Treatment within Al Koot Health Care Provider Network:

The Member would find the latest updated network providers list on our website www.alkoot.com.qa and also in the Al Koot mobile app. Depending on your need, you can search for different types of medical providers including hospitals, clinics, pharmacies, medical centers, and many more across the globe.

It is in the interest of members to use the designated network of medical providers. This means that when you receive treatment at these providers, all bills will be settled directly between the provider and Al Koot Insurance, allowing you to continue the treatment with complete peace of mind without having to worry about the settlement of bills.

NOTE: Please refer to the Benefits Table in your policy for area of cover shown for the plan.

• When you visit a provider within the designated provider network, the insurance coordinator or clinic representative will request for the Al Koot Membership ID Card.
• The provider is entitled to take your finger print impression to validate Member eligibility.
• You can then see the Medical Practitioner, who will give the treatment, along with any prescription or refer you for further investigation.

Remember, some treatments require Pre-Approvals (Prior approvals)

Pre-approval is a process whereby AlKoot Insurance reviews and gives its decision on treatment proposed by the treating Physician. Please note that provider will take care of obtaining the pre-approval without the Member being involved in this process. In addition, these parameters are variable and might change anytime to the best interest of Members and according to best practices. But it shall be the responsibility of both member and the Medical Practitioner to complete and sign the pre-approval request form (the hospital or clinic will provide this) and send it Al Koot for approval should there be any Pre-approval required. To download the pre-approval claim form, please proceed to Download section under media center tab or click here 

Treatment outside Qatar:

Al Koot has partnered with 4 serveral medical service providers listed on the back side of your Al Koot Membership ID card, in order to help the member get healthcare services globally. In case you are travelling abroad and need treatment, please contact Al Koot and we will be happy to organize for Pre-Approval at the Provider facility appropriate to your policy benefits. For availing the treatment abroad, please refer to the policy terms & condition since the treatments abroad come with certain limitations.

Please refer to the policy copy to understand the standard definitions of your health insurance cover. For your easy reference, we have enclosed the standard set of exclusions & limitations for which Al Koot does not pay for as per the policy in section 5. To download standard exclusions & limitations please proceed to Download section under media center tab or​ click here​

Treatment outside Al Koot Provider Network:

When you are not visiting a provider who is not under Al Koot Provider network, you still have the option of taking the treatment, pay the provider up front and then claim for reimbursement.

Please remember that Al Koot will reimburse the cost of treatment based on actual cost or 100% of the usually and customary charges applicable in country of treatment whichever is lower. Usually and customary means the common average cost in most of providers operating in country of treatment.

Submitting the claim for reimbursement is simple but please ensure that you follow the below procedure for a hassle free processing of your claim.

What documentation is required for submitting the claim?

1. Firstly download the claim form or dental claim from our website or the mobile app and take a print out of the same.

2. Ensure all fields on the claim form are complete including symptoms and treatments. If the Medical Practitioner has missed out anything please request him /her to complete his / her sections of the form.

3. The claim form should be stamped and signed by the treating medical practitioner.

4. The claim form should be signed and dated by You.

5. Ensure the following documents are attached along with your claim form:

How to submit reimbursement claim?

"Our all new Al Koot Mobile App helps you in submitting the claim online on the go."

• Go to the claims section.
• Click on Submit Claims; enter the claim amount, upload the claim form duly filled & signed by your doctor and you, upload the supporting documents and click on Submit.
• You will then receive a reference number by email or SMS. You can track the journey of your claim using the reference number.

Please note that claims up to QAR 5000 will be accepted as scanned copies without the need to submit original documents, any amounts above this limit should be submitted with original documents.

Alternatively, you can also submit the claim through courier or visit AlKoot Insurance and submit the claim with all of the required documentation.

Please be aware that all documentation and claims must be submitted within 90 days of receiving the treatment for which the Member is claiming. Invoices sent to AlKoot Insurance after 90 days of treatment will not be eligible for settlement.

Please be aware when submitting any documentation online, you must retain all of the originals as AlKoot Insurance retains the right to request these on a periodic basis for further assessment.

How is the reimbursement claim settled?

Al Koot Insurance will use its best endeavors to settle all eligible reimbursement claims within 15 working days following receipt of completed documents as detailed above, and as per terms and conditions of this policy.

If for any reason the Claim form and supporting documentation is incomplete, this could result in the claim being returned to the Member for completion and may delay the processing of the Claim.

Thanks to our rule based automated system. You will always be informed about the status of the claim throughout its journey through an email or SMS.

If for any reason the Claim form and supporting documentation is incomplete, this could delay the processing of the Claim. The required information (shortfall) for processing is communicated to the member through email and the claim shall be processed on receipt of the required information.

