Medical Practitioner. A person who has full registration under the Medical Acts of the country where they practice and who specialises in nursing, homeopathy, acupuncture, orthopaedic medicine, traditional Chinese medicine, osteopathy, chiropractic, chiropody, podiatry or physiotherapy treatment, and to whom you have been referred by a medical doctor. Medical referral letter A letter from your medical doctor or specialist which refers you to another medical practitioner for treatment covered by your plan. We will only pay for treatment when the start date of your treatment is within 3 months of the date of your medical referral letter. Medical services provider(s) A hospital, out-patient clinic, medical practitioner, dental practitioner, optician or pharmacy that is part of the medical network you are entitled to use for treatment covered by your plan. The medical network you are entitled to use is stated on your Certificate of Insurance, network card or smartphone application. Medical underwriting The process of you providing and us assessing the health and medical information we ask for to decide the terms under which we will accept your application for cover, or for enhanced cover. Based on the information you give us, we may decide to place special terms on your cover. Network card Your personal membership card that will state your plan type and the NextCare network you are entitled to use. It will also state any excess that applies to your plan. Out-of-network penalty The additional co-insurance we will apply to your claim settlement amount when you receive your treatment at a medical services provider that you are not entitled to use. Out-patient A patient who attends a hospital consulting room, emergency room or out-patient clinic, when it is not medically necessary for them to be admitted as a day-patient or an in-patient. Out-patient surgical procedure An out-patient procedure where one or more of the following is medically necessary: - • general or local anaesthesia or intravenous sedation • manipulation or relocation of a fractured bone or dislocated joint by a medical doctor • invasive surgical procedures • invasive diagnostic procedures involving venous cannulation • the use of endoscopic equipment Period of cover A period of 12 months from your date of entry or from any subsequent renewal date. Your period of cover is as shown on your Certificate of Insurance.
Appears in 2 contracts
Samples: Business Health Plan Agreement, Health Plan Agreement
Medical Practitioner. A person who has full registration under the Medical Acts of the country where they practice and who specialises in nursing, homeopathy, acupuncture, orthopaedic medicine, traditional Chinese medicine, osteopathy, chiropractic, chiropody, podiatry or physiotherapy treatment, and to whom you have been referred by a medical doctor. Medical referral letter A letter from your medical doctor or specialist which refers you to another medical practitioner for treatment covered by your plan. We will only pay for treatment when the start date of your treatment is within 3 months of the date of your medical referral letter. Medical services provider(s) A hospital, out-patient clinic, medical practitioner, dental practitioner, practitioner optician or pharmacy that is part of the medical network you are entitled to use for treatment covered by your plan. The medical network you are entitled to use is stated on your Certificate of Insurance, network card or smartphone applicationpharmacy. Medical underwriting The process of you providing and us assessing the health and medical information we ask for to decide the terms under which we will accept your application for cover, or for enhanced cover. Based on the information you give us, we may decide to place special terms on your cover. Network NextCare network card Your personal membership card that will state your plan type and the NextCare network you are entitled to use. It will also state any excess that applies to your plan. NextCare network provider A medical service provider which is part of the NextCare network of medical service providers you are entitled to use for treatment that is covered by your plan. The NextCare network of medical service providers you are entitled to use is as stated on your certificate of insurance and on your NextCare network card. Out-of-network penalty The additional co-insurance we will apply to your claim settlement amount when you receive have your treatment at a medical services provider that who is not a NextCare network provider you are not entitled to use. Out-patient A patient who attends a hospital consulting room, emergency room or out-patient clinic, when it is not medically necessary for them to be admitted as a day-patient or an in-patient. Out-patient surgical procedure An out-patient procedure where one or more of the following is medically necessary: - • general or local anaesthesia or intravenous sedation • manipulation or relocation of a fractured bone or dislocated joint by a medical doctor • invasive surgical procedures • invasive diagnostic procedures involving venous intra-arterial cannulation • the use of endoscopic equipment Period of cover A period of 12 months from your date of entry or from any subsequent renewal date. Your period of cover is as shown on your Certificate certificate of Insuranceinsurance. Plan or plan type The Silver plan or Gold plan or the Dubai Primary Benefits plan on which you and your eligible dependants are covered. Plan holder The person stated as the plan holder on your certificate of insurance. Planned caesarean section A caesarean section which has been scheduled to take place more than 24 hours in advance, whether this be for medical or elective reasons. Post-hospital treatment Medically necessary follow-up consultations, physiotherapy, diagnostic tests and/or treatment required on an out-patient basis following in-patient or day-patient treatment covered by your plan and received within the 90 day period following the date you are discharged from hospital. Pre-admission tests An out-patient assessment during which your health is assessed in order to confirm that you are medically fit to undergo the planned treatment and that you are sufficiently prepared for it. The assessment may include an electrocardiogram, blood and/or urine tests and a chest x-ray. Pre-existing medical conditions Any disease, illness or injury, whether the condition has been diagnosed or not before your date of entry, for which: • you have received medication, advice or treatment; or • you have experienced symptoms Premium The amount(s) you are required to pay to us annually for your insurance plan. Premium due date The date on which your premium is due to be paid. Preventive health checks Health tests, screening and/or clinical procedures specifically designed for disease prevention and early detection. Preventive health services (DHA) Preventive services stipulated by the Dubai Health Authority, including initial diabetes screening. Qualified nurse A nurse whose name is currently on any official register of nurses maintained by a statutory nursing registration body within the country where treatment is provided. Reasonable and customary The charge that would typically be made for your treatment by medical services providers in the country where you receive your treatment, and for the medically necessary length of stay required. If the cost of your treatment is not reasonable and customary, we will only pay up to the amount which is typically charged in that country. If the length of stay is not reasonable and customary, we will only pay for the medically necessary length of stay required. In the event of a dispute, we will identify the amount typically charged for your treatment by obtaining comparable quotations from three other medical services providers in the country where you receive your treatment, and taking a mean average of these three quotations. Rehabilitation Treatment in the form of a combination of therapies such as physical, occupational and speech therapy aimed at restoring full function after an acute event such as a stroke. Rehabilitation hospital or unit A medical facility licensed under the regulations of the country in which it operates and designed for patients who no longer need acute hospital care but who still require medical or nursing supervision and/or assistance with activities of daily living because of their medical disability. Related condition Any disease, illness or injury that is caused by a pre-existing medical condition or results from the same underlying cause as a pre-existing medical condition. Renewal date The anniversary date of your plan as shown on your certificate of insurance, normally the anniversary of your original date of entry to the plan. Restricted Network 3 The medical services providers listed as being within NextCare’s Restricted Network 3. For a list of these medical services providers go to xxxxxxxxxxxxxx.xxx.
