SmartCare by Cigna

Helpful Guide

Your Guide to
using the plan

SmartCare
by
Congratulations

You are now covered under a Group Medical Insurance Plan

that gives you access to quality medical benefits and tools
to manage your wellbeing. Your health insurance plan is
serviced by Neuron – a strategic partner of Cigna.

We have designed this Helpful Guide to make it easy for

you to get to know your benefits and how your plan works.
INTRODUCTION

The purpose of this Helpful Guide is to present

an easy-to-understand reference guide to
valuable information on the benefits, exclusions
and Claims procedures within your policy.

This guide does not replace or override the

definitive policy and contract signed between
the insurance company and your organisation.

For full details of your company’s insurance

contract, please contact your company’s
HR Manager. Please note that the terms and
conditions of your membership may be changed
from time to time by the agreement between
your company and us.

Some words and phrases used in this guide have

specific meanings. These have been defined in
the Plan Definitions section of this guide.

Your insurance policy comprises of your list of

healthcare benefits, your digital ID card, details
of your hospital network and other documents
related to our services including the contract we
have with your employer.

Please take your time to read this guide so you

are fully informed about how to use your Plan.

Together, all the way.®

Contents
About your SmartCare by Cigna Health Plan................1
Insurance regulations in the UAE.......................................2
In case of an emergency.......................................................3
Emergency Out of Area Cover.......................................... 4
Important contact information.......................................... 4
Important information about your plan..........................5
How to use your plan..............................................................7
About your Digital ID Card.................................................. 11
Take charge of your health, anytime, anywhere......... 12
Claims Submission................................................................. 14
Handling your claims............................................................ 16
Reimbursement...................................................................... 17
Reimbursement rule.............................................................. 17
How Co-insurance is calculated....................................... 18
Plans Definitions.................................................................... 22
Frequently Asked Questions............................................ 27
Complaints procedures....................................................... 33
Data Protection...................................................................... 36
 ABOUT YOUR SMARTCARE BY CIGNA
HEALTH PLAN
Membership of the SmartCare plan means that
you and your eligible family members can be
sure of receiving comprehensive advice, and
treatment in case of illness or accident.

A Cigna-Neuron digital ID card is provided for you

and your eligible family members. You will receive
the digital ID card on your registered email ID and
registered mobile number (via SMS). You can also
access your digital ID card through the SmartCare
by Cigna app. Please ensure you have your digital
ID cards with you whenever you visit a healthcare
provider as they are important to access care
within our networks.

Within the UAE, Members can access care simply

by showing their registered Emirates ID and
stating that they are insured with Cigna-Neuron.

Outside the UAE, Members can access care using

their digital ID cards via SmartCare by Cigna app.

<< CONTENTS 1
 INSURANCE REGULATIONS IN THE UAE

For the Emirate of Dubai:

The health insurance law for Dubai exists to
ensure that residents in the Emirate of Dubai
enjoy a minimum level of health cover to protect
them in the case of illness or medical emergency.

All our plans are compliant with the regulations

of the Dubai Health Authority

For the Emirates of Abu Dhabi and Al Ain:

The health insurance law exists to ensure that all

residents in the emirates of Abu Dhabi and Al Ain
enjoy a minimum level of health cover to protect
them in case of illness or medical emergency.

All our plans are compliant with the regulations

of the Health Authority of Abu Dhabi.

<< CONTENTS 2

If it’s an Emergency
Get the Emergency treatment
you need and call us if you
need any advice or support.
Inside the UAE
Your healthcare provider
should call us toll-free on
800 SMARTCARE
(800 76278 2273)
within 48 hours of the
Emergency, to inform us of
the hospitalisation.
Outside the UAE
Either you, one of your
dependants or a colleague
needs to call us on
+971 4 317 8485 or
+971 2 694 0932.
<< CONTENTS
IN CASE OF AN EMERGENCY
While we hope you never face an emergency
situation, it’s important to know how to get
immediate help if you need it. As part of your
plan, we can assist with virtually any medical
emergency that you may encounter.
During an emergency, please contact the numbers
below or on the back of your digital ID card:
If you are inside the UAE call toll-free on:
800 SMARTCARE (800 76278 2273)
If you are outside the UAE call:
+971 4 317 8485 or +971 2 694 0932
We shall co-ordinate evacuation to the nearest
suitable location or repatriation to your home
country if medically necessary;
PLEASE NOTE: Medical repatriation and
evacuation must be pre-approved.
Please refer to your list of benefits to ensure
medical repatriation and evacuation are covered.
It is important that your family members or
colleagues are aware of your insurance
arrangements, should you be unable to contact
the 24-hr helpline yourself.
3
 EMERGENCY OUT OF AREA COVER
If you or your family members travel outside your
Area of Cover your plan will provide you with
healthcare cover for emergency treatment for
a period of 30 days whether you are traveling
for business or pleasure. If you need to move
location for more than 30 days, you must notify us.

An Emergency is defined IMPORTANT CONTACT INFORMATION

as the sudden onset of an Customer Service can be contacted 24 hours a
illness, injury or medical
day, 7 days a week.
condition manifesting
itself by acute symptoms of
sufficient severity (including Our 24-hour Helpline numbers:
severe pain) requiring
If you are inside the UAE call toll-free on:
immediate and unscheduled
medical care, and if left 800 SMARTCARE (800 76278 2273)
untreated could result in
placing the person’s life and/ If you are outside the UAE call:
or health in serious jeopardy; +971 4 317 8485 or +971 2 694 0932
serious impairment to bodily
functions; serious dysfunction For Claims submission and enquiries kindly
of a bodily organ or part; email us at: Smartcare.claims@neuron.ae or
serious disfigurement; or download the SmartCare by Cigna app
in the case of a pregnant
woman, serious jeopardy to You can also visit the Cigna-Neuron member
the health of the foetus. It
portal: https://smartcarebycigna.neuron.ae
is the emergency medical
condition of the patient, not
the diagnosis, which drives
the necessity for immediate
treatment. Symptoms must
be sufficiently severe to
cause the patient to seek
immediate medical aid.

