– Hospital Accommodation & Services
– ICU
– Consultant’s, Physician’s, Surgeon’s & Anesthetist’s Fees
– MRI & CT Scans received as an inpatient and subject to pre – approval
– X rays, Pathology and diagnostic tests and subject to pre – approval
– Blood, Plasma & blood substitutes
– Oxygen and other medical gases
– Oncology test, Drugs and consultant’s fee (including cover for chemotherapy and radiotherapy)
– Surgical fees, including anesthesia & theatre charges
– Physician, Surgeon, & Anesthetist fees
– Prescribed Medicines and Drugs
– Emergency road ambulance services to and from hospital by registered ambulance services provider
– Surgical appliances and internal prostheses (if surgically required)
– Post hospitalization treatment received with 30 days of being discharged from hospital up to 2 weeks, medical care received by a certified nurse (subject to pre-approval)
– Reconstructive surgery following an accident (for medical necessary conditions)
– Acute (reversible) kidney failure
– Sport Related Accident (non – professional and non – hazardous)
– Accidental damage of natural teeth, immediately post an accident, up to 48 hours from occurred accident
– Organ Transplantation (excluding Donor’s expenses, acquisition of the organ and the cost of the organ)
– Physiotherapy Charges
– Nursing at Home, for recovery and in lieu of a hospital stay up to a maximum of 28 days per admission or procedure: maximum benefit per person per year
– Ambulance

– Consultations
– Diagnostics (x-ray, MRI, CT scan, ultra sound, etc.)
– Herbal medicines and Vitamins will be cover if it prescribed by the physician & has medical necessity
– Terminal illness
– Hormonal replacement therapy
– Organ transplant
– Gynecology diseases which not related to Maternity & fertility
– Laboratory
– Prescription

•What is Medical l Insurance?
Health insurance is a type of insurance coverage wherein, an insured can claim payments for his medical and surgical expenses according to insurance plan and terms of the policy. In exchange, the insurer is paid a set premium on a regular basis. Moreover client have the access to a direct billing facility however depends on the policy agreed co-insurance.

•Why do I need health insurance?
Enrolling in high quality health insurance is the best way to be financially prepared against uncertain health risks. It helps you to pay for doctor visits, hospital stays, prescription drugs and important preventive care.

•How many persons are required to receive group medical terms?
In order to issue group medical quotation, we require minimum of 20 employees.

•Which are the network hospitals in your vicinity?
To avail a cashless settlement of your claim, you should be admitted in your network hospital. A company has a list of such hospitals and you can easily find out whether the hospital in the company’s network is your preferred choice of hospital and/or located in your area.

•Can I have direct billing/cashless access while taking treatment outside Qatar?
Yes, however it has to be arranged and with prior approval.

•Does your company offer international / worldwide coverage health insurance?
For groups wishing to get a quote for international health insurance, please visit our partner Aetna International via: https://www.aetnainternational.com. Through Caxa INSURANCE product we also offer a worldwide coverage for the policy holders during business trips and vacation trips subject to customer charge.

•Can you offer different levels of cover within a group?
Generally, all insured members within a group will have the same level of cover. However, for larger groups, we are able to accommodate different levels of cover through the creation of sub-groups upon discussion.

•Can a group upgrade medical and/or dental at a time other than renewal if the group has grown?
The standard time for plan revisions is within the renewal date or prior to 31 days before the renewal date. Midyear plan revisions cannot be considered.