Appears in 1 contract
Samples: Elite Health
Medical Practitioner. A person who has full registration under the Medical Acts of the country where they practice and who specialises in nursing, homeopathy, acupuncture, orthopaedic medicine, traditional Chinese medicine, osteopathy, chiropractic, chiropody, podiatry or physiotherapy treatment, and to whom you have been referred by a medical doctor. Medical referral letter A letter from your medical doctor or specialist which refers you to another medical practitioner for treatment covered by your plan. We will only pay for treatment when the start date of your treatment is within 3 months of the date of your medical referral letter. Medical services provider(s) A hospital, out-patient clinic, medical practitioner, dental practitioner, practitioner optician or pharmacy that is part of the medical network you are entitled to use for treatment covered by your plan. The medical network you are entitled to use is stated on your Certificate of Insurance, network card or smartphone applicationpharmacy. Medical underwriting The process of you providing and us assessing the health and medical information we ask for to decide the terms under which we will accept your application for cover, or for enhanced cover. Based on the information you give us, we may decide to place special terms on your cover. Network Neuron network card Your personal Global Health Elite membership card that will state your plan type and the NextCare Neuron network you are entitled to use. It will also state any excess that applies to your plan. Out-of-Neuron network provider A medical service provider which is part of the Neuron network of medical service providers you are entitled to use for treatment that is covered by your plan. The Neuron network of medical service providers you are entitled to use is as stated on your certificate of insurance and on your Neuron network card. Out of network penalty The additional co-insurance we will apply to your claim settlement amount when you receive have your treatment at a medical services provider that who is not a Neuron network provider you are not entitled to use. Out-patient A patient who attends a hospital consulting room, emergency room or out-patient clinic, when it is not medically necessary for them to be admitted as a day-patient or an in-patient. Out-patient surgical procedure An out-patient procedure where one or more of the following is medically necessary: - • general or local anaesthesia or intravenous sedation • manipulation or relocation of a fractured bone or dislocated joint by a medical doctor • invasive surgical procedures • invasive diagnostic procedures involving venous intra-arterial cannulation • the use of endoscopic equipment Period of cover A period of 12 months from your date of entry or from any subsequent renewal date. Your period of cover is as shown on your Certificate certificate of Insuranceinsurance. Plan/Plan type The Corporate Global Health Elite Silver plan, or Elite Gold plan or the Dubai Primary Benefits plan on which you and your eligible dependants are covered. Plan holder The company or employer as stated on your certificate of insurance. Planned caesarean section A caesarean section which has been scheduled to take place more than 24 hours in advance, whether this be for medical or elective reasons. Post-hospital treatment Medically necessary follow-up consultations, physiotherapy, diagnostic tests and/or treatment required on an out-patient basis following in-patient or day-patient treatment covered by your plan and received within the 90 day period following the date you are discharged from hospital. Pre-admission tests An out-patient assessment during which your health is assessed in order to confirm that you are medically fit to undergo the planned treatment and that you are sufficiently prepared for it. The assessment may include an electrocardiogram, blood and/or urine tests and a chest x-ray. Pre-existing medical conditions Any disease, illness or injury, whether the condition has been diagnosed or not before your date of entry, for which: • you have received medication, advice or treatment; or • you have experienced symptoms Premium The amount(s) your employer is required to pay to us annually for your insurance plan. Premium due date The date on which your premium is due to be paid by your employer. Preventive health checks Health tests, screening and/or clinical procedures specifically designed for disease prevention and early detection. Preventive health services (DHA) Preventive services stipulated by the Dubai Health Authority, including initial diabetes screening. Qualified nurse A nurse whose name is currently on any official register of nurses maintained by a statutory nursing registration body within the country where treatment is provided. Reasonable and customary The charge that would typically be made for your treatment by medical service providers in the country where you receive your treatment. If the cost of your treatment is not reasonable and customary, we will only pay up to the amount which is typically charged in that country. In the event of a dispute, we will identify the amount typically charged for your treatment by medical service providers in the country where you receive it, by obtaining three quotations and taking a mean average of these three quotations. Rehabilitation Treatment in the form of a combination of therapies such as physical, occupational and speech therapy aimed at restoring full function after an acute event such as a stroke. Rehabilitation hospital or unit A medical facility licensed under the regulations of the country in which it operates and designed for patients who no longer need acute hospital care but who still require medical or nursing supervision and/or assistance with activities of daily living because of their medical disability. Related condition Any disease, illness or injury that is caused by a pre-existing medical condition or results from the same underlying cause as a pre-existing condition. Renewal date The renewal date of your employer’s plan as shown on your certificate of insurance.
