Private Medical Insurance

Private Medical Insurance

We Can Provide The Following Cover

We offer a range of schemes providing cover in purely for Iraq through a number of standard options to a full global coverage including North America.

Please read the information which summarises the extent of the cover we can provide but note that certain benefits are only available on specific plans.  For those companies with more than 200 employees we are happy to discuss customized coverage and limits as an alternative to our standard plan offerings.

if the information you require is not shown then please contact us with your requirements and we will see if we can assist.

Persons covered
Currently we are only able to offer Private Medical Insurance to:

  • Companies (Private or Public)
  • State Owned entities
  • NGO’s or similar
  • Ministries or Government Bodies

We are unable at this moment in time to offer cover to private individuals.
Age Limits
The age limitations for which we can provide coverage are as follows and apply to direct employees and if the plan is extended to cover dependents those to.

  • Age 65 for a person to be insured for the first time in his/her life.
  • Renewals on an existing policy are possible up to the age of 74. Coverage terminates at the end of the policy period following attainment of age 75.
  • For dependent children Up to 18 (24 for students).

We will need to be provided with details of the employees and dependents if cover for them is required in the following  format
Enrolment Eligibility Conditions
  • Minimum group size is 5 primary insured
  • All eligible employees must be enrolled (primary insureds).
  • Coverage for dependents may be written on a mandatory or voluntary basis. If mandatory, then all eligible dependents must be enrolled. If voluntary, then eligible dependents must submit a medical health statement and coverage will be underwritten and is not guaranteed.
  • An employee/employer relationship must exist. Independent contractors and consultants are not eligible.
  • All employees must be actively at work and full-time staff (minimum 20 hours) on the effective date of the group plan. Employer must declare any knowledge of employees not actively at work or employees anticipated not to be actively at work.
  • Payroll records may be requested at underwriter discretion to verify the employee/employer relationship and actively at work status.
Medical History Disregarded
  • Applicable while the group’s headcount exceeds 20 primary insureds

Waiting periods
  • All plans, under specific sections have waiting periods that apply for certain types of treatment.  These can vary on a number factors these being:

    • Plan territory covered
    • The extent of cover offered under the plan type
    • The number of employees can also effect whether a waiting period is applied for certain coverages only

Waiting Period – is a period of time from when either the plan incepts or where an employee (and employee dependants if covered) are added to the plan mid term, that the employee has to wait before the cover for that particular section operates.

These waiting period applies to all employees and dependents including newly added employees/dependents as they are enrolled throughout the year.

The waiting periods under the standard policies we offer are as follows:

Cover Section Waiting Period
Inpatient Treatment in a psychiatric clinic 11 Months
Psychiatric out-patient consultations and prescribed Drugs 11 months
HIV/AIDS 22 Months
Adult Health Screening (Check-up) 11 months
Compassionate Trip Home 11 Months
Dental 6 Months
Chronic conditions 11 Months
Maternity 11-Month waiting period. The date of conception may only be confirmed at least 11 months after the policy inception date (or the date of an upgrade to a higher plan), otherwise maternity will not be covered.


Waiver of the waiting period: Waiting periods indicated shall not apply to those insured persons, who were covered under the same insurance plan (or the insurance plan which had similar benefits and waiting periods) before being enrolled in the list of insured persons under our policy , subject to:

  • There being no break in coverage between the prior plan termination and the effective date of coverage with us.
  • Invoice from prior carrier is provided, showing insured employees / dependents and date premium is paid from and through (must be 12 months minimum),
  • a official summary of benefits/copy of policy from the prior group plan is provided.

The waiting period cannot be waived for subsequent joiners (enrolled throughout the policy year).
Major Exclusions
There are always exclusions that apply to any policy coverage, the key ones that apply our Private Medical Insurance are:

  • Charges in excess of usual and customary
  • Cosmetic & elective surgery
  • Addictive conditions
  • Professional or Hazardous sports/activities

Please contact us for more information if required.

Limits Available

Summary of our private medical plans

The table below summarise the cover that can be provided under our plans.

Note that the following applies to all plans indicated.

“Paid in full” below means that relevant expenses shall be paid or reimbursed within the individual Sum Insured, under conditions that such expenses are Usual, Customary and Reasonable, and relevant Treatment is Medically Necessary.

Amounts below mean Limits of possible reimbursement of actual cost paid/expenses incurred under relevant items, under condition that such costs/expenses are Usual, Customary and Reasonable, and relevant Treatment is Medically Necessary.