Group Life & Personal Accident (GLPA) insurance is a type of life insurance. It covers all employees of an organization under single yearly renewable contract. GLPA is usually provided as part of employee benefit package. It provide pre-agreed sum assured in case of death or disability happened to any employee(s).
GLPA provide 24 hour cover and anywhere in the world either natural or accidental. GLPA insurance policy is very flexible and is designed to cater for the changing needs of the employers. Addition of new employees and removal of staff who are no more in employment can be done during the term of the policy. Under this scheme an employer can provide maximum protection to his employees.
The other optional benefits that can be covered in addition to Death benefit are:
•Double Accidental Death Benefit
•Permanent Total Disability due to accident
•Permanent Total Disability due to sickness
•Permanent Partial Disability due to accident
•Permanent Partial Disability due to Sickness
•Temporary Total Disability due to accident
•Temporary Total Disability due to Sickness
•Accidental Medical Expenses
•Repatriation of mortal remains to home country

Credit life insurance is a type of life insurance policy designed to pay off a borrower’s outstanding debts if the borrower dies. The face value of a credit life insurance policy decreases proportionately with the outstanding loan amount as the loan is paid off over time, until both reach zero value.
Benefits:
•Death due to any cause
•Permanent Total Disability

•What is Group Life Insurance?
Group Life Insurance is an insurance that extends cover to a group of people usually employees or individual in case of a death or disability.
It provides a lump sum payment to the employees family or next of kin, should anything happen to them.

•Who are eligible under Group Life insurance?
Any employee/member who is actively & regularly working for remuneration is eligible for insurance under a Group Life Scheme.

•What should be the minimum number of employees / members for Group Life Insurance?
The corporate entity should have at least minimum 20 employees for obtaining Group Life Insurance Quote.

•Why do I need Group Life Insurance
One of the main reasons employers should consider providing Group Life Insurance is that it will allow them to offer some financial support to the families of their employees at a time when they are going to need it most.
At Caxa Insurance Group, we strongly believe that employees are the most valuable asset to your business.

•How much does Employee Life Insurance cost?
Due to our wealth of experience dealing with employee life insurance schemes, we understand the best way to navigate the market from a cost vs cover perspective. The calculated average cost per policy is based on all of the schemes in-force that the industry has, so naturally, the larger the workforce, the lower the cost per employee. Insurers will usually consider the following when pricing a scheme:
 Average age of employees
 Occupation of employees
 Location of workplace(s)
 Total sum to be insured
 Employees that are off sick
 If there is any overseas travel

• Will I be covered if I was not in Qatar or in my resident country at the time of the claim?
Yes. Life insurance covers the insured worldwide, 24/ 7.

•Does the Policy provide cover to the employees / members up to 65 years of age?
Yes, the Policy provides cover to the employees up to 65 years of age provided satisfactory evidence of insurability, which may range from Health Questionnaire to comprehensive Medical Examinations, which have been provided by the Policy Holder to the satisfaction of Caxa Insurance.
*Note: please refer back to the terms and conditions of your chosen policy, exclusions and limitations may apply depending on the insurance plan

Caxa Insurance Group understands that travelling abroad for holiday or business entails a lot of risk. Be prepared in case of trip cancellation or interruption, medical emergencies or luggage losses. Our exclusive Travel Plans cover you for all medical eventualities wherever you go around the world.

•What is travel insurance?
Travel insurance is designed to help cover your expenses if something goes wrong on your trip, and fill any gaps that wouldn’t be covered by your primary medical insurance or other insurance you may have. The insurance company agrees to cover costs (up to a certain limit) for emergency medical treatment, lost or stolen luggage, delayed flights, or nonrefundable expenses should you have to cancel your trip. Caxa INSURANCE travel insurance plans are designed to insure you against expenses and inconvenience caused by emergencies and unforeseen circumstances.

•Why do I need travel insurance?
No one thinks twice before getting health or car insurance. Travel insurance is just as important since it gives you the peace of mind you need by covering your travel expenses in case your trip is cancelled, or cut short for a legitimate reason, all within the policy limits previously agreed upon.

•What documents do you need to make the travel insurance?
Be sure to provide your passport copy alongside with your email address, telephone number, country of residence.

•How long is a travel insurance policy valid?
The period of cover for a travel insurance ranges from one week to one year (annual multiple cover is valid through the year with multiple entry).

•Can I add more travel insurance coverage to my current policy?
We aren’t able to extend your existing policy, but if you extend your trip, you can buy a new policy online while you’re traveling.