Appears in 1 contract
Samples: Global Health Elite Plan Agreement
Medical Practitioner. A person who has full registration under the Medical Acts of the country where they practice and who specialises in nursing, homeopathy, acupuncture, orthopaedic medicine, traditional Chinese medicine, osteopathy, chiropractic, chiropody, podiatry podiatry, or physiotherapy treatment, and to whom you have been referred by a medical doctor. Medical referral letter A letter from your medical doctor or specialist which refers you to another medical practitioner for treatment covered by your plan. We will only pay for treatment when the start date of your treatment is within 3 months of the date of your medical referral letter. Medical services provider(s) provider A hospital, out-patient clinic, medical practitioner, dental practitioner, optician or pharmacy that is part of the medical network you are entitled to use for treatment covered by your plan. The medical network you are entitled to use is stated on your Certificate certificate of Insurance, insurance and your network card or smartphone applicationcard. Medical underwriting The process of you providing and us assessing the health and medical information we ask for to decide the terms under which we will accept your application for cover, or for enhanced cover. Based on the information you give us, we may decide to place special terms on your cover. Network card Your personal membership card that will state your plan type and the NextCare network you are entitled to use. It will also state any excess that applies to your plan. Out-of-network penalty The additional co-insurance we will apply to your claim settlement amount when you receive have your treatment at a medical services provider that you are not entitled to use. Out-patient A patient who attends a hospital consulting room, emergency room or out-patient clinic, when it is not medically necessary for them to be admitted as a day-patient or an in-patient. Out-patient surgical procedure An out-patient procedure where one or more of the following is medically necessary: - • general or local anaesthesia or intravenous sedation • manipulation or relocation of a fractured bone or dislocated joint by a medical doctor • invasive surgical procedures • invasive diagnostic procedures involving venous cannulation • the use of endoscopic equipment Period of cover A period of 12 months from your date of entry or from any subsequent renewal date. Your period of cover is as shown on your Certificate certificate of Insuranceinsurance.
Appears in 1 contract
Medical Practitioner. A person who has full registration under the Medical Acts of the country where they practice and who specialises in nursing, homeopathy, acupuncture, orthopaedic medicine, traditional Chinese medicine, osteopathy, chiropractic, chiropody, podiatry or physiotherapy treatment, and to whom you have been referred by a medical doctor. Medical referral letter A letter from your medical doctor or specialist which refers you to another medical practitioner for treatment covered by your plan. We will only pay for treatment when the start date of your treatment is within 3 months of the date of your medical referral letter. Medical services provider(s) A hospital, out-patient clinic, medical practitioner, dental practitioner, practitioner optician or pharmacy that is part of the medical network you are entitled to use for treatment covered by your plan. The medical network you are entitled to use is stated on your Certificate of Insurance, network card or smartphone applicationpharmacy. Medical underwriting The process of you providing and us assessing the health and medical information we ask for to decide the terms under which we will accept your application for cover, or for enhanced cover. Based on the information you give us, we may decide to place special terms on your cover. Network NextCare network card Your personal membership card that will state your plan type and the NextCare network you are entitled to use. It will also state any excess that applies to your plan. NextCare network provider A medical service provider which is part of the NextCare network of medical service providers you are entitled to use for treatment that is covered by your plan. The NextCare network of medical service providers you are entitled to use is as stated on your certificate of insurance and on your NextCare network card. Out-of-network penalty The additional co-insurance we will apply to your claim settlement amount when you receive have your treatment at a medical services provider that who is not a NextCare network provider you are not entitled to use. Out-patient A patient who attends a hospital consulting room, emergency room or out-patient clinic, when it is not medically necessary for them to be admitted as a day-patient or an in-patient. Out-patient surgical procedure An out-patient procedure where one or more of the following is medically necessary: - • general or local anaesthesia or intravenous sedation • manipulation or relocation of a fractured bone or dislocated joint by a medical doctor • invasive surgical procedures • invasive diagnostic procedures involving venous intra-arterial cannulation • the use of endoscopic equipment Period of cover A period of 12 months from your date of entry or from any subsequent renewal date. Your period of cover is as shown on your Certificate certificate of Insuranceinsurance. Plan or plan type The Elite Silver plan, or Elite Gold plan or the Dubai Primary Benefits plan on which you and your eligible dependants are covered. Plan holder The company or employer as stated on your certificate of insurance. Planned caesarean section A caesarean section which has been scheduled to take place more than 24 hours in advance, whether this be for medical or elective reasons. Post-hospital treatment Medically necessary follow-up consultations, physiotherapy, diagnostic tests and/or treatment required on an out-patient basis following in-patient or day-patient treatment covered by your plan and received within the 90 day period following the date you are discharged from hospital. Pre-admission tests An out-patient assessment during which your health is assessed in order to confirm that you are medically fit to undergo the planned treatment and that you are sufficiently prepared for it. The assessment may include an electrocardiogram, blood and/or urine tests and a chest x-ray. Pre-existing medical conditions Any disease, illness or injury, whether the condition has been diagnosed or not before your date of entry, for which: • you have received medication, advice or treatment; or • you have experienced symptoms Premium The amount(s) your employer is required to pay to us annually for your insurance plan. Premium due date The date on which your premium is due to be paid by your employer. Preventive health checks Health tests, screening and/or clinical procedures specifically designed for disease prevention and early detection. Preventive health services (DHA) Preventive services stipulated by the Dubai Health Authority, including initial diabetes screening. Qualified nurse A nurse whose name is currently on any official register of nurses maintained by a statutory nursing registration body within the country where treatment is provided. Reasonable and customary The charge that would typically be made for your treatment by medical services providers in the country where you receive your treatment, and for the medically necessary length of stay required. If