Please note that the date of receipt of all complete documents required to substantiate, assess and validate the claim will be treated as the first date of receipt of the claim for administration purpose.

In case of shortfalls, the date of receipt of shortfall documents shall be treated as date of receipt for further processing and arriving at the turnaround time.

Complaints Policy & Procedure

 1.   Purpose

The purpose of the documents is to define the complaints policy & procedure for any client or member who would like to raise an official complaints to Al Koot Insurance & Reinsurance or its regulator.

​2.   Scope

The document covers step-by-step procedure for placing and escalating a complaint to Al Koot Insurance or Reinsurance.

3.   Procedure

3.1 If the Insured is not happy with the service offered by their Insurance Company, or the way they have been treated, the insured has the right to complain to the Insurance Company. The Insurance Company will look into the complaint and see if it's appropriate to redress the grievance of the Insured. However, if the

Insured thinks that their claim has been unfairly rejected, they can still raise a complaint against the Insurance Company itself.

3.2 Definitions

'Grievance/Complaint'- A "Grievance/Complaint" is defined as any communication that expresses dissatisfaction about an action or lack of action, about the standard of service/deficiency of service of an insurance company and/or any intermediary or asks for remedial action.

'Inquiry"- An "Inquiry" is defined as any communication from a customer for the primary purpose of requesting information about a company and/or its services.

'Request'- A "Request" is defined as any communication from a customer soliciting a service such as a change or modification in the policy.

'Company' shall mean Al Koot Insurance and Reinsurance Company

'Complainant" shall mean any policyholder(including legal heirs, assigns or legal representatives) who reports a Grievance to the Company

Policy Statement. All Al Koot Insured members have the right to receive the best service as per Insurance Policy Terms and Conditions. However, in case of any

dis-satisfaction of the service offered to the Insured, Al Koot welcomes any complaint or grievance that will be handled in an appropriate, fair, transparent and

timely manner

3.3 Grievance Procedure

Step 1

If the insurance policy is bought though a broker or agent, they might make the complaint on behalf of the Insured. If the insurance policy is provided through a

Corporate Client, they might make the complaint on behalf of the Insured. It is sometimes possible to resolve a complaint through a telephone call to Al Koot helpline

800 2000. The insured should note down the name of the agent the date of call and the phone number from which they called for easy tracking in case of future

escalations

Step 2

In case the Complainant is not happy with Al Koot response they can raise the grievance or complaint through sending a written communication to Senior Customer

Relationship Officer section at the following email address:

Senior Customer Relationship Officer

Al Koot Insurance & Reinsurance

P.O Box 24563

Doha, Qatar

Tel:+974 4040 2000

Email: complaints@alkoot-medical.com

The Complainant can also submit Grievance at Al Koot Office located in Al Maha Building, Bin Omran Area, Doha.

The Grievance should be expressed in writing duly signed by the Complainant or legal heirs, assigns, legal representatives with full details of the complaint and contact details for the complainant.  To download a copy of the Complaint Form, please proceed to Download section under media center tab or​ Click here

Step 3

In case the Complainant is still not satisfied with the response or have not received any response within two weeks, the Complainant can

challenge complaint department decision by approaching Grievance committee. The member need to fill and submit grievance form to below address and explain why he or she still thinks that complaint department reply is unfair or unjustified.

Attention to Grievance commitee

Al Koot Insurance & Reinsurance

P.O Box 24563

Doha, Qatar

Tel: +974 4040 2000

Email: complaints@alkoot-medical.com

Once grievance form received by Grievance committee, a formal investigation will start about grievance, decision, appropriate action and outcome.

Grievance Committee should make a decision within 2 weeks from submitting the grievance form. Their decision is final. To download a copy of the Complaint Appeal Form, please proceed to Download section under media center tab or​ Click here​

Step 4

In case the complainant is not satisfied with the decision or resolution of the Grievance, the Complainant may approach the Insurance Section at QCB. The

details of the Insurance Section of QCB is given below:

Fill in the complaint/inquiry form published on the Qatar Central Bank's website under "Consumer Protection "tab. (or)

Send a complaint/inquiry to fax number +974-44222450 (or) in person to Banking Services Consumer Protection Department located at the building of the Qatar Central Bank, C-ring Road- Near Al Muntaza signal, Doha.

As per section 11.16.2.6.  of QCB Regulations(Claims Complaint Process Policy), No complaint to the Insurance Section of QCB shall lie unless:

The Complainant had before making a complaint to the QCB made a written representation to the Insurer named in the complaint and either the Insurer had rejected the complaint or the Complainant had not received any reply within a period of one month after the Insurer concerned received his representation or the Complainant is not satisfied with the reply given to him by the Insurer.