<< CONTENTS 4
 IMPORTANT INFORMATION ABOUT
YOUR PLAN

Members eligibility:
Our SmartCare plans are available to the eligible
Employees and their eligible dependants (when
applicable) who reside in the UAE. The employees
and their dependants must have the same plan level.
To be an eligible Member of the SmartCare plan,
the Employee must be:
> Any Member of staff who is nominated and in
most cases also provided with UAE residency
visa sponsorship by their company
> The eligibility of local nationals is subject to the
local regulation and therefore requires Cigna
review and approval prior to joining the plan

Employees’ dependants must be:

> The Employee’s Spouse*, whose name has been
provided to and has been enrolled under the
policy by Cigna prior to the commencement of
any treatment
(*Spouse means the Employee’s wife or
husband by legal marriage as advised to Cigna)
> The Employee’s unmarried children, natural
or legally adopted, whose names have been
provided to and has been enrolled under the
policy by Cigna prior to the commencement of
any treatment, who are:
- under 18 years of age; or
- 18 years or over but under 25 years of age and
are living with or in full-time education at the
commencement of any treatment, unless local
applicable law would require otherwise

Your benefits
Your employer has chosen the plan level and
benefits, including any additional options that
are available to you. The SmartCare plan covers
any eligible treatment costs relating to planned
or unforeseen events in line with the terms and
conditions of your policy.
<< CONTENTS 5
 Adding eligible dependants to your plan
Your employer can ask to add your eligible family
members to your policy at any time. All material
facts about your dependants must be given to us.
Please note:
• Your dependants must be added to the same
plan you have.
• For new-born children, unless the applicable
local regulations require otherwise:
- Cover will start on the date of birth of the
new-born, provided the mother is a Member at
the time of delivery Cigna are notified within
30 days of the new-born child’s birth; or
- If the mother is not a Member at the time
of delivery then medical expenses incurred
between delivery and discharge from the
Healthcare Provider will not be reimbursed.
Cover will start for the new born, if the father
is a Member, only from the date of discharge
of the new born from the Healthcare Provider
following delivery.
• Any addition to a policy must be accompanied
by valid supporting documents as requested by
us, and required by law for example: new entry
permit, current visa, birth certificate, etc.
Once the addition is agreed and processed, we
will issue the digital ID cards for each of your
dependants who are covered under the plan.

Leaving your plan

If you are leaving the health insurance plan, a
cancellation request must be sent to us via your
employer.
Please note:
• If you are removed from a plan, your end date
will be the date that we receive the request,
or a future date which was requested by your
employer and given to us.
• If a main Member is removed from a plan, all
of their dependants will also be removed.
• If you wish to remove a dependant please
contact your employer.

<< CONTENTS 6
 HOW TO USE YOUR PLAN level Co-insurance will need to be paid by you.

To keep the experience simple and cost effective we always If you opt to pay out of your own pocket for treatment
advise Members to select an In-Network provider and avail either at an In-Network or Out-of-Network provider, then
you will need to pay and claim. This will be reimbursed as a
direct billing services.
percentage on actual cost, with the percentage depending
Inside the UAE on the plan selected by your employer. Please note that
the reimbursement is also subject to any benefit level co-
Your SmartCare plan gives you access to Cigna Open Network
insurance in addition and where applicable
in the UAE. This means you can choose any In-Network
provider and benefit from the direct billing facilities without Your level of network Co-insurance within the Cigna Open
the hassle of paying and claiming. network will be based on your selected SmartCare plan.
Advantages of Please refer to your member booklet for details on any
You will only need to present your Emirates ID or your digital
visiting In-Network ID at any In-Network provider in order to avail In-Patient
applicable network Co-insurance. The table below show
medical providers: the applicable network Co-insurances for SmartCare plans.
and/or Out-Patient treatment on a direct billing basis. This
will remove the worry or inconvenience of needing to pay for Please refer to page 19-20 for some examples of how
Direct Payment treatment up front. Only the respective network or benefit Co-insurances are calculated and applied.
Facility – only pay your
network Co-insurance
or your benefit level Cigna Open Network
Co-insurance (if Access visualised** SmartCare Plan 1 SmartCare Plan 2 SmartCare Plan 3
applicable) and we will CIGNA OPEN* 1
cover the rest (example list of UAE facilities)
American Hospital
No Claim forms to fill, Mediclinic Group, DXB 20% Co-insurance applicable 30% Co-insurance applicable
on ALL treatment on a direct billing basis on ALL treatment on a direct billing basis
no documents to send Al Zahra Hospital
(I/P capped at AED 5,000 per I/P stay) (I/P capped at AED 10,000 per I/P stay)
Emirates Hospital
Get your medication Cleveland Clinic, AUH
Health Point Hospital AUH
on the spot, all you
need to pay is your CIGNA OPEN* 2
(example list of UAE facilities)
Co-insurance (if
Saudi German Hospital
applicable) Valiant Clinic Client has access to 20% Co-insurance applicable
Dr Sulaiman Habib
Cigna Open 1, 2 & 3 Providers on ALL treatment on a direct billing basis
Pre-approvals are Canadian Specialist Hospital
with no Network Co-insurance (I/P capped at AED 5,000 per I/P stay)
arranged by the applicable
Prime Hospital
network medical Emirates Speciality Hospital (Selected Out-Patient
Client has access to
provider Co-insurance would apply)
Cigna Open 2 & 3 Providers
CIGNA OPEN* 3
(example list of UAE facilities) with no Network Co-insurance applicable
Depending on the Prime Medical Centres (Selected Out-Patient
condition, access to Al Zahra, Sharjah Co-insurance/deductible will apply) Client has access to
Clinical Case Managers King’s College Hospital & Clinics Cigna Open 3 Providers with
to help Members find Zulekha Hospital no Network Co-insurance applicable
International Modern Hospital
the right care path (Selected Out-Patient Co-insurance/
Lifeline Hospital deductible will apply)
Mediclinic Group, AUH
NMC Royal Hospital
SEHA

* Please note: Network providers are subject to change. For a full list of your healthcare providers and their respective networks please refer to the SmartCare by Cigna app.
** Please note, actual co-insurance percentages and AED amounts may differ depending on the plan chosen by your employer 7
<< CONTENTS
 Inside Qatar, Bahrain, Oman and Kuwait* (QBOK)
*if selected Area of Cover allows

Your plan gives you access to Neuron’s regional

network of medical providers.

With over 3,600 medical providers in the

UAE and over 450 medical providers spread
across QBOK you have an extensive network of
preferred providers.

You will only need to present your digital ID card,

at any In-Network QBOK provider in order to
avail In-Patient and/or Out-Patient treatment on
a direct billing basis. This will remove the worry
or inconvenience of needing to pay for treatment
up front.

