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The AXA International Healthcare Series for AGCC residents

Whether you live within the AGCC or are travelling abroad you’ll want to feel sure that, should anything happen to you or your family by way of an illness or injury, you have access to the best possible medical care.

While abroad, you might find that:
 >  The standards of healthcare that we take for granted aren’t
     always available elsewhere.
 >  Local hospitals may be unable to undertake the treatment you
     need or
 >  To arrange transportation to the nearest available healthcare\
     facility in an emergency.
 >  Some countries do not have state healthcare facilities and even
     if they do, as a visitor, it is quite likely that you’ll be entitled to
     nothing more than basic care.

Did you know?
 >
AXA Gulf has more than 500,000 customers

 > AXA Gulf is more than 80% satisfied customer
 > AXA Gulf has a high standard of cover and excellent support
    to its members
 > AXA Gulf provides personal care and attention
 > AXA are able to offer plans authorized by all GCC health regulators - 
    CCHI in Saudi Arabia and HAAD in the Emirate of Abu Dhabi

Health insurance, we cover for your:

 

 

Benefits International Plans Regional Plans Local Plan 
Health
Perfect 
Health Perfect 2 Health Perfect 3 Health Perfect 4 Health Perfect 5 Health Perfect
6
Health Perfect
7
International Cover Yes Yes  Yes No No No  No
Regional Cover Yes Yes Yes  Yes Yes No  No
Routine Dental Cover (after 9 months membership) Yes Yes No  Yes No No  No
Pregnancy and Delivery Cover Yes Yes Yes  Yes Yes Yes  No
After 12 months  
Health Screen Cover Yes Yes  No Yes No No  No

 

Maintenance of Chronic Conditions Cover (From day 1 and Sub-Limited)
Yes Yes Yes  Yes Yes Yes Yes 
Pre-existing Conditions Cover (From day 1 and Sub-Limited) Yes Yes  Yes Yes Yes Yes  Yes
Out-patient direct billing facility in the Gul Region (From day 1) Yes Yes Yes  Yes Yes Yes Yes 
Out-patient network in the AGCC STAR PLUS STAR PLUS  STAR STAR STAR DIAMOND CRYSTAL 
Ancillary Equipment Cover Yes Yes Yes Yes Yes No No
WellBeing Cover Yes Yes Yes Yes No No No
Personal Accident Cover Yes Yes Yes Yes Yes Yes Yes


For Abu Dhabi residents, we cover for your:

 

 

Benefits International Plans Regional Plans Local Plan 
Health
Perfect 
Health Perfect 2 Health Perfect 3 Health Perfect 4 Health Perfect 5 Health Perfect
6
Health Perfect
7
International Cover Yes Yes  Yes No No No  No
Regional Cover Yes Yes Yes  Yes Yes No  No
Routine Dental Cover (after 9 months membership) Yes Yes No  Yes No No  No
Pregnancy and Delivery Cover Yes Yes Yes  Yes Yes Yes Yes
Waiting period according to Abu Dhabi regulation
Health Screen Cover Yes Yes  No Yes No No  No

 

Maintenance of Chronic Conditions Cover (From day 1 and Sub-Limited)
Yes Yes Yes  Yes Yes Yes Yes 
Pre-existing Conditions Cover (From day 1 and Sub-Limited) Yes Yes  Yes Yes Yes Yes  Yes
Out-patient direct billing facility in the Gul Region (From day 1) Yes Yes Yes  Yes Yes Yes Yes 
Out-patient network in the AGCC STAR PLUS STAR PLUS  STAR STAR STAR DIAMOND CRYSTAL 
Ancillary Equipment Cover Yes Yes Yes Yes Yes No No
WellBeing Cover Yes Yes Yes Yes No No No
Personal Accident Cover Yes Yes Yes Yes Yes Yes Yes


Because some things in life are really precious, AXA Gulf is committed to keeping you in the best of health.

International plans Switch

Health Perfect Plans 1, 2 and 3 for an International Cover

These are our top of range plans and allow you to choose to have medical treatment in a well-known hospitals in the AGCC or anywhere in the world. (Please note that treatment in the USA is only available under Health Perfect Plan 1).
In addition you'll receive higher limits on most of the benefits.

