval request to emphasize the coverage and to know the reimbursable amount.

Providers

Using your GPS function, no matter where you are, QLM will guide you to locate the nearest direct billing providers all over the world with all their relevant details.

Various Services

It is the time to adhere to your medications! You can simply set reminders which will alert you to take your medications at set forth times. You can also know you BMI. Say goodbye to paper files! Now you can create and view your personal health records including visit details, doctor remarks, investigations’ reports and even prescriptions.

Health Tips

Your health matters to us. We will help you maintain healthy lifestyle both physically and psychologically. On daily basis, you will receive valuable health tips which will shape your perspective in various health matters.