If you opt to pay out of your own pocket for

treatment either at an In-Network or Out-of-
Network provider, then you will need to pay and
claim. This will be reimbursed as a percentage on
actual cost, with the percentage depending on
the plan selected by your employer. Please note
that the reimbursement is also subject to any
benefit level co-insurance in addition and where
applicable

To find out if your provider is within Neuron’s

network you can:
• Refer to the SmartCare by Cigna app or
• Contact us on any of the numbers listed under
‘Important Contact Information’

Outside the UAE & QBOK*

*if selected Area of Cover allows

To access In-Patient care outside the UAE and

QBOK, we ask that you contact Customer Service
Team on +971 4 317 8485 or +971 2 694 0932. This
will enable us to try and facilitate direct billing
access to care so that you will not be required
to pay for treatment up front. If you choose not
to contact us and opt to pay out of your own

<< CONTENTS 8
 pocket for treatment then the Member
Reimbursement Co-insurance will apply.

For Out-Patient treatment, you are required

to pay and claim. You can then submit the
Claim for reimbursement via the SmartCare
by Cigna app. In this instance, the Member
Reimbursement Co-insurance would not
apply, only the respective benefit level
Co-insurance would apply.

Access to Care

Member
In-Patient Out-Patient Reimbursement
Claim
UAE Neuron network – Neuron network – Member Reimbursement Co-
direct billing settlement direct billing settlement insurance plus selected
Out-Patient Co-insurance

Qatar, Bahrain, Neuron network – Neuron network – Member Reimbursement Co-

Oman & Kuwait* direct billing settlement direct billing settlement insurance plus selected
Out-Patient Co-insurance

Rest of the Call +971 4 317 8485 or Direct billing unavailable, As per In-Patient and
World* +971 2 694 0932 for a therefore the Member Out-Patient application
Guarantee of Payment Reimbursement Co-insurance
(GOP) will not apply
If GOP not possible the The selected Out-Patient
Member Reimbursement Co-insurance will apply
Co-insurance will
not apply

*Members selected Area of Cover will determine eligibility of Claim.

<< CONTENTS 9
 Introducing Cigna Select Privileges

Now, every Cigna customer can get privilege treatment

at King’s College Hospital and Clinics.
It’s the dawn of a new era for Cigna customers. One that improves the entire healthcare experience
– from the moment you seek care right through to any follow-ups. Cigna Select Privileges caters to
your needs to make your in-hospital experience, at King’s College Hospital and Clinics, easier and
more efficient. Feel confident knowing that you’ll be treated by Cigna Select Providers - healthcare
professionals that meet our highest standards.

Dedicated Cigna Health Advocates

Our Health Advocates are there for you to arrange priority
appointments and expedite lab results or prescription refills. These white-glove
features are just the
Privilege care from the moment you arrive
At any scheduled In-Patient treatment, your Cigna Health beginning. As we’ve
Advocate will greet you upon arrival and escort you to a just launched Cigna
private room with upgraded amenities.
Select Privileges,
In-hospital support keep an eye out for
A Cigna Health Advocate will coordinate your care and an expanded list of
handle logistics until your discharge. Our Health Advocates
are ready to assist you from 9 AM to 7 PM, 7 days a week. benefits, services and
hospital partners.
Worry-free transportation
Enjoy free valet parking or luxury transportation within
Dubai, for all In-Patient or wellness appointments.

Free home delivery of medication

Experience Cigna Select Learn more about Cigna

Select Privileges today
Privileges for yourself
Have questions? Want more details?
Hospital Partner Call 800 SMARTCARE (800 76278 2273)
King’s College Hospital and Clinics
(Dubai Marina and Jumeirah)
Cigna Support Number
04 -2477797

<< CONTENTS 10
 ABOUT YOUR DIGITAL ID CARD

You will receive your Cigna-Neuron digital ID

card on your registered email and via SMS on
your registered mobile number. You can also
access your card through the SmartCare by
Cigna app. This card will give you access to
treatment within your Area of Coverage.

ACCESS THE SMARTCARE BY CIGNA APP

As a new Member, you have received a
Welcome Letter on your registered email
address. It includes a QR code to download
the SmartCare by Cigna app and populate all
the information. You can log in from anywhere
in the world to gain access to information and
expert advice.

With the help of our app you can:

> Find a provider: Hello,

Through extensive selection

procedures and physician -
directed referrals, you have
access to quality medical
facilities and healthcare
Eligibility Code Help Line Contact Us Promotions

practitioners. eCards Network Family ePrescription

> View your Table of Benefits:

Your SmartCare plan has list Name

Cigna

of benefits that your employer Smartcare - Mobile App

Effective Date 01-Nov-2020

has chosen for your health Expiry Date

Open Network
31-Oct-2021

and wellbeing. Here you can Download Network List

see your plan benefits, their Download Table of Benefits

descriptions, your Area of Claim Reimbursement Form

Coverage, the applicable

network Co-insurance and lots
of other useful information.
<< CONTENTS 11
 > You can also:

View and download your digital ID card

View and download your network list
Search for a doctor and book an
appointment
Download the Receive e-prescription
SmartCare by Cigna
Contact the customer service team
app by scanning
the QR code in your
Welome letter. You
can also download
it directly from the
Apple® App Store or
the Google® Play Store: TAKE CHARGE OF YOUR HEALTH,
ANYTIME, ANYWHERE.
The SmartCare by Cigna app and the TruDoc
app can be accessed from anywhere in the
by

world. They provide your Employees with

tools and programmes that support them in
managing their health and wellbeing, while
keeping up with their busy lifestyle, for example:

• Chronic Medication Programme

If you or your covered family members are
diagnosed with a chronic condition, our
Chronic Medication Programme can help.
By enrolling in this programme, you will be
able to receive prescription refills at the
convenience of your home or at the nearest
pharmacy.

All you have to do is download the SmartCare

by Cigna app or contact 800 SMARTCARE
and submit the required documents.

• Promotions & Offers

As a SmartCare Member, you can also enjoy
a wide variety of promotions and offers on
the app. To avail, all you have to do is show
the offer on the app to the provider.

<< CONTENTS 12
 Doing The Right Thing.