Please click here to download the summary of benefits
or click here for Abu Dhabi residents

 

Regional plans Switch

Health Perfect Plans 4 and 5 for Regional Cover

Our most popular plans, they cover you for treatment in North Africa and Middle East as well as the major trading nations of the Indian sub-continent and South-East Asia. Where Health Perfect 4 features all the key benefits of the International plans, Plan 5 will provide competitive comprehensive and access to the best medical car available in your country of residence and beyond.

Please click here to download the summary of benefits
or click here for Abu Dhabi residents

 

Local plan Switch

Health Perfect Plans 6 and 7 for a Local Cover

Specifically designed for those who want the reassurance of quality health plus the security of a substantial overall annual benefit limit for high value treatment at a lower premium. Health Perfect 6 and 7 are ideal for those who do not travel extensively outside their country of residence.

Please click here to download the summary of benefits
or click here for Abu Dhabi residents

 







 

 

 

 

Members Information Switch

Welcome to the members section. Thank you for choosing AXA as your healthcare insurance provider. You can rest assured that, whatever the year brings, we will give you access to the best available care. In order to communicate with you efficiently, we have included some useful information on this page.

Prior Approval

AXA Insurance requires prior authorization for some treatments. The reason is to protect you from unexpected costs.

When issuing confirmation of cover in this way, we confirm the following;

  • Planned treatment is eligible under your policy;
  • The planned treatment is medically necessary; 
  • The planned treatment is within the reasonable and customary costs; 
  • The planned treatment falls within the remaining benefit of your plan.

Our agreement with you requires you to seek authorization for the following treatment and services:

In-patient & Daycare

  • All in-patient and daycare admissions 
  • Diagnostics, treatment, surgery and other medical services. 
  • All in-patient maternity services 
  • All in-patient dental services

Out-patient

  • Non-emergency MRI, CT, PET and Gait scans and internal diagnostics such as but not limited to endoscopy, colonoscopy, gastroscopy etc. 
  • Physiotherapy services 
  • Prescriptions covering consumables for 30 days or more 
  • All out-patient dental services received on a direct billing basis 
  • All out-patient services costing or exceeding Dhs/QR 1,000, BHD/OR 100

When do I need to contact AXA for pre-approval?

In the network shown for your plan

When you visit a hospital/clinic in the network shown for your plan, the hospital/clinic representative will contact us directly in order to pre-authorize any appointment or medical treatment needed (including in an emergency)

Outside the network shown for your plan

If you are visiting a hospital/clinic outside the network shown for your plan for out-patient treatment, then there is no need to pre-authorize with AXA, you will follow the reimbursement process. If you need to be hospitalized for a planned treatment then you will need to contact AXA at least 5 days prior to your treatment taking place.

Planning an admission to a hospital

Why do I need to contact AXA?

If you need to go to the hospital for the day or to stay overnight for eligible medical treatment and this is planned, contact us at least 48 hours before your admission so that we can discuss this with you.

The reason for this is so that AXA can:

  • If necessary, advise you of hospitals in your area 
  • Confirm that you are covered for the planned treatment
  • Confirm how much we will pay for the planned treatment 
  • Confirm how long we will pay for you to stay in hospital 
  • Confirm whether we will be able to settle directly your hospital bills or not 
  • And if you are travelling we will be able to help you with your admission.

Going into a network hospital covered by your plan

What do I need to do?

First things first…

  • Bring your current/valid AXA medical card and another form of identification, such as your passport or local ID AND the claim form which is included in your health plan pack or print one from our web site www.axa-gulf.com
  • Show these documents to the clinic/hospital representative before you see a Medical Practitioner.

Remember to…

  •  Remind the hospital that you are insured with AXA Insurance and ask them to confirm they have received authorization for your stay and treatment. You should check what our authorization says as you may have to pay for anything not shown on that authorization before you leave the hospital. Please contact us before admission if you have any concerns. 
  • The hospital will ask you to complete an Admission Form. Make sure that this includes your insurance details before you sign it. 
  • The hospital will probably ask you for a credit card. This may be used to collect payment, from you, for anything that is not covered by your plan or for which the hospital has not received authorization from us.