the cost of your treatment is not reasonable and customary, we will only pay up to the amount which is typically charged in that country. If the length of stay is not reasonable and customary, we will only pay for the medically necessary length of stay required. In the event of a dispute, we will identify the amount typically charged for your treatment by obtaining comparable quotations from three other medical services providers in the country where you receive your treatment, and taking a mean average of these three quotations. Rehabilitation Treatment in the form of a combination of therapies such as physical, occupational and speech therapy aimed at restoring full function after an acute event such as a stroke. Rehabilitation hospital or unit A medical facility licensed under the regulations of the country in which it operates and designed for patients who no longer need acute hospital care but who still require medical or nursing supervision and/or assistance with activities of daily living because of their medical disability. Related condition Any disease, illness or injury that is caused by a pre-existing medical condition or results from the same underlying cause as a pre-existing medical condition. Renewal date The renewal date of your employer’s plan as shown on your certificate of insurance. Restricted Network 3 The medical services providers listed as being within NextCare’s Restricted Network 3. For a list of these medical services providers go to xxxxxxxxxxxxxx.xxx.
Appears in 1 contract
Samples: Elite Health
Medical Practitioner. A person who has full registration under the Medical Acts of the country where they practice and who specialises in nursing, homeopathy, acupuncture, orthopaedic medicine, traditional Chinese medicine, osteopathy, chiropractic, chiropody, podiatry podiatry, or physiotherapy treatment, and to whom you have been referred by a medical doctor. Medical referral letter A letter from your medical doctor or specialist which refers you to another medical practitioner for treatment covered by your plan. We will only pay for treatment when the start date of your treatment is within 3 months of the date of your medical referral letter. Medical services provider(s) A hospital, out-patient clinic, medical practitioner, dental practitioner, optician or pharmacy that is part of the medical network you are entitled to use for treatment covered by your plan. The medical network you are entitled to use is stated on your Certificate of Insurance, network card or smartphone applicationpharmacy. Medical underwriting The process of you providing and us assessing the health and medical information we ask for to decide the terms under which we will accept your application for cover, or for enhanced cover. Based on the information you give us, we may decide to place special terms on your cover. Network NextCare network card Your personal Global Health Foundation membership card that will state your plan type and the NextCare network you are entitled to use. It will also state any excess that applies to your plan. Out-of-NextCare network provider A medical service provider which is part of the NextCare network of medical service providers you are entitled to use for treatment that is covered by your plan. The NextCare network of medical service providers you are entitled to use is as stated on your certificate of insurance and on your NextCare network card. Out of network penalty The additional co-insurance we will apply to your claim settlement amount when you receive have your treatment at a medical services provider that who is not a NextCare network provider you are not entitled to use. Out-patient A patient who attends a hospital consulting room, emergency room or out-patient clinic, when it is not medically necessary for them to be admitted as a day-patient or an in-patient. Out-patient surgical procedure An out-patient procedure where one or more of the following is medically necessary: - • general or local anaesthesia or intravenous sedation • manipulation or relocation of a fractured bone or dislocated joint by a medical doctor • invasive surgical procedures • invasive diagnostic procedures involving venous intra-arterial cannulation • the use of endoscopic equipment Period of cover A period of 12 months from your date of entry or from any subsequent renewal date. Your period of cover is as shown on your Certificate certificate of Insuranceinsurance. Plan/Plan type The Corporate Global Health Foundation plan, or Foundation Plus plan, or the Dubai Primary Benefits plan on which you and your eligible dependants are covered. Plan holder The company or employer as stated on your certificate of insurance. Planned caesarean section A caesarean section which has been scheduled to take place more than 24 hours in advance, whether this be for medical or elective reasons. Post-hospital treatment Medically necessary follow-up consultations, physiotherapy, diagnostic tests and/or treatment required on an out-patient basis following in-patient or day-patient treatment covered by your plan and received within the 90 day period following the date you are discharged from hospital. Pre-existing medical conditions Any disease, illness or injury, whether the condition has been diagnosed or not before your date of entry, for which: • you have received medication, advice or treatment; or • you have experienced symptoms Premium The amount(s) your employer is required to pay to us annually for your insurance plan. Premium due date The date on which your premium is due to be paid by your employer. Preventive health checks Health tests, screening and/or clinical procedures specifically designed for disease prevention and early detection. Preventive health services (DHA) Preventive services stipulated by the Dubai Health Authority, including initial diabetes screening. Qualified nurse A nurse whose name is currently on any official register of nurses maintained by a statutory nursing registration body within the country where treatment is provided. Reasonable and customary The charge that would typically be made for your treatment by medical service providers in the country where you receive your treatment. If the cost of your treatment is not reasonable and customary, we will only pay up to the amount which is typically charged in that country. In the event of a dispute, we will identify the amount typically charged for your treatment by medical service providers in the country where you receive it, by obtaining three quotations and taking a mean average of these three quotations. Rehabilitation Treatment in the form of a combination of therapies such as physical, occupational and speech therapy aimed at restoring full function after an acute event such as a stroke. Rehabilitation hospital or unit A medical facility licensed under the regulations of the country in which it operates and designed for patients who no longer need acute hospital care but who still require medical or nursing supervision and/or assistance with activities of daily living because of their medical disability. Related condition Any disease, illness or injury that is caused by a pre-existing medical condition or results from the same underlying cause as a pre-existing condition. Renewal date The renewal date of your employer’s plan as shown on your certificate of insurance. Restricted Network The medical services providers listed as being within NextCare’s Restricted Network. For a list of these medical services providers go to Xxxxxxxxxxxxxx.xxx.