Virtual health through TruDoc

As part of your SmartCare plan, you are
eligible for 24/7 medical and wellness services
through the TruDoc app. All you have to
do is to download the TruDoc app, register
with your Neuron ID or Emirates ID to start
enjoying a range of services including:

24/7 access to highly trained & licensed

doctors and wellness experts

Medication delivery and lab tests at your

home*

Support for acute & chronic conditions

Customised wellness programmes

including nutrition and exercises

By clicking on ‘Meet Doctor’ in the SmartCare

Eligibility Code Help Line Contact Us Promotions
by Cigna app you will be connected through
TruDoc – or you can simply download the
eCards Network Family ePrescription
TruDoc app by clicking on the respective app
store icons below:
Appointments CMP Call Doctor Meet Doctor

* home delivery currently only available in Dubai

<< CONTENTS 13

iConnectYou
Scan QR code to download app
Email:
support@resourcesforyourlife.com
Website:
Available at: www.cigna.com/ieap
**If you are calling from outside the UAE then please visit
Employee Assistance Programmes* (EAP)
As part of your SmartCare plan, you and
your family are eligible for 24/7/365 access
to free confidential assistance with any work,
personal or family issue.
Any time, any day. Download, register and
use the iConnectYou app or call toll-free on
800 044 0597**.
You can avail up to 3 sessions per topic, either
telephonically or face-to-face. Topics include,
but are not limited to:
Financial support services
Couples’ support
Handling stress
Managing anxiety and depression
Managing life changes
Improving family communication
Harmony between work and home life
*Optional benefit - based on selection by employer, please
refer to your Table of Benefits for details.
the website for the global freephone list. In the event that
a freephone number is not listed for your location you
can call +44 208 987 6230 and request a call back.
Please note: International call charges may apply.

CLAIMS SUBMISSION
Where treatment takes place at an In-Network
provider, we will settle your invoices directly
with the provider. Please ensure you present
your digital ID card, or your Emirates ID (in
the UAE), at the time of receiving treatment.
You only need to pay any applicable network
or benefit level Co-insurance to the provider
at the time of receiving treatment.
<< CONTENTS 14
 When applicable to your plan, for treatment
received at an Out-of-Network provider you will
need to pay the provider and then submit your
invoice and Claim Form.

The Claim Form can be downloaded from the

SmartCare by Cigna app or the member portal.

WHEN TO SUBMIT?
For reimbursement, Claims should be submitted
within a maximum of 120 days of receiving
treatment. Any Claims submitted after 120 days
Submit a Claim

will not be considered. As per the reimbursement

rule, the following needs to be submitted – all
Missing Documents

Recent Reimbursement Claims

Claim Forms duly completed, together with all
Reimbursement Claims certificates, invoices, reports, test results etc., and
Network Claims more particularly a clear diagnosis by a medical
Authorizations
practitioner. We reserve the right to request
Download Reimbursement Claim Forms
original copies of all documentation at any time.

WHAT TO SUBMIT?
You will have to submit at all times a duly filled
Claim Form attaching the following:
• Copy of radiology/imaging reports, blood test
results, other reports for special/diagnostic
procedures etc. (where you have paid and
are Claiming for radiology/x-rays, imaging
procedures e.g. Ultrasound, CT and/or MRI
Scans, blood tests, etc.)
• Copy of the prescription/s (where you have
paid and are Claiming for medications)
• Discharge summary and medical report (in case
you are Claiming In-Hospital Patient admissions)
• In case of surgical procedure, please attach
operative notes, anesthesia sheets, and all
histopathology reports
• All invoices (with proper and detailed
breakdown of amounts) and receipts (clearly
showing that cash/credit card payment has
been made by you)
For Out-Patient treatment:
• Official receipt showing the attending
physician’s detailed charges.
<< CONTENTS 15
 WHERE TO SUBMIT CLAIMS?

- Online:
https://smartcarebycigna.neuron.ae

- Mobile App:
SmartCare by Cigna

- Email:
TIPS TO smartcare.claims@neuron.ae
ENSURE
A SPEEDY - Registered mail:
Neuron
CLAIMS
IT Plaza Building, 6th Floor,
SETTLEMENT: Dubai Silicon Oasis, P.O Box 72071,
• Provide a diagnosis or Dubai, UAE.
explanation of treatment
on the Claim Form.

• State how and where you

want the reimbursement
HANDLING YOUR CLAIMS
issued.

• Where the payment If your employer has arranged for a broker

method selected is to administer you and your dependants’
‘Electronic Bank Transfer’,
healthcare plan, you should be aware of the
full details must be
provided, including following process which we follow when
bank name and address, handling Claims and medical information.
account name, account
We do release the following information, if
number and your bank’s
SWIFT code. requested by the broker, about you and your
• Upload clear scanned dependants’ Claims:
copies through the
• who the Claim was paid to.
SmartCare by Cigna
app or member portal. • when the Claim was paid.
You can also email them
rather than sending them
• which payment method was used to pay
by post. the Claim.

We do not release medical information about

you and your dependants to the broker.

In the event that you have any queries

about this process, please contact your HR
department for further information.

<< CONTENTS 16
 REIMBURSEMENT
Please note that reimbursement will be
processed more efficiently by the receiving
bank if you provide full bank details for your
transfer (payee name, address, account
number/IBAN, routing codes/SWIFT).

We will bear any charges applied to the

reimbursement of Claims imposed by the
remitting bank. However, any charges that
may be imposed by the beneficiary’s bank /
other third-party provider and/or any currency
conversion charges, will be borne by the
beneficiary. We recommend that you confirm
any bank charges with your banking provider.

Please note: Only the cost of the Treatment

excluding any VAT is reimbursable Any charge
relating to VAT will not be reimbursed.

Remember you can submit and track the

progress of your Claim by accessing
the SmartCare by Cigna mobile app or the
member portal.

REIMBURSEMENT RULE
The patient will forward to Neuron (the Policy
administrator), via post or email, the Claim
forms duly completed, together with all
certificates, invoices, reports, test results etc.,
and more particularly a clear diagnosis by a
medical practitioner. The INSURER or policy
administrator reserves the right to request
original copies of all documentation at any
time. Only Claims made within 120 days of
receiving treatments will be considered.

<< CONTENTS 17
 HOW CO-INSURANCE IS CALCULATED
If your SmartCare plan has a Co-insurance it
means you have to pay a certain percentage
of the treatment cost. This amount will
depend on:
• The percentage of Network and/or
Out-Patient Co-insurance set out in your
member booklet
• The utilised benefit; Maternity Co-insurance
is in addition to any Network or Out-Patient
Co-insurance
• Whether you visited an In-Network provider
on a direct billing basis or pay and claim
basis. Or, an Out-of-Network provider on a
pay and claim basis
• Your Co-insurance caps; where multiple
Co-insurances are applicable, the
sequencing of how they are applied always
starts with any benefit level Co-insurance.
See example #3 & 7 for a visual explanation
Please refer to your member booklet for
more details.
The examples on the next three pages show
how the different Co-insurances will be
calculated based on different scenarios. The
actual Co-insurances applied will be based on
the plan selected by your employer
If you have any further questions do not
hesitate to contact the Customer Service
Team on 800 SMARTCARE (800 76278 2273)
if you are inside the UAE, or if you are outside
the UAE you can call on +971 4 317 8485 or
+971 2 694 0932.