While in hospital…

While you are in the hospital, if you have any doubts about what you are being told or if you do not understand something, please do not hesitate to contact us for advice. If you are not able to contact us yourself we will be happy to talk to someone else with your permission. Working with us to manage your care while in hospital reduces the risk that you will have to pay for all or any part of the cost.

Leaving the hospital…

Before leaving the hospital you will be asked to pay for anything not covered by your policy and not included in our authorization. If this is the case please keep all receipts for future reference. If you need any advice following your discharge from hospital please contact us.

Visit to Clinic’s/Hospitals & Dentists

What do I need to do when I visit a Clinic/Hospital or Dentist in the network shown for my plan?

First things first…

  • Bring your current/valid AXA medical card and another form of identification such as your passport or local ID. 
  • Show these documents to the clinic/hospital representative before you see a Medical Practitioner. 
  • See the Medical Practitioner, who will give you the treatment you need, any prescription you might need or refer you for further investigation. 
  • At the end of this consultation you and the Medical Practitioner should complete and sign the claim form (the hospital/clinic will provide this).

NB. Do not sign an empty, incomplete or incorrect claim form.

Don't forget your deductible…

  • If your plan requires you to pay a deductible you must pay it before leaving the clinic/hospital. Details of this are given on your AXA medical card.

Now your medication…

  • If you have been prescribed any medications you will have been given the pink copy of your claim form. Take this along with the prescription to a network pharmacy (this may be inside the clinic/hospital itself). If not please refer to the Pharmacy Network shown for your plan. 
  • If you wish to use a pharmacy outside the network take the prescription with you to a non-network pharmacy, collect your medication and a receipt. You will need to send the receipt and the pink copy of your claim form to us as shown in the Section “Reimbursement”.

What if the clinic/hospital or dentist is not in the network shown for my plan?

  • Bring your current/valid AXA Medical card and another form of identification such as your passport or local ID AND the claim form which is included in your health plan pack or print one from our web site www.axa-gulf.com. • Show these documents to the clinic/hospital representative before you see a Medical Practitioner.

Dont forget to take the claim form in with you when you go to see the

Medical Practitioner…

  • See the Medical Practitioner, who will give you the treatment you need, any prescription you might need or refer you for further investigation. 
  • At the end of this consultation you and the Medical Practitioner must complete, sign and date the claim form (the hospital/clinic will normally not provide this). Do not sign an empty, incomplete or incorrect claim form! If the doctor does not wish to complete the claim form please remind them that, if they do not do so, you will not be able to make a claim. 
  • You will need to pay the clinic/hospital for your consultation. Keep the receipt for this as you will need to send this, the completed claim form and any other related bills to us for payment. See Section “Making a claim”.
  • If you have been prescribed any medications you will have been given a prescription. Pay for any medication and collect a receipt. You will need to send the receipt, together with the receipt for your consultation and any investigations plus your fully completed claim form to us.

Contact Us

Who can I contact to answer my queries?

Our Customer Service Team and Medical Board are available 24 hours a day, 7 days a week, and 365 days a year:

 

 

Country Telephone Fax
Kingdom of Saudi Arabia 00 966 (0) 1 478 0282 00 966 (0) 1 477 3097
United Arab Emirates 00 971 (0) 4 429 4000 00 971 (0) 4 429 1378
Qatar 00 974 4412 8733
00 974 412 8734
Bahrain 00 973 17 582 612 00 973 17 582 648
Oman
80072926 or 00 968 24 00 100
--
Kuwait 00 965  2 232 2970
00 965 2 232 2971
Lebanon
00 961 1 518018
--
Syria 00 963 11 6631118 --
USA 00 1 312 356 5976 --
UK 00 44 1892 556 6767
--

           

By Email:

WORLDWIDE:

For customer service:  medexcs-gulf@axa-gulf.com 

For pre-approvals:  medicalboard.gulf@axa-gulf,com  

Kingdom of Saudi Arabia:

For pre-approvals:  medicalboard.KSA@axa-gulf.com

Where do I send documents?

If you are sending documents by email send to the given email address above.

When do I contact my Human Resources Department?