Number of visits/days/nights means that the reimbursement shall be based on the actual number of visits/days/nights, but no more than for the number visits/days/nights indicated below

 

Sum Insured per person (all sections combined)Global Healthplan

 

 

Iraq Only (inc ACIBADEM hospitals in Turkey
We can offer cover from USD1m to 3m per person under our standard Plan.  For plans with more that 200 members customisation of limits is availableFrom USD80,000 to USD500,000
Primary Area of Cover

Areas Covered*

AREA I:    Europe excluding Switzerland, Russia and UK

AREA II:     Worldwide excluding Nth. America, Switzerland, Russia, UK, China, HK & Singapore

AREA III:   Worldwide excluding Nth. America

AREA IV: Worldwide (maximum continuous stay of 3 months in Nth. America), for stays of more than 3 months please refer to the Underwriter

·          There is flexibility in territorial Areas dependant on scheme size

Iraq & ACIBADEM Network Turkey Only
HOSPITALISATION Planned and emergency In-patient Treatment (including day-patient), except for dental Treatments
Accommodation and mealsA Standard or Semi-Private room to a Superior private room depending on plan chosen A Standard or Semi-Private room to a Superior private room depending on plan chosen
If the room of the level specified in the Schedule of Benefits is not available at the time of admission, then the Usual, Customary and Reasonable expenses for the lower level accommodation conditions shall be paid for/reimbursed.
The Insured Person is allowed to select any of the available categories of more comfortable rooms, however, the reimbursement will be limited to an amount corresponding to the accommodation in room level specified in the Schedule of Benefits, while the difference in the accommodation cost must be paid at Insured Person’s own expense.

In-Patient Treatment

Costs and fees of attending Doctor, Surgeon and anaesthetist, other medical staff involved – for Treatment, consultations, development of Treatment plan, Surgery and medical manipulations, conservative Treatment or monitoring as well as other Medically Necessary services, Day-Care Treatment

paid in full paid in full
Operating theatre, emergency room, recovery room, intensive care unit (ICU), coronary care unit, high dependency unitpaid in fullpaid in full
Diagnostic tests, laboratory and instrumental tests, electrocardiograms; medical imaging (X-Rays, CT, MRI, PET)paid in fullpaid in full
Drugs, dressings, medical materials (bandages/surgical dressings, casts, plaster, etc.)paid in fullpaid in full
Parental Accommodation with an insured child aged under 16From 30 nights to 50 nights dependant on Plan chosennot covered
Per night limit100 
Accommodation for a baby who is breast fed with the insured motherDepending on plan chosen from no cover provided to Paid in Fullnot covered
Inpatient Treatment in a psychiatric clinic or unitDepending on plan chosen from no cover provided to 30 nightsDepending on plan chosen from no cover provided to 30 nights
(subject to 11 months Waiting Period since entry into force of the insurance cover under the Contract in respect of the Insured Person concerned) 
Reconstructive Surgery paid in fullpaid in full
Internal Prosthetic Devices and aids paid in fullpaid in full
Transplantation of kidney, heart, heart-lung, liver, bone marrow and stem cell treatment Depending on plan chosen from 100,000 to 200,000Depending on plan chosen from 50,000 to 100,000
Palliative Treatment of terminal Illness & hospice care

Depending on plan chosen from not covered to 40,000

Note Limit is a Lifetime limit not per year limit

not covered
Hospitalisation Daily Allowance
(Alternative to reimbursement of Hospitalisation costs)
 Depending on plan chosen from 100 per night to 150 per nightnot covered
Subject to maximum of 20 to 30 nights dependant on plan chosen
POST-HOSPITAL TREATMENT
Rehabilitation course in the profile Rehabilitation centre, immediately following inpatient TreatmentDepending on plan chosen from not covered to 1,500 Depending on plan chosen from not covered to 1,000
Physiotherapy outpatient, if prescribed by the Doctor in connection with and immediately following the inpatient TreatmentDepending on plan chosen from 20 to 40 visits per plan yearDepending on plan from 20 to 30 visits per plan year
External Prosthetic Devices and aids  which are medically required following Hospitalisation, Day-Care Treatment or Accident and emergency room TreatmentDepending on plan chosen from 800 to 1,500Depending on plan chosen from not covered to 1,000
ONCOLOGY TREATMENT
Consultations, tests, radiotherapy or chemotherapy, take-home Drugs received as an In-patient or as an Out-patient at a Hospital or a registered Cancer Treatment centre following discharge from Hospital confinement or Surgerypaid in full paid in full
Cost of a wig/hairpiece if required following a course of cancer TreatmentDepending on plan chosen from 800 to 1,500Depending on plan chosen from not covered to 1,000
OUT-PATIENT CARE (except for ONCOLOGY TREATMENT and dental Treatments)
Treatments and consultations received from private Doctors and from out-patient clinicsDepending on plan chosen from 2,000 to paid in full 