The complaint is made within one year after the Insurer had rejected the representation or sent final reply on the representation of the Complaint; and the complaint is not on the subject matter, for which any proceedings before any court, or arbitrator is pending

 AlKoot Healthy Rewards Program

1. What happens if I am outside Qatar and I need treatment?

You should use a hospital in our global network where possible and if you telephone us or check our web site you will find the nearest medical facility. In an emergency you should have your treatment immediately and contact us (or have someone contact us on your behalf) as soon as you can. Emergency treatment is covered up to the reasonable and customary costs in the area in which it is received. Non-emergency treatment will be reimbursed at actual or 120% of the cost of the treatment in Qatar whichever is lower.

2. Who decides what an ‘emergency’ is?

Al Koot medical team will make the decision on the basis of the medical evidence whether the condition needing treatment constituted a medical emergency.

3. What happens if I can’t get the treatment I need in Qatar?

If we accept that the treatment needed is not available in Qatar we will agree to your having treatment elsewhere. In this case the cost of treatment will be covered up to the reasonable and customary cost for the area in which it is received. When we decide on the availability of a given treatment we will assess whether, even if the treatment can be given in Qatar, it is safe, the practitioner has sufficient experience and it can be carried out within a reasonable time.

4. Can you tell me how much you will pay before I have treatment?

In most cases of pre-planned in-patient and day care treatment we will be able to give an indication of our reasonable and customary cost. This can only be indicative as every medical case is different. We are unable to give an absolute decision until we receive the full claim.

5. Am I covered for diabetes?

You are covered under the chronic condition benefit of your plan for both the maintenance of the condition and any flare up. This also applies to other, similar, chronic conditions. However we do require you to get our approval for any medication or treatment that is going to last for more than 30 days. We recognize that, for many stable chronic conditions, it is useful to have a supply of medication that lasts more than 30 days and we therefore recommend that you apply for prior approval before your next consultation for any such condition.

6. Can I have my baby outside Qatar?

Yes you can. We will apply the 100% of usually and customary charges rule to both the delivery and any complications experienced by you or the new-born(s), and up to maximum of maternity and delivery limit specified in your table of benefits.

7. Can I stay with my child when he/she is in hospital?

If your child is covered under the plan and is under 18 years of age the child’s cover allows you to stay with him/her if hospitalized.

8. Do I need to pay a deductible at every visit to the doctor?

No. ( yes , for new consultations but not for follow up ) However it is important that all members use this policy sensibly and do not visit medical practitioners unnecessarily. This helps to control costs and allows us and your company to provide comprehensive benefits without charging you a deductible.

9. Am I covered for the treatment of an illness I have had before joining this plan?

Yes. All treatment of pre-existing conditions is included in accordance with your benefits table.

10. Can I claim for periodical routine check-ups?

No. Only the monitoring of a pregnancy and/or a chronic condition is covered. Unless it is mentioned in your table of benefits.

11. Are my children’s vaccinations covered?

Yes. Provided your child is less than 14 years of age the vaccinations shown in your benefits table are covered and, as per MOH updates list of vaccinations required.

12. Which hospitals and clinics can I use in Qatar?

There are 3 networks for you to use in Qatar – Elite, Premium & Prime. Kindly refer to your table of benefits to determine level of network you are entitled for, this list is frequently updated, updates of these details can be obtained from Al Koot through our website or mobile app.

13. What happens if I fall ill in a country where there are no medical facilities?

Your plan includes an International Emergency Medical Assistance benefit. If you need emergency treatment anywhere in the world and there are no suitable medical facilities, a call to the telephone number shown on the back of your card will alert the Al Koot Customer Service Team. They will help you to find appropriate treatment or, if medically necessary, to evacuate you to the nearest place where treatment is available.

• View Policy information (policy start & end date), benefits covered.
• Option to download E-Card for all family members as it’s the key for accessing healthcare services. It helps us identify you by the Al Koot ID mentioned on your card and provide necessary assistance when you are in need.
• Search the​ nearest network provider. Depending on your need, you can search providers by name, location, type of facility and/or specialty.
• View the status of Pre-Approvals.
• Submit new claim & track the status of claim till payment.
• Reminder setting for medication.
• Mobile App for Android Devices ; https://play.google.com/store/apps/details?id=com.alkoot​
• Mobile App for iOs Devices ; https://itunes.apple.com/us/app/alkoot-global-care/id1312660868?mt=8
• To download User Manual for the mobile app, please proceed to Downloads section under Media Center tab or Click here​

AlKoot 24/7 Customer Care support: Toll Free: 800 2000 Outside of Qatar: +974 4040 2000 or email ar: customercare@alkoot-medical.com

AlKoot Complaints section: complaints@alkoot-medical.com

For reimbursement claims: riclaims@alkoot-medical.com

For pre-approval queries (for medical providers): preauthorization@alkoot-medical.com