Premier Healthcare Plan

INTRODUCTION

The provision of a Healthcare Scheme is the most important provision for your Employees and it means that you can ensure you receive quality healthcare and medical attention promptly and choose where you receive it.

This information is to help you and your Families make better use of the Employees' Scheme available and answer many of the healthcare questions you will have.

TYPES OF PLANS

Covers you on worldwide basis up to the limit of BD 25,000. This Plan is one of the top of the range catering for almost all of your medical requirements including wellness check-up and direct billing with most well reputed hospitals in Bahrain. Specifically tailored for people frequently travel globally.

Covers you on worldwide basis excluding USA and Canada up to the limit of BD 15,000. This Plan is one of the top of the range catering all most all of your medical requirements including wellness check-up and direct billing with most well reputed hospitals in Bahrain with less annual limit and reduced other benefits to fit with your budget.

Covers you in GCC, Middle East and Asian Countries up to the limit of BD 10,000. This Plan is a basic Plan for those seeking to meet with their medical requirements in GCC and Asian Countries with affordable premium. Members can travel and can obtain treatment within the area of cover on selective basis.

Covers you only in Bahrain up to the limit of BD 5,000 with very affordable cost and direct billing facility from day one.

BENEFITS EXPLAINED

If during the period of insurance an Insured Person suffers from an accident, injury, illness, sickness or disease, we, under the Terms and Conditions of the Policy, will pay necessary, customary and reasonable expenses per Person per year up to a maximum of what is stated in your Schedule of Benefits.

MAIN BENEFITS

Direct Billing Facility: A facility under which we will pay to the Designated Healthcare Providers (i.e. our network of hospitals, clinics and pharmacies) the cost of treatment on behalf of our Insured Members. Clients can use Membership Cards, issued to them by bnl, to obtain treatment from the Designated Healthcare Providers.

In-Patient and Daycare Treatment: In-patient and daycare treatment including all Consultants, Surgeons, Physicians and Anaesthetist’s fees or charges, diagnostic tests and procedures and physiotherapy.

Out-Patient Treatment: Out-patient treatment including consultations, diagnostic tests and procedures, prescribed medicines, physiotherapy and out-patient surgical operations.

Emergency Treatment Abroad: This Benefit is available to all of our Insured Members or Policyholders. Cover is applicable worldwide excluding USA and Canada.

Non-Emergency Treatment Abroad: This Benefit is available but is subject to pre-authorization and we will:

  • Provide a full refund if treatment is not available in Bahrain and recommended by Bahrain Medical Authorities.
  • Refund the cost up to the reasonable and customary charges applicable in Bahrain or whichever is lower, if Insured Member opts to receive treatment outside Bahrain at his/her own option.

Radiotherapy and Chemotherapy: Radiotherapy treatment of disease by ionising radiation. Chemotherapy treatment of disease by means of chemicals.

Chronic Conditions: Maintenance, palliative treatment and prescribed medications.

Ambulance Service: Emergency transport to the nearest hospital or Centre of treatment.

Nursing at Home: Primary care services of a Registered Nurse in the Insured Person's home following in-patient treatment for a maximum of 14 days.

Tele-Medicine: Tele-Medicine provides world-class second medical opinions and treatment plans electronically from the best medical centres in North America for life threatening illnesses (serious and critical) utilizing advanced and secured telecommunications technology.

This service can be requested when you and your Doctor decide a second medical opinion would be helpful in situations like:

  • You have a serious diagnosis and want to be reassured.
  • When you and or your Doctor have additional medical questions.
  • When you have a choice of treatment options.
  • When you are facing a high-risk surgery.
  • When you have a multiple medical problem.
  • When your Physician wants to be certain that there is no better solution available.

This service can be utilized for a maximum of 2 e-consultations per Member per policy period.

Repatriation of Mortal Remains: In the event of death, the costs of air transportation of the mortal remains of an Insured Member, from the place of death to the country of origin or Bahrain. Excluding death in the country of origin.

ADDITIONAL BENEFITS

Routine Dental Treatment: Coverage includes consultations, x-rays, cleaning twice a year, fillings, extractions, root canal and gum infection. Excludes gum infection due to insufficient oral hygiene, inlays, mouthguards, bridges, crowns, orthodontic and other cosmetic treatment.

Pre-existing Conditions: Any medical condition which the Insured Member had or suffered from prior to the attachment date of the Policy, whether known or unknown to the Insured Member or consulted with a Medical Practitioner.

Maternity: Applicable to all eligible females aged from 18 up to 45 years. Coverage available is for pre and post-natal care, normal and abnormal delivery, caesarian and legal abortion, hospital service and standard laboratory tests for new-born babies.

Optical: Coverage includes vision tests for errors of refraction (eye examinations), lenses for spectacles (eye glasses). Excludes spectacle frames and contact lenses.

AREAS OF COVER

The geographical area where treatment may be received is stated in the Policy Schedule.

PLAN LIMITS

The total overall limits that may be claimed by a Member. Such limits are stated in the Schedule of Benefits.

A FEW IMPORTANT POINTS

Remember that you must go to hospital/clinic only when you have an ailment requiring medical attention. If you simply go for a medical check-up and nothing is diagnosed, then this is not a valid Claim and is not admissible.

Take note that many non-essential hospital bills are not covered for example:-
  • Telephone calls.
  • The cost of a Relative or a Friend staying the night in the hospital, additional Video hire charges, etc.
  • Purchase of flowers and other gifts.
  • Any other bills not related to the treatment.
 
Non-essential treatment would include for example:
  • General check-ups.
  • Saunas.
  • Cosmetic surgery/treatment.
 
FLOWCHART FOR AVAILING TREATMENT
 

Direct billing within Network

Non-direct billing Claims (reimbursement)

Make appointment informing nature of treatment required and provide Insurer’s name and Membership Card number.  Confirm that any pre-authorization required for the treatment is obtained by the hospital from the Insurer

Carry Claim Form and present to Reception at hospital/clinic for completion by the treating Doctor

Show Membership Card to Provider’s Insurance Reception on the day of treatment

Avail treatments required and ensure that the Doctor has filled and stamped the Claim Form

Proceed to Doctor and sign the Claim Form after consulting with the Doctor

Pay for the treatment and medication, obtain original receipts, prescription and test results/reports

Proceed to Insurance Cashier, pay deductible and pay for any treatment/medication not covered (if applicable)

Fill out the patient part of the Claim Form and prepare a Claim with all original support documents

Collect receipt and invoice copy and proceed to lab and/or pharmacy to collect medicine

Submit the Claim to your Company’s HR Department that you work at if you are covered by a Company

 
DOCUMENTARY EVIDENCE REQUIRED TO PROCEED WITH APPLICATION