<< CONTENTS 18
 Summary of when and how Co-insurances are applied

In-tier Higher-tier Member

Network Claim Network Claim Reimbursement Claim

Network Co-insurance X X

Out-Patient Co-insurance X

Maternity Co-insurance/
Deductible *Applies in aggregate

Member Reimbursement
N/A N/A
Co-insurance

Example #1: In-Patient In-Network Claim

SmartCare 2: Member avails In-Patient treatment at a Cigna Open Access 1
provider

Net Network In-Patient Member’s Cigna’s

Service
Amount Co-ins: 20% Cap Share Share
In-Patient Stay AED 30,000 AED 6,000 AED 5,000 AED 5,000 AED 25,000

Example #2: Out-Patient In-Network Claim

SmartCare 2: Member goes to a Cigna Open Access 1 provider for Out-Patient
treatment - 20% up to AED 50 per O/P consultation

Net OP Consultation Network Member’s Cigna’s

Service
Amount Co-ins: AED 50 Co-insurance Share Share
Consultation AED 300 AED 0 AED 60 AED 60 AED 240
Laboratory AED 300 AED 0 AED 60 AED 60 AED 240

<< CONTENTS 19
 Example #3: Out-Patient Member Reimbursement Claim (UAE)
SmartCare 2: Member goes to a Cigna Open Access 1 provider for Out-Patient
treatment - 20% up to AED 50 per Out-Patient consultation

Net OP Consultation 50% Member Reimbursement Member’s Cigna’s

Service
Amount Co-ins: AED 50 Co-insurance Share Share
Consultation AED 300 AED 50 AED 125 AED 175 AED 125
Laboratory AED 300 AED 0 AED 150 AED 150 AED 150

* Please refer to the Access to Care to section for when member

reimbursement co-insurance applies

DUBAI

Example #4: Out-Patient Maternity In-Network Claim

SmartCare 2: Member goes to a Cigna Open Access 1 provider for Out-Patient
Maternity treatment - 10% Maternity Co-insurance

Net 10% Maternity 20% Network Member’s Cigna’s

Service
Amount Co-insurance Co-insurance Share Share
Consultation AED 300 AED 30 AED 60 AED 90 AED 210
Laboratory AED 300 AED 30 AED 60 AED 90 AED 210

ABU DHABI
Example #5: In-Patient In-Network Claim (AUH)
SmartCare 2: Member goes to a Cigna Open Access 1 provider for a routine
Maternity Delivery - AED 500 Deductible per delivery

Net AED 500 In-Patient Member’s Cigna’s

Service
Amount Deductible Cap Share Share
In-Patient Maternity
AED 30,000 AED 500 AED 5,000 AED 5,500 AED 24,500
Delivery and Stay

<< CONTENTS 20
 Example #6: Dental In-Network Claim

SmartCare 1: Member goes to an In-Network Dental clinic for treatment

- 20% Co-insurance on all classes

Net Network Dental Member’s Cigna’s

Service
Amount Co-insurance Co-insurance: 20% Share Share
Exam AED 500 N/A AED 100 AED 100 AED 400
Filling AED 500 N/A AED 100 AED 100 AED 400

Example #7: Dental Member Reimbursement Claim

SmartCare 1: Member goes to an Out-of-Network Dental clinic for treatment

- 20% Co-insurance on all classes

50% Member Dental

Net Member’s Cigna’s
Service Reimbursement Co-insurance:
Amount Share Share
Co-insurance 20%

Exam AED 500 AED 200 AED 100 AED 300 AED 200
Filling AED 500 AED 200 AED 100 AED 300 AED 200

<< CONTENTS 21
 Plans Definitions
PLANS DEFINITIONS

Area of Cover - All countries world-wide with the exception of The United States
Worldwide excluding USA of America (USA).

Area of Cover - Gulf Cooperation Council (GCC) countries, Saudi Arabia, United
Regional Arab Emirates, Kuwait, Oman, Bahrain and Qatar, Jordan,
Lebanon, Egypt, Tunisia, Morocco, Algeria, Libya, India, Pakistan,
Sri Lanka, Bangladesh, Korea, the Philippines, Thailand, Indonesia,
Nepal & Bhutan, except where coverage and services (including
payments) are illegal pursuant to and in compliance with
applicable sanction laws).

Area of Cover - Extends the Area of Cover to a Member’s country of citizenship.

Home Country Cover Evidence of dual citizenship is required at enrolment of a Member
(if selected) in order to have Home Country Cover in both locations.
USA cover is not part of the Home Country Cover.

Benefit Any benefit shown in the Table of Benefits.

Chronic A disease, illness, or injury that has one or more of the following
characteristics:
• it needs ongoing or long-term monitoring through
consultations, examinations, check-ups, and / or tests
• it needs ongoing or long-term control or relief of symptoms
• it may require rehabilitation or the patient to be trained to cope
with it.
• it continues indefinitely
• it comes back or is likely to come back.

Client The client named in the Policy Schedule.

Co-insurance A set amount or percentage of Treatment costs sum required to

be paid by the Member for Treatment which is covered under the
Policy.

Cosmetic Services, procedures or items that are supplied only for aesthetic
purposes and which are not needed in order to maintain an
acceptable standard of health.

Day Case treatment Care involving admission to a healthcare provider and using a
bed but not staying overnight.

Dependant The Employee’s Spouse, whose name has been provided to and
has been enrolled under the Policy by the INSURER prior to the
commencement of any Treatment;
The Employee’s unmarried children, natural or legally adopted,
whose names have been provided to and has been enrolled
under the Policy by the INSURER prior to the commencement of
any Treatment, who are:
• under 18 years of age; or
• 18 years or over but under 25 years of age and are living with or
in full-time education at the commencement of any Treatment,
unless local applicable law would require otherwise.

Designated Healthcare A group of healthcare providers contracted by the INSURER

Providers for the purpose of providing access to their services on a Direct
Billing basis in conformity with the terms of this Policy.

<< CONTENTS 22
 Direct Billing Direct Billing means where the INSURER has arrangements
with the Designated Healthcare Providers in the region allowing
the Member to avail medical Treatment on Direct Billing basis
meaning that the INSURER will pay for the Treatment direct to
the Designated Healthcare Provider and the Member does not
have to submit a Claim for reimbursement to the INSURER.

Effective Date The date cover starts for the employee and their dependents.