Appears in 1 contract
Medical Practitioner. A person who has full registration under the Medical Acts of the country where they practice and who specialises in nursing, homeopathy, acupuncture, orthopaedic medicine, traditional Chinese medicine, osteopathy, chiropractic, chiropody, podiatry or physiotherapy treatment, and to whom you have been referred by a medical doctor. Medical referral letter A letter from your medical doctor or specialist which refers you to another medical practitioner for treatment covered by your plan. We will only pay for treatment when the start date of your treatment is within 3 months of the date of your medical referral letter. Medical services provider(s) A hospital, out-patient clinic, medical practitioner, dental practitioner, optician or pharmacy that is part underwriting Means we will ask you to complete an application form with a number of the medical network you are entitled to use for treatment covered by questions about your plan. The medical network you are entitled to use is stated on your Certificate current state of Insurance, network card or smartphone application. Medical underwriting The process of you providing and us assessing the health and your medical history. We will assess the information you give us and use it when we ask for to decide the terms under which we will accept your application for cover, or for enhanced increased cover. Based on the information you give us, we may decide to place special terms on your cover. Network card Your , such as personal membership card medical exclusions that will state your plan type and restrict the NextCare network you are entitled to use. It will also state any excess that applies to your plan. Out-of-network penalty The additional co-insurance we will apply to your claim settlement amount when you receive your treatment at a medical services provider cover that you are not entitled to usehave for certain medical conditions. Out-patient A patient who attends a hospital consulting room, emergency room or out-patient clinic, when it is not medically necessary for them to be admitted as a day-patient or an in-patient. Employee Plan Agreement 2015 Out-patient surgical procedure An out-patient procedure where one or more of the following is medically necessary: - • general General or local anaesthesia or intravenous sedation sedation; • manipulation Manipulation or relocation of a fractured bone or dislocated joint by a medical doctor doctor; • invasive Invasive surgical procedures procedures; • invasive Invasive diagnostic procedures involving venous cannulation intra-arterial cannulation; • the The use of endoscopic equipment equipment. Personal medical exclusions A restriction on your cover that is stated on your certificate of insurance and which restricts the cover that you have for certain medical condition(s) and any related conditions. Period of cover A The period of 12 months from your date of entry or from any subsequent renewal date. Your stated as the period of cover is as shown on your Certificate certificate of insurance. Plan / Plan type The Corporate Global Health Silver plan, or Gold plan on which you and your eligible dependants are covered. Plan holder The company or employer as stated on your certificate of Insurance. Planned caesarean section A caesarean section which has been scheduled to take place more than 24 hours in advance. Post-hospital treatment Medically necessary follow-up consultations, physiotherapy, diagnostic tests and/or treatment required on an out-patient basis following in-patient or day-patient treatment covered by your plan and received within the 90 day period following the date you are discharged from hospital.