Depending on plan chosen from 2,000 to 8,000

Subject to 20% co-pay

Fees of GPs, Family Doctor, Specialist, also in case of visiting patient at home
Prescription Drugs & dressings
X-rays, diagnostic and pathology tests, instrumental tests, electrocardiograms
Hi-tech scans (CT, MRI & PET)
Hormone Replacement TherapyDepending on plan chosen from 2,000 to paid in fullDepending on plan chosen from 2,000 to paid in full
When not related to the menopause
PhysiotherapyDepending on plan chosen from 10 to 20 visits per plan yearDepending on plan chosen from not covered to 10 visits per plan year
When prescribed by a Physician
Alternative/Complementary Medical Practices (available after the Insured Person pays the first two visits by himself/herself):  
Acupuncture, needle therapy, aromatherapy, chiropractic, homeopathic, naturopathic, and osteopathic medicine, Ayurvedic and Traditional Chinese medicine, hydrotherapyDepending on plan chosen from 10 to 30 visits per plan yearnot covered
limit per visitDepending on plan chosen from 35 to 50
Prescribed drugs limit and co-pay applicable under homeopathic and Chinese medicineDepending on plan chosen from 350 to 1,000
Subject to 20% co-pay
Nursing at HomeDepending on plan chosen from not covered to 90 daysDepending on plan chosen from not covered to 90 days
Psychiatric out-patient consultations and prescribed DrugsDepending on plan chosen from not covered to 3,000Depending on plan chosen from not covered to 1,500
(subject to 11 months Waiting Period since entry into force of the insurance cover under the Contract in respect of the Insured Person concerned)
Restorative speech therapyDepending on plan chosen from 5,000 to 10,000Depending on plan chosen from not covered to 5,000
Subject to 50% co-paySubject to 50% co-pay
RESTRICTIONS AND LIMITS APPLICABLE TO CERTAIN MEDICAL CONDITIONS OR EVENTS
(Waiting Periods and limits indicated in this section prevail over those envisaged elsewhere in the Schedule of Benefits)
Chronic Conditions (other than malignant tumour, congenital and hereditary conditions):
Consultations, In-Patient and Out-Patient Treatment & Drugs (subject to 11 months Waiting Period since entry into force of the insurance cover under the Contract in respect of the Insured Person concerned)
Depending on plan chosen from 3,000 to 7,000 Depending on plan chosen from not covered to 5,000
HIV/AIDS: Consultations, In-Patient and Out-Patient Treatment & Drugs (subject to 22 months Waiting Period since entry into force of the insurance cover under the Contract in respect of the Insured Person concerned)Depending on plan chosen from 15,000 to 25,000
Note Limit is a Lifetime limit not per year limit
Depending on plan chosen from not covered to 15,000
Note Limit is a Lifetime limit not per year limit
Congenital / hereditary diseases Depending on plan chosen from 2,000 to 5,000Depending on plan chosen from not covered to 2,000
only for children up to the age of 18Depending on plan chosen from 10,000 to 25,000
Note Limit is a Lifetime limit not per year limit
Depending on plan chosen from not covered to 10,000
Note Limit is a Lifetime limit not per year limit

War and Terrorism Limits

Individual limit per Insured Person per event, but subject to the Aggregate limit per event

175,000 all plansDepending on plan chosen from 100,000 to 175,000
Aggregate limit per event700,000 all plans700,000 all plans
DENTAL CARE Depending on plan chosen from 500 to 3,000Depending on plan chosen from not covered to 500
Subject to 20% co-paySubject to 20% co-pay

 Depending on the plan chosen cover is from Basic Dental Restorative Treatment Only to Basic Dental Restorative, Preventive & Diagnostic Treatments

Cover is subject to Waiting Periods of 6 to 11 months depending on plan chosen starting from date insured person joins plan

 Depending on the plan covered from not covered to providing Basic Dental Restorative Treatment Only
Cover is subject to a waiting period of 6 months starting from date insured person joins plan
DENTAL TREATMENT FOLLOWING AN ACCIDENTDepending on plan chosen from 2,000 to 5,000Depending on plan chosen from not covered to 1,000
MATERNITY CARE (subject to 11 months Waiting Period for Pregnancy conception from the inception date of the MATERNITY CARE coverage. Limits below established on a per Pregnancy basis)
Normal Pregnancy and ChildbirthDepending on plan chosen from not covered to 12,000 Depending on plan chosen from not covered to 5,000
Complicated Pregnancy and Childbirth Depending on plan chosen from not covered to paid in full
Where a plan has a cash limit to the cover provided in life-threatening situations paid in full
Depending on plan chosen from not covered to 20,000 (but in life-threatening situations paid in full)
New-born Care within first 14 days since the baby’s birth dateDepending on plan chosen from not covered to 75,000
Where cover is provided a private room covered