Emergency The sudden onset of an illness, injury or medical condition

manifesting itself by acute symptoms of sufficient severity
(including severe pain) requiring immediate and unscheduled
medical care, and if left untreated could result in placing the
person’s life and/or health in serious jeopardy; serious impairment
to bodily functions; serious dysfunction of a bodily organ or part;
serious disfigurement; or in the case of a pregnant woman, serious
jeopardy to the health of the foetus. It is the emergency medical
condition of the Member, not the diagnosis, which drives the
necessity for immediate treatment. Symptoms must be sufficiently
severe to cause the patient to seek immediate medical aid.

Eligible Female A person who is a female Employee or a female Spouse of an

Employee.

Employee Any Member of staff who is nominated and in most cases also
provided with UAE residency visa sponsorship by the Client.

Gene Therapy Treatment or services that seeks to modify or manipulate the

expression of a gene or to alter the biological properties of
living cells for therapeutic use. Gene therapy is a technique that
modifies a person’s genes to treat or cure disease.
Gene therapies can work by several mechanisms:
• Replacing a disease-causing gene with a healthy copy of the gene
• Inactivating a disease-causing gene that is not functioning properly
• Introducing a new or modified gene into the body to help treat
a disease

Healthcare Provider Any organisation which is registered or licensed as a medical

or surgical hospital, clinic or individual licensed to provide
healthcare services in the country in which it is located and
where the Member is under the daily care or supervision of a
Medical Practitioner or Qualified Nurse and includes Designated
Healthcare Providers.

Home Nursing Visits from a qualified nurse to the patient’s home to give expert
nursing services:
• immediately after a healthcare provider’s treatment for as long
as is required by medical necessity;
• visits for as long as is required by medical necessity for
treatment which would normally be provided by healthcare
providers.
In either case, the specialist who treated the patient must have
recommended these services.

Injury A physical injury.

In-Patient A patient who stays overnight at a healthcare provider’s facility

while undergoing treatment.

International Emergency The services arranged by the Medical Assistance Service for the
Services Policy that may cover emergency medical evacuation, medical
repatriation, and repatriation of mortal remains.

<< CONTENTS 23
 INSURER Cigna Insurance Middle East S.A.L.

Local Ambulance A purpose-built vehicle operated as an ambulance by a

recognised private ambulance service or the private hospitals
ambulance service.

Medical Assistance A service which provides medical information and referrals,

Service evacuation, assistance and repatriation. This service can be multi-
lingual and assistance is available 24 hours per day.

Maternity Benefit All aspects of pregnancy or childbirth, including pre and post
natal visits, check-ups, any complications and delivery, for any
eligible female covered under the plan, but excluding:
• treatment by way of the intentional termination of pregnancy
unless two medical practitioners certify in writing that the
pregnancy would endanger the life or mental stability of the
mother and as permitted by the applicable law; and
• treatment by way of nursery care for a dependant in a healthcare
provider following childbirth, unless due to medical necessity
during treatment that is otherwise covered by this policy.

Medical Necessity and Services and supplies determined to be:

Medically Necessary • Required to diagnose or treat an illness, Injury, disease or its
symptoms;
• Orthodox, in accordance with generally accepted standards of
medical practice;
• Clinically appropriate in terms of type, frequency, extent, site
and duration;
• Not primarily for the convenience of the Member, physician or
other Healthcare Provider; and
• Rendered in the least intensive setting that is appropriate for the
delivery of the services and supplies.

Medical Practitioner A doctor or Specialist who is registered or licensed to practice

medicine under the laws of the country, state or other regulated
area in which the Treatment is provided.

Member An Employee or Dependent that has been enrolled by the

INSURER or it’s administrator in the systems to enable access to
the Benefits.

Medicine Pharmaceuticals authorised in the local country of prescription,

which can only be obtained through a prescription written by a
medical practitioner.

Minor Surgical Procedures Any surgical treatment or procedure that does not require a
And Associated Treatment general anaesthetic or overnight healthcare provider stay, e.g.
surgical treatment of an ingrown toe nail.

Network The grouping of Designated Heathcare Providers as set out in the

Table of Benefits which determines what Co-insurance is payable
by a Member.

Operation Any procedure described as an operation in the schedule of

surgical procedures.

Orthodox In relation to a procedure or Treatment that is medically accepted

in the jurisdiction in which it was performed and which meets
minimally accepted international medical standards at the time
of the commencement of the procedure or Treatment, in that
it accords with that upheld by a respectable, responsible and
substantial body of medical opinion, experienced in the particular
field of medicine.

<< CONTENTS 24
 Out-Patient A Member who does not need to stay overnight in a Health Care
Provider for either consultation with a Specialist or for Treatment.

Patient The Employee or eligible Dependant who undergoes Treatment.

Plan The healthcare Benefits that the INSURER agreed to offer and
which were accepted by the Client.

Policy The International Employee Healthcare Policy (Client Agreement)

and its Policy Schedules, comprising the General Terms and
Conditions, the Policy Details, Premium Details, Table of Benefits,
Exclusions, Special Conditions Schedule(s) and the Arbitration
Agreement Appendix.

Policy Administrator Neuron LLC

Policy Schedule(s) The latest Policy Schedule(s) issued as part of the Policy
including any endorsements to it.

Pre-authorisation The process through which a Member or Designated Healthcare

Provider seeks approval from INSURER prior to undergoing
Treatment to ensure that the proposed Treatment falls within the
Table of Benefits and scope of cover, subject to the Policy terms
and conditions and shall fall within the HealthCare Providers
agreed rates.

Pre-existing Condition Any known/unknown medical condition or related medical

condition (Injury, illness, Sickness, disease or other physical,
medical, mental or nervous condition, disorder or ailment) that
with reasonable medical certainty existed prior to joining the
policy, whether or not previously manifested or symptomatic,
diagnosed, treated or disclosed, including any subsequent,
chronic or recurring complications related to it.

Qualified Nurse A nurse who is registered or licensed as such under the laws
of the country, state or other regulated area in which the
Treatment is provided.

Selected Area of Coverage The locations listed in the Table of Benefits Area of Cover and
if Home Country Option Cover is selected includes for each
Member the country of citizenship of that Member (or two
countries where evidence of dual citizenship of a Member has
been advised).

Short-term Means a period of time consistent with the recuperation time

required for the Treatment and as prescribed by the treating
medical practitioner with the approval of the INSURER

Sickness A physical or mental illness.

Specialist A doctor who:

• Has received advanced specialist training;
• Practices a particular branch of medicine or surgery;
• Holds or has held a consultant appointment in a healthcare
provider or an appointment which the INSURER accepts as
being of equivalent status; and
• Is registered or licensed as such under the laws of the country,
state or other regulated area in which the Treatment is provided.