Appears in 1 contract
Medical Practitioner. A person who has full registration under the Medical Acts of the country where they practice and who specialises in nursing, homeopathy, acupuncture, orthopaedic medicine, traditional Chinese medicine, osteopathy, chiropractic, chiropody, podiatry or physiotherapy treatment, and to whom you have been referred by a medical doctor. Medical referral letter A letter from your medical doctor or specialist which refers you to another medical practitioner for treatment covered by your plan. We will only pay for treatment when the start date of your treatment is within 3 months of the date of your medical referral letter. Medical services provider(s) A hospital, out-patient clinic, medical practitioner, dental practitioner, optician or pharmacy that is part of the medical network you are entitled to use for treatment covered by your plan. The medical network you are entitled to use is stated on your Certificate of Insurance, network card or smartphone applicationpharmacy. Medical underwriting The process of you providing and us assessing the health and medical information we ask for to decide the terms under which we will accept your application for cover, or for enhanced cover. Based on the information you give us, we may decide to place special terms on your cover. Network card Your , such as personal membership card that will state your plan type and the NextCare network medical exclusions, or we may decide not to offer you are entitled to use. It will also state any excess that applies to your plan. Out-of-network penalty The additional co-insurance we will apply to your claim settlement amount when you receive your treatment at a medical services provider that you are not entitled to usecover. Out-patient A patient who attends a hospital consulting room, emergency room or out-patient clinic, when it is not medically necessary for them to be admitted as a day-patient or an in-patient. Out-patient surgical procedure An out-patient procedure where one or more of the following is medically necessary: - • general or local anaesthesia or intravenous sedation • manipulation or relocation of a fractured bone or dislocated joint by a medical doctor • invasive surgical procedures • invasive diagnostic procedures involving venous cannulation • the use of endoscopic equipment Period of cover A period of 12 months from your date of entry or from any subsequent renewal date. Your period of cover is as shown on your Certificate of Insurance. Personal medical exclusions A restriction on your cover that is stated on your Certificate of Insurance and specifically excludes treatment of a certain medical condition or conditions and any related conditions. Plan The BronzeLite plan, Bronze plan, SilverLite plan, Silver plan, or Gold plan on which you and your eligible dependants are covered. Plan holder The person stated as the plan holder on the Certificate of Insurance. Planned caesarean section A caesarean section which has been scheduled to take place more than 24 hours in advance, whether this be for medical or elective reasons. Post-hospital treatment Medically necessary follow-up consultations, physiotherapy, diagnostic tests and/or treatment required on an out-patient basis following in-patient or day-patient treatment covered by your plan. Pre-admission tests An out-patient assessment during which your health is assessed in order to confirm that you are medically fit to undergo the planned treatment and that you are sufficiently prepared for it. The assessment may include an electrocardiogram, blood and/or urine tests and a chest x-ray. Pre-existing medical conditions Any disease, illness or injury, whether the condition has been diagnosed or not before your date of entry, for which: - • you have received medication, advice or treatment; or • you have experienced symptoms Premium The amount(s) you are required to pay to us either annually, half- yearly, quarterly or monthly for your insurance plan. Premium due date The date on which your premium is due to be paid. Preventive health checks Health tests, screening and/or clinical procedures specifically designed for disease prevention and early detection. Qualified nurse A nurse whose name is currently on any official register of nurses maintained by a statutory nursing registration body within the country where treatment is provided. Reasonable and customary The charge that would typically be made for your treatment by medical services providers in the country where you receive your treatment, and for the medically necessary length of stay required. If the cost of your treatment is not reasonable and customary, we will only pay up to the amount which is typically charged in that country. If the length of stay is not reasonable and customary, we will only pay for the medically necessary length of stay required. Rehabilitation Treatment in the form of a combination of therapies such as physical, occupational and speech therapy aimed at restoring full function after an acute event such as a stroke. Rehabilitation hospital or unit A medical facility licensed under the regulations of the country in which it operates and designed for patients who no longer need acute hospital care but who still require medical or nursing supervision and/or assistance with activities of daily living because of their medical disability. Related condition Any disease, illness or injury that is caused by a pre-existing medical condition or results from the same underlying cause as a pre-existing medical condition. Renewal date The anniversary date of your plan as shown on your Certificate of Insurance, normally the anniversary of your original date of entry to the plan.
Appears in 1 contract
Samples: Personal Health Plan Agreement
Medical Practitioner. A person who has full registration under the Medical Acts of the country where they practice and who specialises in nursing, homeopathy, acupuncture, orthopaedic medicine, traditional Chinese medicine, osteopathy, chiropractic, chiropody, podiatry or physiotherapy treatment, and to whom you have been referred by a medical doctor. Medical referral letter A letter from your medical doctor or specialist which refers you to another medical practitioner for treatment covered by your plan. We will only pay for treatment when the start date of your treatment is within 3 months of the date of your medical referral letter. Medical services provider(s) A hospital, out-patient clinic, medical practitioner, dental practitioner, optician or pharmacy that is part of the medical network you are entitled to use for treatment covered by your plan. The medical network you are entitled to use is stated on your Certificate of Insurance, network card or smartphone applicationpharmacy. Medical underwriting The process of you providing and us assessing the health and medical information we ask for to decide the terms under which we will accept your application for cover, or for enhanced cover. Based on the information you give us, we may decide to place special terms on your cover. Network card Your , such as personal membership card that will state your plan type and the NextCare network medical exclusions, or we may decide not to offer you are entitled to use. It will also state any excess that applies to your plan. Out-of-network penalty The additional co-insurance we will apply to your claim settlement amount when you receive your treatment at a medical services provider that you are not entitled to usecover. Out-patient A patient who attends a hospital consulting room, emergency room or out-patient clinic, when it is not medically necessary for them to be admitted as a day-patient or an in-patient. Out-patient surgical procedure An out-patient procedure where one or more of the following is medically necessary: - • general or local anaesthesia or intravenous sedation • manipulation or relocation of a fractured bone or dislocated joint by a medical doctor • invasive surgical procedures • invasive diagnostic procedures involving venous cannulation • the use of endoscopic equipment Period of cover A period of 12 months from your date of entry or from any subsequent renewal date. Your period of cover is as shown on your Certificate certificate of Insuranceinsurance. Persistent vegetative state and neurological damage We will not pay for any treatment received after you have been in a vegetative state for a period of eight weeks or received after you have sustained permanent neurological damage and remained in hospital for a period of eight weeks, apart from any treatment you are eligible for under the lifetime care benefit. Personal medical exclusions A restriction on your cover that is stated on your