QLM Life & Medical Insurance Company QPSC
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Can I get individual insurance coverage?
We have different family and individual insurance plans.

What is the process if I want to include my dependents?
Simply ask your HR department to include your spouse and / or children on your policy. An eligible child will be covered until the end of the contract year in which he/she reaches age 18, and can be extended up to age of 23 years if a full time student, in line with the company HR Policy.

Can I add my parents to my health insurance policy?
Only spouses (wives, husbands) and children of the primary policy holder can be included in the insurance policy.

Is Maternity Cover included in my plan?
Maternity coverage is an optional add-on that is selected at the Group level. This means that all members of the Group will have to select the add-on, rather than individuals being able to to request this.

Is there an age limit for Maternity Coverage?
Yes, from 15 to 50 years and the cover is only applicable to married females.

Are Caesarean Sections covered?
Yes, if this maternity benefit is included in your plan, Caesarean Section will be covered subject to the maternity sub-limit mentioned in the table of benefits.

Is Miscarriage covered?
Yes, if this maternity benefit is included in your plan, legal abortion will be covered subject to the maternity sub-limit mentioned in the Table Of Benefits.

What if I give birth outside Qatar?
Coverage will only apply to the territories mentioned in your policy.

What is covered under Dental Benefit?
Please visit our website and click on Dental “Sub-benefit” to view the Dental benefits.

When is pre-authorization required?
QLM approval must be obtained for certain medical procedures/treatments. If your healthcare provider is in the QLM network, they will be required to obtain the pre-approval from QLM. Pre-approval is mandatory for the following:

All hospital admissions and surgical procedures
Outpatient procedures such as: MRI, CT, Endoscopies, physiotherapy
Optional benefits (dental, maternity and optical).

If your healthcare provider is not within the QLM network, it is your responsibility to get QLM approval in advance either by fax or email. Contact our call center on 800 0880 (from within Qatar) or
00974 44533666 (from abroad).

Email: qlm_medical@qlm.com.qa

What is the mode of payment for a cash-reimbursement claim?
Based on your preference, payments can be made either through a cheque or through a bank transfer.

What is the maximum time limit to submit my cash claims/invoices?
Claims should be submitted within 30 days from the date of treatment.

When can I receive the payment of the processed claims?
Payment for cash reimbursement of processed claim can be settled within 10 working days from the date of receiving complete claims documents.

How can I get a claim form?
You may download QLM Reimbursement Claim Form from QLM’s website.

How can I find the nearest hospital or specialists?
You can use the “Find Provider” feature in the QLM Mobile App.

What should I do in case of a medical emergency?
You can seek medical care immediately or speak to our 24/7 call centre to assist you with any queries you may have. You must notify us within 24 hours of admission to the hospital.

Do I need a referral to see a specialist or consultant?
No, you can access a specialist or consultant directly.

If my doctor is not part of your network, am I still covered?
Yes you can. Please submit the claim for cash reimbursement.

How will I know if the treatment prescribed for me is covered or not?
Use our mobile app for direct messaging or chat with one of our agents.

Alternatively, contact our call centre on
800 0880 (from within Qatar) or
00974 44533666 (from abroad)

Email: qlm_medical@qlm.com.qa

What is the difference between co-payment, deductible & co-insurance?
Deductible is the amount of a claim which has to be borne by the Insured before the relevant benefits are payable under the Policy, apart from the optional benefits.
Co-payment is the percentage of costs the Insured must pay related to Dental, Optical & Maternity related treatments.
Co-insurance is the percentage of patient share applicable for Cash reimbursement claims or specific service provider.

What should I do if I lose my membership card?
You will need to notify your HR department to ask for a replacement. A replacement fee will be levied.

If I do not utilise my policy limit this year, can I use it in the next policy year?
No, there are no rollovers.

Information center

What is my policy?

  • The Table of Benefits (TOB) details the services, treatments, limits, and benefits that you are entitled for
  • Online access is available for each and every member detailing benefits of the Policy/Plan
  • The Providers give specific details in accordance with your network tier. Network Tier is detailed in your plan as well as in your medical card. The Network Providers include Hospitals, Polyclinics, Private Practitioner Clinics, Laboratory and Diagnostic Centers and Pharmacies that you may choose to avail your service / treatment from both within Qatar as well as outside of Qatar
  • The Policy Exclusions detail those services that you are not covered for under your Plan/Policy
  • The expenses incurred within the Network Providers shall be on a direct billing basis unless stated otherwise in your TOB/Policy Terms and Conditions
  • The expenses incurred Outside the Network Provider (within and outside Qatar) shall be on a Cash Reimbursement basis, the details of which are explained under Reimbursement Claims / Table of Benefits
  • Should there be any queries or further clarifications, you may contact our call center on the contact numbers provided on the back of your Medical card
  • Our call center is available for your assistance 24/7, throughout the year

The Insured should have a clear understanding of the Policy/ plan of cover and the benefits included prior to submitting a claim.