Spouse The Employee’s wife or husband by legal marriage as advised to

INSURER.

<< CONTENTS 25
 Start Date The date the Policy starts, as shown in the Policy Details Schedule
or otherwise being the date that the INSURER first communicates
with Members enrolled under the Policy to confirm Benefits.

Table of Benefits The latest list of Benefits and Exclusions included as Schedule 3 to
the Policy.

Treatment Any relevant treatment controlled by a Medical Practitioner to

cure or substantially relieve acute or Chronic conditions within
the scope of the Benefits.

Vision benefit Procedures and treatment relating to the vision of an Employee

or Dependant.

Wellness Benefit Tests as defined in the Table of Benefits carried out by a Medical
Practitioner.

Year of insurance The annual period starting on the Start Date or Annual Renewal
Date.

Definitions - Dental
Dental Injury Injury to the Employee or Dependent’s dentition and supporting
structures (including damage to dentures while being worn)
caused by extra-oral impact.

Dentist A dentist or dental surgeon or dental practitioner who is

registered or licensed as such under the laws of the country, state
or other regulated area in which the Treatment is provided.

Full case assessment Extensive examination in order to establish current state of teeth.

<< CONTENTS 26
 Frequently Asked
Questions
1. Who is Neuron? Neuron is a strategic partner of Cigna.
Your health insurance plan is serviced by Neuron.

2. How do I know which Through the SmartCare by Cigna app or your personalised
providers are in the member portal. You can also call your Customer Service Team on
network? 800 SMARTCARE (800 76278 2273) if you are inside the UAE,
or if you are outside the UAE you can call us on: +971 4 317 8485
or +971 2 694 0932.
Please note: The provider list and categorisation is subject to
change, so please always check your network list prior to any
treatment.

3. What is the Cigna
Open Network?
Cigna Open Network allows you to choose any hospital, clinic or
doctor within Neuron’s network in the UAE. You will be able to
choose from over 3,600 providers. This means you can choose
any In-Network provider and benefit from the direct billing
facilities without the hassle of paying and claiming.
Your access to the Cigna Open Network will be based on your
selected SmartCare plan. You may need to pay an applicable
network Co-insurance to access providers within Cigna Open 1
and Cigna Open 2. Please refer to your member booklet for
details on any applicable Network Co-insurance.

4. How do I make a To access In-Patient care outside the GCC but within your Area
Claim for accessing of Cover, we ask that you contact Customer Service Team on
care outside the GCC +971 4 317 8485 or +971 2 694 0932. This will enable us to try
within my Area of and facilitate direct billing access to care so that you will not
Cover? be required to pay for treatment up front. If you choose not to
contact us and opt to pay out of your own pocket for treatment
then the Member Reimbursement Co-insurance will apply.
For Out-Patient treatment, you are required to pay and claim. You
can then submit the Claim for reimbursement via the SmartCare
by Cigna app. In this instance, the Member Reimbursement
Co-insurance would not apply, only the respective benefit level
Co-insurance would apply.
Please make sure you send your reimbursement Claims within
a maximum of 120 days from the date of making the Claim to
avoid rejection of payment.

5. Can you please The details of the SmartCare plan chosen by your organisation or
specify benefit details employer will be highlighted in your Welcome email – information
for Vision and Dental of your Vision and Dental coverage will be outlined in your
coverage? member booklet. You may also view your plan benefits on the
SmartCare by Cigna app or the member portal.

<< CONTENTS 27
 6. Where do I get a Claim Forms can be downloaded from the SmartCare by Cigna app
Claim Form from? or the member portal.

7. How long does it take Please allow up to 10 working days for your Claim to be
for a Claim to get processed and a further 5 to 7 working days for a bank transfer
reimbursed? to be received in your account.

8. How will I know that You can track the status of your Claim on the SmartCare by Cigna
my Claim has been app or online on the member portal. Once your Claim has been
paid? assessed we will send you an email to confirm this. If your Claim is
not showing through the app, please contact the Customer Service.
Please allow at least 10 working days from submission of your Claim

9. What if the hospital Please call our Customer Service Team on 800 SMARTCARE
I want to use is not (800 76278 2273) if you are inside the UAE, or if you are outside
listed in the network the UAE you can call us on: +971 4 317 8485 or +971 2 694 0932
and I need In-Patient so we can source a suitable In-Network provider. If the treatment
treatment? is not available anywhere in your network then the Member
Reimbursement Co-insurance would be waived.
If however, the treatment is available in network but you choose
to go outside of the network then you should be prepared to
settle the costs yourself and seek reimbursement. The Member
Reimbursement Co-insurance would be applied, along with any
plan benefit Co-insurance.

10. What is the difference The network Co-insurance applies to all treatments received
between a network at select providers that fall in Cigna Open 1 or Cigna Open 2
Co-insurance and Out- networks (depending on the SmartCare plan selected by your
Patient Co-insurance? employer). Please refer to page 7 of this booklet or to the back of
Do I need to pay both your digital ID card for your applicable network Co-insurance.
The Out-Patient Co-insurance applies to Out-Patient treatments
received at any provider, however when a network Co-insurance
applies you will NOT be required to pay an Out-Patient
Co-insurance except for Maternity.
A 10% Maternity Co-insurance will apply in addition to the
network Co-insurance.

11. If I pay and Claim, will Yes, if you choose to pay and Claim the applicable benefit
I still need be charged Co-insurance will be deducted from the claimed amount.
for Co-insurance? As per your Table of Benefits, you will be reimbursed a percentage
of the actual cost after deducting the benefit Co-insurance.

12. I received treatment Yes, if you fail to present your ID, you will have to pay and submit
at an In-Network the Claim for reimbursement. The total claimed amount will be
provider, however subject to the applicable benefit Co-insurance and limits of your
I failed to present SmartCare plan. It is recommended that you always visit
my digital ID or my In-Network providers and you can always access your digital ID
Emirates ID (in the on your SmartCare by Cigna app.
UAE only), do I need
to pay and Claim?

