Subscriber Guide

We are proud of your joining one of our medical insurance programs, We put this guide between your hands to help you to have an idea about insurance programs’ advantages and benefits as well as the way which must be followed up to obtain a complete advantage of the available medical services, so when we designed our programs we make them harmonized with the actual needs of the growing up medical services

Medical Insurance Application

 Dear subscriber: you should fill the medical insurance application with required
information, including: past medical and surgical history, otherwise you will not be
provided with medical services concerning with the previous cases. Your information
must be correct to avoid the legal, financial and medical responsibilities as well as to
enable us to provide you with the necessary medical care. Thus we promise you to
deal with your information secretly and we’ll not declare it without your written

MIS medical Network

MIS chose an excellent health care provider depends on the medical competence and
geographic positions. MIS covers some governorates and aspires to covers all the
governorates with the necessary medical hospitals, centers, clinics, pharmacies, labs,
x-ray centers, physiotherapy centers, optical and others……

Medical Insurance card

Medical Insurance cards issue for each subscriber and contain his necessary information and enable hem to get medical services from varies health care providers whom contracts with MIS. So you must have medical insurance card and identification card with you to compare the information in both cards. When you lose your card, you should notice MIS immediately so we cooperate to avoid any abuse by your lost card.

Taking medicines

Doctor will write down the suitable medicines on your coupon and hand it to you,
this will enable you to take the medicines easily from any approved pharmacy
after showing both subscription and identity cards.

Prior approval

Some of the services provided to patients may required prior approval, such as
inpatient or when you make a Catheter, MRI, Endoscopy or Physiotherapy. The taken
to assist getting the appropriate action and avoiding the patient any unnecessary
procedures. As well as to ensure that those services are covered in your Health
Insurance policy.

Reviewing emergency centers in hospitals

In emergency cases, that mean if the condition of the patient is required an immediate
care, follow these:

1- Call your doctor as soon as possible for more consultation .(if you can)
2- Go to the nearest emergency room in the nearest hospital within the network,
carrying with you the insurance and identity cards, The emergency department
will do the right thing to help you.
3- You can go to any Out of Network hospital, in the absence of the medical
Network providers, after taking the basic rescue procedures then you can move to
any Network hospitals.

Reimbursement Procedure

Although we have a wide medical network, If the subscriber had to go Out of Network because of his emergency situation (when the medical condition requires immediate attention and can not be postponed) or if the subscriber is present in the city where there is no medical network, the subscriber can visit any appropriate health service provider and pays all medical expenses, When treatment has been provided, then you should file a claim form and send it to (MIS). Medical Service Provider’s name, phone number, fax should be indicated with the attached following documents :

1. Original invoices.
2. Original prescriptions along with application forms for tests and x-rays.
3. Original receipts for all expenses requiring reimbursement.
4. Results of laboratory tests and x-rays.
5. Medical report signed and stamped by physician tasked with treating the cases
in need of admission to hospital (operation – rest).
6. In case of operation and rest, all previous documents should be attached as
well as a detailed statement.

A subscriber – reimbursement claimant – should ensure that undated or unnamed documents are not attached to avoid delay in full and due
reimbursement. Completed, signed and documented claims will be processed by MIS within two weeks from the date of receipt of the claim by (MIS) then a check on behalf of beneficiary will be written. If (MIS) asks for any clarifications or justifications, they should be provided to the company during one week from the request

Your Rights

1. To be treated with all respect and appreciation.
2. To get a clear explanation of your insurance benefits at any time.
3. To call (MIS) If you have any questions regarding the benefits and services at
any time.
4. To get a kind help and an appropriate assistance.
5. To be notified by your doctor or health care providers regarding your illness
and to be involved in taking the decision about any medical procedure will be
provided to you.
6. To have the right to refuse any health except if your medical condition
requiring an emergency care.
7. To give your feedback on all health services and to bring any complaints,
whether for health service providers or (MIS) or both.
8. To sign all the medical expenses bills provided to you by health providers.
9. To be dealing in a complete secrecy regarding your health condition and
medical record.

Your Duties

  1.  To deal respectably with all service providers.
  2.  To get an adequate knowledge of the insurance benefits and exclusions related
    to your policy.
  3.  To know how you can receive the health services in the regular and emergency
  4. To show your insurance card before receiving any health service and not let
    someone else to use your card at any circumstances.
  5.  To give a full and correct information regarding your health status for MIS and
    your health service providers.
  6.  To respond to all the procedures and measures regarding the health service
    providers which taken to ensure the provision of adequate health services.
  7.  To pay the health insurance copayment existed in your insurance card.
  8.  To pay the expenses regarding the not covered health services, in addition to
    those which exceed the insurance ceiling.
  9. To follow all the directions and advices given by the health service providers
    related to your health caring.

Important Note

If any inconsistency is happened between this guide and any generalizations or formal
modification issued by the insurance company (in coordination with the employer)
priority will be given to the modifications even if they are not stated in this guide.