•What does travel insurance cover?
Travel insurance can cover your expenses due to medical and non-medical emergencies before you travel or even during, such as:
– Trip delay, cancellation, or interruption due to an unforeseen event
– Lost, delayed, damaged, or stolen gear or bags
– Medical Emergency- Dental Coverage Lost/ Delayed Baggage Coverage & More.
•Does my travel insurance cover adventurous sports?
Involvement in any adventurous sport is typically not covered. However, the policy may be extended for an additional premium to include Winter Sports Extension (limited to recreational skiing and snowboarding).
•How can I submit a claim?
You will need to complete a claim form as soon as possible after the incident has occurred or within 4 months of your return to your country of residence.
The completed claim form, together with original invoices, proof of ownership, travel documents and any other relevant details should be submitted.
*Note: please refer back to the terms and conditions of your chosen policy, exclusions and limitations may apply depending on the insurance plan.

All inpatient treatments require written pre-approval. You can contact the 24/7 customer service team to guide you the process.
Within Qatar Toll Free – 800-01-08
Outside Qatar – +971-4438-7602
Email  MEAservices@Aetna.com
Out Patient Services, within the Network Providers
Present your membership card upon each visit. You may be required to present an ID for verification.
Pay the provider any applicable deductible or coinsurance. Any other treatment charges will be billed to the insurer.
Pre approval is required ONLY for the following:
• Single treatment or service that costs more than $500 (QAR 1800) or equivalent
• Prescription for more than three months’ supply of drugs for a chronic medical condition
• Psychiatric, Dental, Optical & Vaccinations
Out Patient Services, outside the Network Providers
The member pays at point of service.
Member to collect – Medical report/ test results/ prescription/ itemized invoice / bill & receipt
Complete the Claim Form and submit via:
Health Hub (secured online portal)
Email to – MEAservices@Aetna.com
Claim will be reimbursed within 15 working days.

Whenever you have to seek a medical care:

1. Refer to the network providers you are entitled to have access (General Network +, General Network & Restricted Network).
2. Do not forget to take with you your (Access Cards, & QID)

In case of Hospitalization occurring at a Network Provider in Qatar, prior authorization has to be taken from the TPA Customer Support Center by the provider before the procedure.
(In case of emergency, prior approval is required to be taken once the patient is stabilized. This ensures that the administrative procedures do not hinder any emergency medical attention / service needed by the TPA Cardholder)

Network Provider Outside Qatar
For your Hospitalization occurring at a Network Provider Outside Qatar, make sure TPA Customer Support Center ( +974 6664 4423) that the has been informed by yourself at least 7 working days before the treatment date.
In emergency cases, the TPA Customer Support Center must be informed at least 48 hours before discharge.
TPA will strive to arrange the treatment at free access subject to the availability of all necessary information as well as adequate time for the case management.
In emergency cases with inability to arrange free access due to time constraints, you are requested to pay for the treatment and file the same for reimbursement.

1. You should present your valid Access Card and your I.D. to the Network Provider.
2. In case Deductible Excess is applicable, you shall be asked to settle the specified AMOUNT as printed on the Access Card
Out Patient Services, outside the Network Providers
Out-of-Hospital expenses incurred at a Non-Network Provider are eligible for reimbursement as per the terms and conditions of the benefit description approved by your Insurer.

Please ensure the submission of the following to facilitate quicker adjudication of your claim and submit the original below doc. to Caxa INSURANCE Office.
 Completed “Reimbursement Form”
 Full and Complete Medical Report / Diagnosis / Discharge summary from the treating doctor
 Original itemized invoices or receipts for the amount claimed (Invoice must show cost per service)
 Original Results of Diagnostic Tests
NB –

1. Absence of any one of the above document makes your claim liable to denial.

Claims incurred within Qatar must be submitted within 30 days from the date of treatment and claims incurred outside Qatar within 60 days, failing which the claims becomes time barred for payment.