You can’t plan when you will require medical attention, therefore it is important to understand your insurance benefits as soon as your policy starts.

The easiest way to check your policy benefits is to login on the Bayzat Benefits mobile app or on our website http://www.bayzat.com/login, and click on ‘’My Policy’’ tab. Alternatively, contact your HR Department to request a copy of the table of benefits of your policy.

To download the Bayzat app, click on one of the app store icon below

Before requesting for a treatment, make sure to:

1. Check your policy Table of Benefits to understand the treatments covered under your policy.

2. Understand your overall limit and sub-limit applicable for the specific treatments. Dental, maternity and wellness often have sub-limits far less than the overall limit.

3. For physiotherapy claim submissions - Make sure to provide a medical report and a referral letter from a GP or orthopedic doctor, stating the need to carry out the physiotherapy sessions.

Understanding your health insurance policy

01

STEP 1SELECT YOUR TREATMENT FACILITY

Bayzat’s Claim User Guide - OMAN INSURANCE

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• For Basic Essential Plans, please note that if you go out of your network, you will not be covered.

• Make sure you have a printout of the Oman Insurance claim form, as you will need it to claim reimbursement. The Oman Insurance claim form has been attached to this user guide for your reference.

• Please note that the insurer will limit the amount of your reimbursement to a Network Tariff Rate*, to which a deductible may apply.

At Bayzat, we continually stress the importance of staying within your direct billing network as much as possible to avoid having to claim for reimbursement.

To check which hospitals and clinics are part of your direct billing network, login the Bayzat Benefits mobile app or visit our website (http://www.bayzat.com/login), and click on the ‘’Hospitals & Clinics’’ tab: a customised map of the medical facilities covered in your network will appear. If your company does not have access to Bayzat Benefits, please contact your HR Department to request access or to receive a copy of the relevant Network List.

*The Network Tariff Rate is determined in advance by the insurer for each treatment type and is used as a reference to calculate your claim reimbursement amount when you go out of your network.

For example: you have decided to consult a specialist doctor for a consultation of AED 400 at the Saudi German Hospital, and the hospital is not within your policy network.

If Oman Insurance Network Tariff Rate for this treatment is AED 300 (arbitrary amount set for this example), and if your policy also includes a 10% deductible for out of network claims, the claim reimbursement amount will be calculated as AED 300 minus the 10% deductible, leaving you with AED 270 paid by Oman Insurance and AED 130 to be paid out of pocket.

WITHIN YOUR NETWORK

OUTSIDE YOUR NETWORK

*Disclaimer: This document is intended to provide you helpful information on the insurer’s claim reimbursement process. By voluntarily using this document, you acknowledge that under no circumstances shall Bayzat or its a�liates, partners or suppliers be liable for any kind of damages arising out of or in connection with this document.

02

CAUTION

1. Claim documents must always be provided in English or Arabic.

2. Make sure to submit your claim documents within 60 days from the treatment date. All claim documents submitted after 90 days will be rejected by Oman Insurance.

3. Original claim documents are required by Oman Insurance if the claimed value is more than AED 1500.

4. All of the following documents must be collected for the insurer to process the claim. Any missing document will delay the claim assessment and reimbursement.

• Claim form signed and stamped byyour treating doctor on the medicalpractitioner declaration section

• Diagnosis to be indicated on the claimform by your medical practitioner

• All invoices related to the treatment

• For payments made by credit card:Credit card receipt copy

• For payments made in cash: 'Paid'stamp on each of the invoices

• Pharmacy: all prescriptions andpharmacy invoices

• All Lab test results and reports (if any)mentioned on the invoice. For example:Ultra sound, Radiology, X ray, Blood testresults etc..

• Medical card copy

• Collect all the documents mentionedunder outpatient treatments as well asthe below:

• Itemized breakdown of all services/items provided on the invoice

• Discharge summary/report

(no overnight stay at the hospital) treatment within or outside the UAE:

If you are claiming forAN OUTPATIENTTREATMENT

If you are claiming forAN INPATIENTTREATMENT

(overnight stay(s) at the hospital) treatment within or outside the UAE:

STEP 2COLLECTING CLAIM DOCUMENTS FOR REIMBURSEMENT

Option 1:

The main applicant must update their bank details by using their login credentials on the OIC Mobile App or through the website link: https://medical.tameen.ae/Account/Registration. Once the IBAN details are updated the claim can be submitted by the member directly on the app or on the website link.

Option 2:

Once your bank details have been updated on the Oman insurance portal, please send your claim documents to claims@bayzat.com to process the claim.

Important: The claims team at Bayzat can ONLY process your claim if your bank details are updated on the portal.

Always keep original claim documents, and if the claim value amount is AED 1,500 or higher, original claim documents need to be sent to our office: Arya Insurance Brokerage, Control Tower, 9th Floor 902, Motor City

In view of the new process in submission of reimbursement claims with Oman, the main

STEP 3SUBMITTING YOUR CLAIM

STEP 4CLAIM PROCESSING

A. Claim processing

10 to 15 working days for the claim to be processed and the claim report to be shared with you.

B. Payment processing:

• Wire transfer: 3 to 5 working days for the payment to be deposited in your bank account, after the claim has been processed.

• Claim cheque: 7 to 10 working days for the cheque to be dispatched by the insurer, after the claim has been processed.

C. Claim re-submission:

If for any reason Oman Insurance requires additional information to process your claim because of pending/missing documents, we will re-submit it to Oman Insurance upon receiving the missing documents.

Once the claim report is provided, we advise you to provide the pending documents within 30 days to re-process the claim.

Once the claims team confirms via email that the claim documents are complete, the same will be

forwarded to the insurer for processing as follows:

applicant needs to first register on the Oman insurance portal and update their bank account details.