When treatments are taken outside the designated QLM Network Provider or when the insured has paid all expenses in full at the service provider, the claim should be submitted to QLM via any of the following routes:

  • Visiting QLM office at QIC Building, 5th floor, Tamin Street, West Bay, Qatar.
  • Submit claims online at www.qlm-online.com
  • Submit claims through our QLM Mobile App.

Documents needed for submission:

When filing a claim, please provide all relevant documents including but not limited to the following –

  • Copy of QLM Heath Insurance card.
  • Original Itemised Invoice with date.
  • Original Receipt or Payment Proof.
  • Detailed Medical Report / Discharge Summary duly filled in, signed and stamped by the attending Medical Practitioner.
  • Copy of result of investigations (Laboratory / Radiology / Endoscopies, etc.)
  • Copy of the Prescription
  • Copy of birth certificate (Maternity)

All claims must be submitted within 30 days from the date of service wherein the above mentioned documents are appropriately filled. The insured shall be reimbursed subject to the insured’s policy plan, terms and conditions.

The insured shall be liable for any deductible / co-payment / co-insurance and / or excess that is mentioned in the Benefits of your Policy.

Failure to fully substantiate your claim will result in delayed processing and settlement or may invalidate your claim.

Compassionate Visit Claim Reimbursement

  • Wherein the policy extends to include the costs of a return economy class ticket fare to and from the home country of an insured employee in the event of critical illness or death of an immediate family member (father, mother, spouse, daughter or son)
  • This option is not operative when the insured is travelling to the home country on holiday or business trip
  • The additional benefit provided by this extension shall be limited to the amount per employee as set forth in the schedule and shall form part of the maximum benefit stated in the schedule

The insured may submit the following but not limited to documents to claim for Air Fare Reimbursement –

  • Copy of QLM Health Insurance card
  • Original ticket / print out
  • Original invoice / receipt
  • Original Boarding Pass
  • Death Certificate copy / Medical certificate copy (in case of Critical illness)
  • Proof of age of the deceased / sick person
  • Proof of relation of the deceased / sick person to the insured employee
  • Copy of exit & entry stamped page of the passport as well as the front page of the passport

Reimbursement Settlement Mode

Reimbursement claims are settled in the following modes:

  • Payment Cheque issued in the local currency under name of the insured employee / policyholder’s name (as per the request) along with a detailed breakdown summary of the submitted claim.
  • Bank Transfer in local currency to the insured employee’s local Bank Account and a detailed breakdown summary shall be emailed to the employee’s mail address

Outside Qatar

  • Please ensure that any expenses for non-emergency inpatient and day-patient treatment are agreed by QLM local / international call center in writing i.e. fax / e-mail / letter before any planned treatment is undertaken
  • Pre-authorisation of any Elective Treatment or non-emergency treatment should be submitted in writing to QLM local / international call center as soon as reasonable and at least 48 hours prior to admission.
  • Planned Treatment undertaken without pre-authorisation from QLM may not be eligible for a full refund in accordance with the policy terms and conditions, unless the Help Line response was delayed more than the due time
  • Verbal confirmation does not constitute pre-authorisation. If in doubt, please contact the medical helpline, as shown on your membership card
  • QLM will grant 24 hours a day, 365 days of the year medical helpline staffed by multi-lingual operators

We have arranged a direct settlement network with certain Medical Providers in certain countries where you can receive treatment for eligible medical conditions on a direct billing basis. Please note you will still be responsible for payment of any co-Insurance or Excess at the time of your appointment.

  • The plan you are covered under is printed on your card. You may refer to your online Table of Benefit (TOB) to get the detailed services, treatments, limits, and benefits that you are entitled for
  • You may choose the Provider from the list of Network Providers enlisted under your network tier
  • We have an arrangement of Direct Billing with our Network Providers for the eligible expenses. When you visit the Provider, please present your QLM Medical Card to the receptionist to ensure you avail your benefits efficiently
  • You may be asked to pay before or after meeting with your medical practitioner the Deductible and / or Coinsurance/Copayment specified on your QLM Medical Card at the provider
  • You may also be asked to sign a QLM claim form so that the Medical Practitionercan fill in the details of your visit / illness which are essential for the processing of your claim
  • Please ensure that you have signed the QLM claim form as well all the invoices pertaining to the expenses incurred by you
  • Make sure that the Physician has completed the required data, signed and stamped your QLM claim form, which shall then be forwarded by the Provider to QLM
  • You will be liable for payment of any Deductible / Co-payment / Co-Insurance and/or excess that is mentioned in the Table of Benefits (TOB) in your policy
  • You will bear any expenses incurred for treatments or services that are not covered by your policy
  • You may contact the insurance coordinator at your preferred Provider or QLM Call Center for any queries or immediate assistance
  • Your Physician may require a pre-approval from QLM on certain Out Patient / Daycare / In-Patient services which are detailed under the Pre-Authorisation section