certificate of insurance and specifically excludes treatment of a certain medical condition or conditions and any related conditions. Plan or plan type The Essential Care plan or Essential Care Plus plan on which you and your eligible dependants are covered. Plan holder The person stated as the plan holder on the certificate of insurance. Planned caesarean section A caesarean section which has been scheduled to take place more than 24 hours in advance, whether this be for medical or elective reasons. Post-hospital treatment Medically necessary follow-up consultations, physiotherapy, diagnostic tests and/or treatment required on an out-patient basis following in-patient or day-patient treatment covered by your plan and received within the 90 day period following the date you are discharged from hospital. Pre-existing medical conditions Any disease, illness or injury, whether the condition has been diagnosed or not before your date of entry, for which: • you have received medication, advice or treatment; or • you have experienced symptoms Premium The amount(s) you are required to pay to us either annually, half- yearly, quarterly or monthly for your insurance plan. Premium due date The date on which your premium is due to be paid. Preventive health checks Health tests, screening and/ or clinical procedures specifically designed for disease prevention and early detection. Qualified nurse A nurse whose name is currently on any official register of nurses maintained by a statutory nursing registration body within the country where treatment is provided. Reasonable and customary The charge that would typically be made for your treatment by medical services providers in the country where you receive your treatment, and for the medically necessary length of stay required. If the cost of your treatment is not reasonable and customary, we will only pay up to the amount which is typically charged in that country. If the length of stay is not reasonable and customary, we will only pay for the medically necessary length of stay required. In the event of a dispute, we will identify the amount typically charged for your treatment by obtaining comparable quotations from three other medical services providers in the country where you receive your treatment, and taking a mean average of these three quotations. Rehabilitation Treatment in the form of a combination of therapies such as physical, occupational and speech therapy aimed at restoring full function after an acute event such as a stroke. Related condition Any disease, illness or injury that is caused by a pre-existing medical condition or results from the same underlying cause as a pre-existing medical condition. Renewal date The anniversary date of your plan as shown on your certificate of insurance, normally the anniversary of your original date of entry to the plan.
Appears in 1 contract
Samples: Health Plan Agreement
Medical Practitioner. A person who has full registration under the Medical Acts of the country where they practice and who specialises in nursing, homeopathy, acupuncture, orthopaedic medicine, traditional Chinese medicine, osteopathy, chiropractic, chiropody, podiatry podiatry, or physiotherapy treatment, and to whom you have been referred by a medical doctor. Medical referral letter A letter from your medical doctor or specialist which refers you to another medical practitioner for treatment covered by your plan. We will only pay for treatment when the start date of your treatment is within 3 months of the date of your medical referral letter. Medical services provider(s) A hospital, out-patient clinic, medical practitioner, dental practitioner, optician or pharmacy that is part of the medical network you are entitled to use for treatment covered by your plan. The medical network you are entitled to use is stated on your Certificate of Insurance, network card or smartphone applicationpharmacy. Medical underwriting The process of you providing and us assessing the health and medical information we ask for to decide the terms under which we will accept your application for cover, or for enhanced cover. Based on the information you give us, we may decide to place special terms on your cover. Network Neuron network card Your personal Global Health Foundation membership card that will state your plan type and the NextCare Neuron network you are entitled to use. It will also state any excess that applies to your plan. Out-of-Neuron network provider A medical service provider which is part of the Neuron network of medical service providers you are entitled to use for treatment that is covered by your plan. The Neuron network of medical service providers you are entitled to use is as stated on your certificate of insurance and on your Neuron network card. Out of network penalty The additional co-insurance we will apply to your claim settlement amount when you receive have your treatment at a medical services provider that who is not a Neuron network provider you are not entitled to use. Out-patient A patient who attends a hospital consulting room, emergency room or out-patient clinic, when it is not medically necessary for them to be admitted as a day-patient or an in-patient. Out-patient surgical procedure An out-patient procedure where one or more of the following is medically necessary: - • general or local anaesthesia or intravenous sedation • manipulation or relocation of a fractured bone or dislocated joint by a medical doctor • invasive surgical procedures • invasive diagnostic procedures involving venous intra-arterial cannulation • the use of endoscopic equipment Period of cover A period of 12 months from your date of entry or from any subsequent renewal date. Your period of cover is as shown on your Certificate certificate of Insuranceinsurance. Plan/Plan type The Corporate Global Health Foundation plan, or Foundation Plus plan, or the Dubai Primary Benefits plan on which you and your eligible dependants are covered. Plan holder The company or employer as stated on your certificate of insurance. Planned caesarean section A caesarean section which has been scheduled to take place more than 24 hours in advance, whether this be for medical or elective reasons. Post-hospital treatment Medically necessary follow-up consultations, physiotherapy, diagnostic tests and/or treatment required on an out-patient basis following in-patient or day-patient treatment covered by your plan and received within the 90 day period following the date you are discharged from hospital. Pre-existing medical conditions Any disease, illness or injury, whether the condition has been diagnosed or not before your date of entry, for which: • you have received medication, advice or treatment; or • you have experienced symptoms Premium The amount(s) your employer is required to pay to us annually for your insurance plan. Premium due date The date on which your premium is due to be paid by your employer. Preventive health checks Health tests, screening and/or clinical procedures specifically designed for disease prevention and early detection. Preventive health services (DHA) Preventive services stipulated by the Dubai Health Authority, including initial diabetes screening. Qualified nurse A nurse whose name is currently on any official register of nurses maintained by a statutory nursing registration body within the country where treatment is provided. Reasonable and customary The charge that would typically be made for your treatment by medical service providers in the country where you receive your treatment. If the cost of your treatment is not reasonable and customary, we will only pay up to the amount which is typically charged in that country. In the event of a dispute, we will identify the amount typically charged for your treatment by medical service providers in the country where you receive it, by obtaining three quotations and taking a mean average of these three quotations. Rehabilitation Treatment in the form of a combination of therapies such as physical, occupational and speech therapy aimed at restoring full function after an acute event such as a stroke. Rehabilitation hospital or unit A medical facility licensed under the regulations of the country in which it operates and designed for patients who no longer need acute hospital care but who still require medical or nursing supervision and/or assistance with activities of daily living because of their medical disability. Related condition Any disease, illness or injury that is caused by a pre-existing medical condition or results from the same underlying cause as a pre-existing condition. Renewal date The renewal date of your employer’s plan as shown on your certificate of insurance.