Depending on plan chosen from not covered to 5,000

Where cover is provided a private room covered

PREVENTIVE CARE
Well Child CareDepending on plan chosen from not covered to 1,000 Depending on plan chosen from not covered to 500
Subject to 20% co-pay Subject to 20% co-pay
Adult Health Screening (Check-up)Depending on plan chosen from not covered to 1,000Depending on plan chosen from not covered to 500
(subject to 11 months Waiting Period since entry into force of the insurance cover under the Contract in respect of the Insured Person concerned)Subject to 20% co-pay Subject to 20% co-pay
VaccinationDepending on plan chosen from 100 to 500Depending on plan chosen from not covered to 100
LOCAL ROAD AMBULANCE
if arranged by the Assistance Service
paid in fullpaid in full
EMERGENCY CARE
Emergency Medical Evacuation In acute medical conditions when proper medical aid cannot be arranged locally1,000,000 Depending on plan chosen from 50,000 to 100,000
Emergency Medical Evacuation – Companion Related Costs 3,5003,500
Companion Flight ticketEconomyEconomy
Hotel accommodation limit for companion14 nights14 nights
Taxi / transportation costs of companion visiting the Insured Person hospitalised, per day150150
Hotel accommodation limit for Insured Person upon the end of Hospitalisation5 nights5 nights
Compassionate Trip Home
(subject to 11 months Waiting Period since entry into force of the insurance cover under the Contract in respect of the Insured Person concerned)
Economynot covered
Repatriation or Burial locallyDepending on plan chosen from 15,000 to 20,000Depending on plan chosen from 15,000 to 20,000
Emergency Care out of Primary Area of Cover100,000not applicable
Depending on plan chosen from 30 to 60 days

information required

Know more
To obtain a quotation please contact us

We try to keep information requirements to a minimum however to provide you with competitive terms we do require time to be able to assess the information to be able to provide our most competitive terms.  If you require a quotation within 48 hours of contacting us then we will not be able to assist.

To obtain the best terms it is preferable to provide a minimum of 14 days to enable the information to be assessed and any queries raised answered.  This is especially relevant to quotations where cover is to take over an existing scheme or where there has been an existing scheme in the previous 3 years.

Whilst the general information we require is the same as to whether you have had cover in the past or Private Medical Insurance is completely new to you, there is additional information that we require should you either have a policy or had one within the last 36 months
Employers who have never had Private Medical Insurance Previously
To enable us to provide a competitive quotation we need the following:

  • A completed employee Census
    • We prefer to be provided with a full census in the following format ‘PMI Census ‘A’+’ this will provide the information required to give you a bindable quotation.
    • If this information is not immediately available, then more general information can be provided as per ‘PMI Census ‘B’+’

Note however that figures provided using census B are no binding until a full employee (+employee dependants if cover required) census is supplied

  • Details as to the Plan required which will need to include:
  • Territories cover is required for
  • Overall Plan limit per employee

We will provide you or your broker with full details of the standard plans we provide to enable you to make an informed choice or you can provide us with the proposed plan coverage you are seeking.  For plans with less than 200 employees we will offer quotations/indications based on the nearest plan that we offer to the cover you require.
Additional Information required for those who have existing Private Medical Insurance cover
For those who have an existing plan in place as well as the employee census which is required for any quotation we will need :

  • Details of the existing plan coverage if you require us to provide cover on the same basis or details as to the new coverage that is required
  • A full claims experience for the previous five years or duration of the plan if the plan has been enforced for a shorter period of time.

In either case please contact us should you require any help or further information concerning our private medical insurance coverage
Census information required for both above
For any quotation we require the following information to be provided.  You can contact us and we will send you a template or you can supply the information in Word, PDF or Excel format

Travel Schedule of Persons To be covered:
Emp No. Title First Name Middle Name Last Name Age Gender  Date of Birth Dependent Y/N Occupation Pre- Existing Medical Condition

If you cannot supply the above, then we can possible indicate on Age band information but please contact us prior to sending anything in in case it will not be sufficient for ours and our reinsurers underwriting needs. Prior to binding any cover we will need the information in the above format.

use of captives

Know more

Almaseer are used to captives participating in Insurance Programs and will discuss a clients / potential clients captive utilisation in their programme based on the clients own unique needs.