FAQs

Nextcare is a TPA (Third Party Administrator) and not an Insurance company. Nextcare
specializes in providing complete health insurance management and third party administration services for insurers and other payers of healthcare.

Network Providers are healthcare facilities (hospitals, clinics, laboratories, pharmacies, etc.) contracted by Nextcare, allowing you to benefit from direct settlement of bills. You can access their services by simply presenting your insurance card or national ID (depending on the country where services are obtained).

You may search for a healthcare provider through the Nextcare website www.nextcarehealth.com or through the Mobile App available on Google Play and Apple Store.

• To see the list of Network Providers applicable for your policy, please log in to Lumi app and choose Healthcare Providers section. For more information on how to use the app, you can watch here the tutorial videos.
• Search for a Healthcare Provider by Name, Country, City, Area, Type and Network
• You can also locate providers near your home, work or the nearest based on your current location

To benefit from your insurance policy, it is advised to visit healthcare providers within your covered network as you will either pay nothing or pay a small percentage of the bill, depending on your policy.

It is advisable that prior to visiting medical facility of your choice, you call and book for an appointment with the respective physician/doctor. We also advise that while booking you confirm with the acceptance of your policy by the physician of your choice.

• You shall visit your healthcare provider and consult with the physician/specialty doctor
• Provider will submit the request for the services directly to Nextcare wherever pre-approval is required
• Nextcare will provide approval directly to the provider within pre-agreed turnaround time
• Healthcare provider will inform you about the amount that you may need to pay directly to the facility (co-pay, co-insurance, deductible, if applicable, or any non-covered services as per your policy terms and conditions) and will inform you about date and time of further treatment if needed

Yes, you can as per your policy terms and conditions. You will be required to pay all bills and then claim only the eligible amount with applicable deductions as per your policy terms and conditions.

• Please ensure that you pre-notified Nextcare prior to availing the service by calling our care center or sending an email to: membercare@nextcarehealth.com. Once pre-notified, you will receive a ticket number for your reference as per your policy terms and conditions.
• If you still wish to visit provider outside your network, please download reimbursement form to be filled and stamped in the medical facility of your choice, collect necessary documents, including medical report, itemized bills and original receipts.
• If you are submitting Reimbursement Claim for the first time, please consult your employer whether your policy is eligible for direct submission to Nextcare or you have to submit Reimbursement Claim through your employer.

Go to Lumi

Register or log in through your user name and password

Go to “Claims”

Go to “Submit New Claim” and make sure you have on hand the following:

Complete details such as the healthcare provider name, service date and description and the physician name.

All necessary supporting documents, including the medical report, itemized bills and original receipts.

After completing all required information, follow these steps:

• Complete your claim information
• Upload or capture all required supporting documents, including:

1. Itemized medical form signed by your doctor and stamped by the clinic/hospital, should include the history of the current illness, the past medical history, the clinical history, and the prescribed medical tests and/or medicines
2. Medical results, if any (e.g. test results and radiology reports)
3. Itemized medical invoice from the clinic/hospital

Click “Submit Claim” to complete the process

After you submit your completed claim form, you will receive a notification by e-mail to confirm that it has been submitted successfully.

You can easily follow up on your reimbursement claim either by using Lumi app or by calling the Call Center number on the back side of your insurance card.

On the Lumi app, go to Claims, View Claims page and you can Search for any submitted reimbursement claim to know its status:

• If the status is Registered, it means that the claim was submitted to Nextcare but not yet reviewed by Nextcare team
• If the status is Authorized, it means that the claim was reviewed and approved by Nextcare team.
• If the status is Pending for Beneficiary Response, it means that the claim was received by Nextcare team and some mandatory documents that have to be submitted by you are missing.
• If the status is Processed, it means that the claim was reviewed, totally / partially approved by Nextcare team and ready for settlement.
• If the status is Settled, it means that the claim is settled and money had been wired either to your direct account or to your beneficiary.
• If the status is Declined, it means that the claim was denied since you are not eligible as per your insurance policy terms and conditions.
• If the status is Not Used, it means that the claim was authorized but later cancelled

The amount you receive will be decreased by the following amounts, depending on your policy terms and conditions

• Co-pay, co-insurance percentage deducted from the total claimed amount, as stated in your policy terms and conditions
• Deductible amount if applicable and as stated in your policy terms and conditions
• If the cost of services you claimed, exceeds average cost of services within your Nextcare provider network, the excess amount will be deducted from the total bill

• Most often reason for the claim to be denied is because claimed benefit is not covered by your policy terms and conditions
• Also note that there are standard EXCLUSIONS & EXCEPTIONS for each policy, that are mostly related to non-declared pre-existing medical conditions, allergy testing, dietary supplements, alternative medicines, dental prostheses and orthodontic treatments, contraception, treatments and services arising as a result of hazardous activities, preventive services and vaccinations outside the scope mandated by insurance authorities.

Always refer to the benefits highlights available on the mobile app, or your Table of Benefits provided by your insurer to be aware of the policy conditions in advance.

Emergency is covered as per your policy terms and conditions (if applicable). You can always contact our local Call Center number available at the back side of your insurance card so we can provide assistance and clarify procedures.

Get in touch

WhatsApp

For Bahrain, Egypt, Kuwait, Oman, and UAE: +971 56 344 8951

For Lebanon: +961 81 504 015

For Qatar: +974 55 066 687

Mobile app support

appsupport@nextcarehealth.com

Member Care

membercare@nextcarehealth.com

Go to Contact Us page on the website, choose your respective country and get in touch with our Customer Service team who will help you with your query.