Adamnazir’s valued Health cardholders would enjoy 24/7customer service through our TPA Claims Center for guidance, pre-approval, network selection, and any other information that may be required.
The following guide is pertaining your health insurance benefits:
Emergency
- If you are at a participating provider for emergency care, please present your card at the time of admission. Your doctor will attend to your healthcare needs immediately and will contact TPA.
- We will obtain all required information and will arrange settlement of expenses for covered treatment.
- For treatment abroad, you may obtain TPA assistance through our 24-hour claims center. You will find the telephone number on the back of your card. For emergencies that require inpatient hospitalization, direct billing will be arranged with the international provider according to your policy provisions.
- If you select to use a non-participating provider, please follow the reimbursement procedure mentioned hereafter.
Non- Emergency
- For planned hospital admissions and other non-emergency scheduled healthcare visits, you may call the claim center for assistance. Claims center doctors will assist you selecting and arranging access to an appropriate clinic, hospital, or other facility based on the scope of coverage.
- Always carry your insurance card with you and make sure that the provider you intend to seek treatment at is mentioned in your network list. For any queries, direction, referral or assistance at any provider, please call at any time using 24-hour number listed on the back of your medical card.
- For treatment abroad, kindly follow the same procedure by calling the number on the back of your card. Direct billing will be arranged for in-patient cases at the international provider according to your policy provisions.
- In the event you select a non-participating provider, please follow the reimbursement procedure.
- The Health card holder should sign the documents provided by the health care provider on receiving treatment and/or purchasing medicines.
Reimbursement Claims Procedure
Incurred claims outside the network require payment in full by you. Reimbursement through Adamnazir can be obtained by providing the following:
- Original reimbursement claim form duly filled, signed, and stamped by the treating doctor.
- Original invoices/bills/receipts, itemized or broken down into individual investigations or medicine prescribed.
- Prescription of medications (if any).
- Reports/results of tests conducted (if any).
- Complete medical reports and results including: surgical reports, discharge summary of inpatient, lab results, radiology reports (if any).
- Your card number.
The above must be submitted to your Human Resources Department or Adamnazir 90 days from the date of service. Reimbursement claims will be settled in accordance with your policy terms and conditions within 21 working days from the date the claim is received by Adamnazir.