Appears in 1 contract
Medical Practitioner. A person who has full registration under the Medical Acts of the country where they practice and who specialises in nursing, homeopathy, acupuncture, orthopaedic medicine, traditional Chinese medicine, osteopathy, chiropractic, chiropody, podiatry or physiotherapy treatment, and to whom you have been referred by a medical doctor. Medical referral letter A letter from your medical doctor or specialist which refers you to another medical practitioner for treatment covered by your plan. We will only pay for treatment when the start date of your treatment is within 3 months of the date of your medical referral letter. Medical services provider(s) A hospital, out-patient clinic, medical practitioner, dental practitioner, practitioner optician or pharmacy that is part of the medical network you are entitled to use for treatment covered by your plan. The medical network you are entitled to use is stated on your Certificate of Insurance, network card or smartphone applicationpharmacy. Medical underwriting The process of you providing and us assessing the health and medical information we ask for to decide the terms under which we will accept your application for cover, or for enhanced cover. Based on the information you give us, we may decide to place special terms on your cover. Network Neuron network card Your personal membership card that will state your plan type and the NextCare Neuron network you are entitled to use. It will also state any excess that applies to your plan. Neuron network provider A medical service provider which is part of the Neuron network of medical service providers you are entitled to use for treatment that is covered by your plan. The Neuron network of medical service providers you are entitled to use is as stated on your certificate of insurance and on your Neuron network card. Out-of-network penalty The additional co-insurance we will apply to your claim settlement amount when you receive have your treatment at a medical services provider that who is not a Neuron network provider you are not entitled to use. Out-patient A patient who attends a hospital consulting room, emergency room or out-patient clinic, when it is not medically necessary for them to be admitted as a day-patient or an in-patient. Out-patient surgical procedure An out-patient procedure where one or more of the following is medically necessary: - • general or local anaesthesia or intravenous sedation • manipulation or relocation of a fractured bone or dislocated joint by a medical doctor • invasive surgical procedures • invasive diagnostic procedures involving venous intra-arterial cannulation • the use of endoscopic equipment Period of cover A period of 12 months from your date of entry or from any subsequent renewal date. Your period of cover is as shown on your Certificate certificate of Insuranceinsurance. Plan or plan type The Elite Silver plan, or Elite Gold plan or the Dubai Primary Benefits plan on which you and your eligible dependants are covered. Plan holder The company or employer as stated on your certificate of insurance. Planned caesarean section A caesarean section which has been scheduled to take place more than 24 hours in advance, whether this be for medical or elective reasons. Post-hospital treatment Medically necessary follow-up consultations, physiotherapy, diagnostic tests and/or treatment required on an out-patient basis following in-patient or day-patient treatment covered by your plan and received within the 90 day period following the date you are discharged from hospital. Pre-admission tests An out-patient assessment during which your health is assessed in order to confirm that you are medically fit to undergo the planned treatment and that you are sufficiently prepared for it. The assessment may include an electrocardiogram, blood and/or urine tests and a chest x-ray. Pre-existing medical conditions Any disease, illness or injury, whether the condition has been diagnosed or not before your date of entry, for which: • you have received medication, advice or treatment; or • you have experienced symptoms Premium The amount(s) your employer is required to pay to us annually for your insurance plan. Premium due date The date on which your premium is due to be paid by your employer. Preventive health checks Health tests, screening and/or clinical procedures specifically designed for disease prevention and early detection. Preventive health services (DHA) Preventive services stipulated by the Dubai Health Authority, including initial diabetes screening. Qualified nurse A nurse whose name is currently on any official register of nurses maintained by a statutory nursing registration body within the country where treatment is provided. Reasonable and customary The charge that would typically be made for your treatment by medical services providers in the country where you receive your treatment, and for the medically necessary length of stay required. If the cost of your treatment is not reasonable and customary, we will only pay up to the amount which is typically charged in that country. If the length of stay is not reasonable and customary, we will only pay for the medically necessary length of stay required. In the event of a dispute, we will identify the amount typically charged for your treatment by obtaining comparable quotations from three other medical services providers in the country where you receive your treatment, and taking a mean average of these three quotations. Rehabilitation Treatment in the form of a combination of therapies such as physical, occupational and speech therapy aimed at restoring full function after an acute event such as a stroke. Rehabilitation hospital or unit A medical facility licensed under the regulations of the country in which it operates and designed for patients who no longer need acute hospital care but who still require medical or nursing supervision and/or assistance with activities of daily living because of their medical disability. Related condition Any disease, illness or injury that is caused by a pre-existing medical condition or results from the same underlying cause as a pre-existing medical condition. Renewal date The renewal date of your employer’s plan as shown on your certificate of insurance.
Appears in 1 contract
Samples: Elite Health
