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Frequently Asked Questions
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| A1. |
It takes 10 working days for reimbursement of eligible medical
costs, providing that the claim is completed with original invoices, and no
further medical documentation is required.
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| A2. |
horizon PMI is a Private Medical Insurance plan designed,
administered and serviced by MEDMARK Health & Life. Delta Insurance Co.
provides the necessary insurance back-up for the plan.
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| A3. |
MEDMARK Health & Life has been the sole BUPA International
Advisor in Egypt since 1990 and horizon PMI is a product designed, administered
and serviced by MEDMARK Health & Life. horizon PMI has no direct
relationship with BUPA International.
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| A4. |
Coverage outside Egypt is an optional benefit which provides you
with emergency international coverage while traveling. The international
coverage is serviced by International SOS, globally recognized as the premier
medical assistance and emergency services provider world-wide.
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| A5. |
No, you only have to fill a medical questionnaire. It is in your
interest to fill the questionnaire accurately and truthfully in order to avoid
various problems in the future.
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| A6. |
You have to ask your treating doctor to fill his part on your claim
form and sign it. After completing the claim form with your personal details,
you submit the claim form with attached original invoices to MEDMARK Health
& Life at 44 Abdel Moneim Riad St., Mohandessin (or to your HR Department
if you are under a Corporate Plan). It will take a maximum of 10 working days
for your expenses to be refunded. If you want to download a claim form you have
to be a member.
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| A7. |
You receive full treatment without payment when you seek in-patient
treatment at any horizon Preferred Hospital, while at all other hospitals and
at doctor’s clinics you receive treatment and make payment, then we refund you
100% of the cost within the allowable plan ceilings.
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| A8. |
Drug addiction, alcoholism, allergies, sexually transmitted
diseases, congenital abnormalities, pre-existing, and chronic conditions are
the main exclusions. For a full list of specific exclusions, please call a
Sales Advisor on 19 24 7.
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| A9. |
The minimum number is 5 employees.
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| A10. |
Family plans are for individuals or families who will directly pay
the subscription premiums of the plan. Corporate Plans are designed as an
employee retention and attraction tool where the company directly pays for all
or some of the subscription premiums. companies receive discounted rate for
Corporate Plan starting with a minimum of 5 employees.
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| A11. |
PMI (Private Medical Insurance) focuses on providing you with the
highest quality of medical treatment, while HMOs (Health Maintenance
Organizations) focus on providing treatment at the lowest cost.
PMI plans don’t require any pre-approvals, referrals or authorization and allow
you to go directly to any doctor or hospital whenever you want. PMI doesn’t
limit you to a network of hospitals or doctors so you have the freedom to
choose the best possible medical attention available. HMO plans usually require
you to visit a specific ‘Primary Care Physician’ before you gain access to one
of the doctors or hospitals within a specific network. HMOs make contracts with
all doctors and hospitals on their network which force them to offer treatment
at the lowest possible cost.
PMI also covers all major / complex treatment and gives you very generous
ceiling of coverage. HMO plans often avoid coverage of major cases in order to
keep costs at a minimum.
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| A12. |
Premiums increase according to age, and each age bracket is 10
years long. There may also be an increase in your premiums according to
inflation in the cost of medical treatment in Egypt.
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| A13. |
The maximum age to become a member is 60 years old. However for
existing Family Plan members who pass the age of 60, horizon PMI will continue
to renew their membership.
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| A14. |
Yes. horizon PMI offers you a generous coverage for such major
cases so that your financial savings are secure. In addition, you’ll have the
freedom to choose any doctor or hospital in Egypt for your treatment.
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| A15. |
The overall ceiling for treatment expenses is EGP 150,000 per
person per year. So you’ll have peace of mind in knowing that you can seek the
best medical attention without worrying about the cost.
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| A16. |
You and your family members are always just one quick phone call
away from professional emergency assistance. Just call our 24-hour emergency
hotline on
19 24 7 and speak to a qualified medical doctor who can help you right
away. |
| A17. |
The contract duration is always 1 year, regardless of how often you
are paying your premiums (e.g. annually, quarterly etc.)
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| A18. |
Your insurance coverage begins on your start date which you
specified in your application, provided that we have received your completed
application, signed contract and first subscription payment, even if you have
not yet received your membership card. If you are unsure about your start date,
please feel free to contact us on 19 24
7.
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| A19. |
Your membership will be put on suspension, meaning no claims can be
reimbursed to you, until your outstanding subscription is received. If your
subscription premium is later than 3 months after the due date, then your
membership is cancelled as of the due date of the outstanding payment.
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| A20. |
If you need a replacement membership card please
contact us on 19 24 7 and we can issue a new card for you.
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| A21. |
A Main Applicant is the person who signs the application and
contract. A Dependant is a Main Applicant’s family member (spouse or child) who
joins as a horizon PMI member under the same policy.
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| A22. |
Dependants can only be your spouse or your children. If you have
another relative who wishes to join, they will need to apply for a new
membership in their name.
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| A23. |
Anyone who is between the age of 18 - 60 yrs can be a Main
Applicant. Minors under the age of 18 yrs can only be Dependants.
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| A24. |
You can pay subscriptions either by cheque or by bank transfer.
Cheques should be payable to ‘Delta Insurance Co.’ and should be delivered to
our Cairo or Alexandria offices – please click
here for address details. If both of these payment methods are not
convenient, please contact us and we
would be happy to help.
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Claims and Medical Services |
| A25. |
After completing all sections of the claim form, you should attach
all original invoices (receipts) for the expenses mentioned in the claim form.
It’s advisable to keep photocopies of these receipts and the claim form for
your own reference.
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| A26. |
No, we can only accept original invoices / receipts.
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| A27. |
Ask the medical provider (doctor / hospital etc.) to give you
authenticated duplicates for the lost invoices. If this is not possible and you
still have photocopies of the lost invoices, ask the medical provider to
validate these copies as “identical copy to original invoice” along with the
provider’s official stamp.
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| A28. |
Yes, your claims are valid for up to 90 days from the start date of
treatment (this is the start date indicated on the original invoices submitted
with your claim form). Invoices dated over 90 days upon submission of the claim
will be considered invalid.
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| A29. |
There are two ways to be refunded for eligible claims - by cheque or by bank
transfer. You can select the method required by completing the relevant section
in the claim form. Corporate Plan
clients can choose to have claim refunds paid directly to the members, or to
the company account.
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| A30. |
All refunds are paid in Egyptian Pounds.
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| A31. |
There are two ways to follow up on your claims: by
contacting us on 19 24 7, or by using the
My Claims area on this website.
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| A32. |
This is a report that you receive with every claim refund giving a
full explanation of the claim payment. It shows a breakdown of each invoice
submitted with the claim, the amount claimed and the eligible amount due for
refund and which benefit item (covered medical condition) each amount falls
under.
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| A33. |
Yes, as a horizon PMI member you have complete freedom to choose
any doctor, medical centre or hospital for your treatment. As always, you will
still be refunded for 100% of the expenses paid for eligible treatment up to
the limits specified in your plan.
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To add a question, Please click here
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