Reimbursement

Reimbursed is not the same as refunded

A reimbursement claim is settled against the policy's terms, not against the invoice. Where a plan states a reimbursement scale — a percentage of usual and customary charges, or a fixed amount per consultation — the member can be fully covered and still get back less than they paid. That gap is the part clients do not expect.

What it requires from the member

An original invoice, a receipt showing payment, the treating doctor's report, and prescriptions for anything dispensed, submitted inside the claim notification window. Miss the window — commonly 30 to 90 days — and a valid claim is declined on timing alone.

When reimbursement is the only route

Treatment outside the direct billing network. Treatment abroad on most UAE plans, even where the territorial scope covers it. Emergencies at a hospital the member could not choose. It is worth telling a client which of these applies to them at the point of sale rather than at the point of admission.