Claim Process of Watania Takaful Health Insurance
Direct Billing within the Network
Watania Takaful has a direct billing facility for its approved medical network. This means you can receive treatment at network hospitals and clinics without paying upfront.
The process is as follows —
- Present your insurance card at the reception of the network healthcare provider
- The provider will verify your details and coverage
- Approved treatments are directly billed to the insurer
Reimbursement for Non-Network or International Claims
If you get treatment outside the network or during international travel, you may need to pay the medical bills upfront.
The reimbursement process involves —
- Collecting all necessary documents, such as original invoices, medical reports, and proof of payment
- Submitting these documents along with the claim form to the insurer or TPA (Third-Party Administrator)
The insurer then processes the claim and reimburses the amount as per policy terms. Reimbursement may be at 80-100% of the usual and customary rates, depending on the network and region.
Emergency Cases
For emergencies, treatment is generally covered without prior approval. However, you must inform the insurance provider or TPA within 24 hours of hospitalisation.
The claim process includes —
- Providing all relevant documents post-treatment, such as discharge summaries, emergency admission reports, and medical invoices
- Claims for emergencies are settled as per the policy's terms and conditions
Pre-Authorisation Requirements
Certain treatments, including inpatient services, surgeries, and specialised investigations, require prior approval.
Here are the steps —
- The healthcare provider submits a request for pre-authorisation to the TPA
- The TPA evaluates the request and provides approval if the treatment is covered
- Pre-authorisation provides a smoother claim process and direct settlement
Documentation for Claims
The following documents are generally required for any claim —
- Completed claim form
- Original invoices and payment receipts
- Medical reports, including diagnosis and treatment details
- Discharge summary in case of hospitalisation
- Prescription and diagnostic test results (if applicable)
Timelines for Claim Submission
Claims must be submitted within the specified period, often 15-30 days from the date of treatment or discharge. Delayed submissions may result in claim rejection unless valid reasons are provided.
Claim Settlement Timeline
Once all documents are submitted, Watania Takaful usually processes claims within 7-14 working days. The time may vary depending on the complexity of the claim.
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