Your HR team can provide a full list of exclusions under your AXA policy and clarifications required relating to the benefits under your policy. In addition if you have any queries regarding your membership addition and deletion of members under the scheme) or your cover under the employee policy they can help.

 

KSA

UAE

Bahrain

Qatar

Oman

AXA Cooperative Insurance,
Medical Department,
PO BOX 21044,
11475 Riyadh,
Kingdom of Saudi Arabia
AXA Insurance,
Building 5,
Dubai Outsource Zone,
Medical Department,
PO BOX 32505,
Dubai,
United Arab Emirates
AXA Insurance,
Medical Department,
PO BOX 45,
Manama,
Kingdom of Bahrain
AXA Insurance,
Medical Department,
Qatar Financial Centre,
6th Floor, Office 604,
PO BOX 15319,
Doha,
State of Qatar
AXA Insurance,
Safeway Buiding,
Ground floor, Unit 1 and 2,
Opp Assarain complex,
Dohat al Adab Street,
Al khuwair,
Sultanate of Oman

Medical_Provider_locator_Banner_small_ALL_EN.png

What to do next?

For further assistance, please call our Customer Service Team on 8004845

Useful Downloads


What is PBM, ePrescription and eAuthorization?

Pharmaceuticals Benefits Management (PBM) is used in the Abu Dhabi market whilst ePrescription and eAuthorization (eRx) is used in Dubai.

Both services offer:

1. Instantaneous online approval for medicines removing the need for manual pre-approval.

2. Improved clinical quality as within seconds the system checks the suitability of the prescription and dosage against the members unique circumstances.


These services are focused on improving healthy drug practices, reducing unnecessary, conflicting or excessive drug prescriptions to optimize health and safety standard.

What should I now expect when I visit a Physician/Doctor or Pharmacy?

1. Should you require a prescription in Dubai the treating Physician/Doctor will complete an ePrescription whereas in Abu Dhabi a standard prescription will be provided by the treating Physician/Doctor and the Pharmacy will upload your prescription into PBM.

2. Once your prescription is entered into the system within seconds it will check if the prescription is appropriate for you and will provide the Physician/Doctor/Pharmacy with an eAuthorization or a clear explanation for the reason for rejection. If rejected the Physician/Doctor/Pharmacy can either amend the prescription or can contact AXA to discuss further. Should the rejection be due to the prescription being outside the scope of your insurance you would continue to proceed on a reimbursement/cash basis.

Should the eAuthorisation have been provided by the treating Physician/Doctor they will provide you with an ePrescription to take to an AXA Pharmacy network provider. The AXA Pharmacy Network will enter the ePrescription reference into their system to have immediate access to the ePrescription and eAuthorization along with any rejection details.

3. The Pharmacy will then proceed to dispense the drugs accordingly without any further approval required.

What happens if the Physician/Doctor are unable to provide an ePrescription?

In some cases or in some regions should a Physician/Doctor be unable to provide you with an ePrescription they will provide a paper prescription which would then be converted into an ePrescription by the AXA Pharmacy Network provider. Should the Pharmacy also face any issues they can contact us.

If a prescribed drug is rejected what should I do?

The physician would be provided with clear explanation of the rejection reason. Members are encouraged to ask their physician for the explanation. The rejection reasons are also available to the pharmacy should you wish to consult with them. If the prescription still remains recommended by your physician then the case will be subject to pre authorization by AXA as per existing approval process. Should the prescription be outside the scope of your insurance you can proceed on a self-pay basis.

How can I be sure that the service is providing the right clinical responses?

We are working closely with internationally renowned solution providers approved by the health regulators in the region to ensure the system meets the highest local and international regulatory standards.
AXA is committed to being attentive to the interests of its customers and to the requirements of the regulators and authorities. We believe in providing our clients with the best healthcare insurance services and delivering responsible medical prescribing practices for your health and safety.

800 48 45

Sun to Wed 8am to 8pm
Thu 8am to 5pm & Sat 8am to 6pm

Building 11 A&B, National Consultative Council Complex,
Delma Street, (Street No. 13)
Al Nahyan Camp Area

Telephone: +971 2 495 79 99


OmanKSAUnited Arab EmiratesQatarBahrainQatarBahrain