<< CONTENTS 28
 13. If I have to receive Yes, it will be covered and the actual cost of one Economy home
treatment outside airfare ticket will be reimbursed if treatment is required outside
the UAE, will my of the UAE provided the following conditions are met:
home flight airfare be • Area of Cover includes your country of citizenship
covered? • Treatment occurs in your country of citizenship
• Treatment is In-Patient only (medical report and Cigna Clinical
Team review required)
• The airfare is Economy class
• The airfare claimed is for a flight taken by the you for the
purpose of receiving treatment
• The overall cost of the airfare and the treatment cost does
not exceed 90% of the cost for the same treatment if it was
provided In-Network within the UAE at the highest Network
level where you have no Co-insurance applicable

14. Who should I contact Your dedicated Customer Service Team are available 24/7/365.
if I have any questions If you are inside the UAE call toll-free on: 800 SMARTCARE
about the policy? (800 76278 2273), or if you are outside the UAE call on:
+971 4 317 8485 or +971 2 694 0932.
You can also contact the Customer Service Team via email
smartcare.support@neuron.ae we will respond to you as soon as
possible. Please allow up to 48 hours.

15. What happens if If you have decided to be treated at a provider which is not listed
I Claim outside in the direct billing network covered by your plan a different
my direct-billing process applies.
network? • You can pay and claim reimbursement. The member
reimbursement co-insurance is applicable on actual cost, along
with any benefit level Co-insurance.
• You must take a Claim form with you (available on the SmartCare
by Cigna app and on the member portal) and make sure it is
filled in and signed by yourself and the medical practitioner
treating you and sent back to us as quickly as possible, please
ensure you submit your Claim within 120 days from the date
of your treatment.
• Please provide us with the following information to ensure your
Claim is processed without delay: A fully completed Claim form
together with all certificates, invoices, reports, test results etc.,
and a clear diagnosis by a medical practitioner will ensure your
Claim will be processed promptly. An incomplete or unsigned
Claim form may delay settlement of your Claim and in some
cases, may lead to the Claim form being returned to you for
completion. It may be necessary for us to obtain a medical
report from the attending medical practitioner.
• Please note:
- we reserve the right to request original copies of all
documentation at any time.
- we do not pay for medical reports.
- we will only consider Claims made within 120 days of
treatment being received.

<< CONTENTS 29
 16. What if I do not have You can download your digital ID card through the SmartCare by
my ID card with Cigna app. If you are at a healthcare provider within the UAE, you
me when accessing can also access care by presenting your registered Emirates ID
treatment? and informing the provider that you are insured by Cigna-Neuron.
Note: If you chose to pay and claim the applicable member
reimbursement and benefit Co-insurances will apply.

17. What if a provider If a provider rejects your ID card and the provider is on our
rejects my ID card? network list, please contact the Customer Service Team on
800 SMARTCARE (800 76278 2273) or send an email to
smartcare.support@neuron.ae.

18. What if the service/ If an In-Patient or Out-Patient service/treatment in line with

treatment I require our Medically Necessary definitions is unavailable at a Network
isn’t available at a provider in your location, the Claim will not be subject to the
Network provider? Member Reimbursement Co-insurance or the network Co-insurance.

19. Are Dental and Vision Dental and Vision claims are not subject to the network
Claims subject to the Co-insurance however, they are subject to the Member
network Co-insurance? Reimbursement and/or benefit level Co-insurance.

20. If I receive treatment If your pharmacy claim is incurred at the hospital pharmacy of
at a provider that a provider that is subject to the network co-insurance, then the
is subject to the network co-insurance will apply to the pharmacy claim.
network Co-insurance
is my pharmacy Claim
subject to the same?

21. Is my Member As there is an insufficient network of providers offering Alternative

Reimbursement Therapy services e.g Ayurvedic, any eligible claim will not be subject
Claim for Ayurvedic to the Member Reimbursement Co-insurance, but will be subject to
treatment under the any benefit level Co-insurance.
Alternative Therapy
benefit subject
to the Member
Reimbursement
Co-insurance?

22. If I receive my Yes, for Maternity Claims the Maternity level Co-insurance would
Maternity care at a apply in addition to the network Co-insurance. This is the only
hospital where the benefit where the benefit level Co-insurance applies in addition
network Co-insurance to the network Co-insurance.
applies, does any
other Co-insurance
apply?

23. What is a Guarantee A Guarantee of Payment (GOP) assures payment directly to a

of Payment? healthcare provider inside your chosen network should they
agree to accept a Guarantee of Payment from Cigna for covered
services. This helps prevent you from having to pay for services
that would normally be covered under your plan.

<< CONTENTS 30
 24. Who is responsible If a healthcare professional requests payment up front, always
for requesting ask them to contact Neuron as per the normal process that they
a Guarantee of use to verify benefits and confirm payment for urgent/emergency
Payment? services on your behalf.
If you are requesting a GOP for urgent/emergency service, call
toll-free on 800 SMARTCARE (800 76278 2273). We will verify
benefits and confirm payment.
Below is the list of information needed for GOP request:
• Hospital/Facility performing the services
• Country where services will be rendered
• Facility fax number, phone number and email address
• Requesting physician name, phone number and email address
• Recipient (who will receive the GOP)
• Patient Name
• Patient Neuron ID number
• Diagnosis
• Procedure to be performed
• Dates of Service
• Statement summarizing service to be covered on the GOP
“please issue a GOP for xxxx reason”
• Please include in the subject heading of email communication;
“Urgent XXcompany nameXX GOP request – (customer name
ID number)” and mark as urgent.

25. Who will bear any We will bear any charges applied to the reimbursement of Claims
charges applied imposed by the remitting bank. However, any charges that may
to reimbursement be imposed by the beneficiary’s bank/other third-party provider
of Claims by the and/or any currency conversion charges, will be borne by the
remitting bank? beneficiary. We recommend that you confirm any bank charges
with your banking provider.

26. On my Claim Only the actual cost of the service is reimbursable. Any charge
submission will relating to VAT will not be reimbursed.
the VAT part of
the invoice be
reimbursed?

<< CONTENTS 31
 Cancellation
In case of termination or cancellation, the

client will be the sole and fully liable party

towards the medical healthcare provider

and/or to INSURER in respect of any

expenses incurred or misuse of membership

card by the insured Members from the

termination or cancellation date of this policy.

<< CONTENTS 32
 Complaints
procedures
COMPLAINTS PROCEDURES
We are committed to providing the highest
standards of service to our customers. However,
should there ever be an occasion when you
feel that we have failed to honor our promise
and that you would like to share your valuable
feedback, we will do everything possible to
ensure that your complaint is dealt with fairly,
effectively and promptly.

The information provided here will show you

how to:
1. Submit a complaint
2. Contact the right person quickly
3. Take further action if you are unhappy with
the outcome

The following standards apply to all complaints

handling:
• We will conduct complaints handling in a fair,
transparent and timely manner;
• We will only ask and take into account relevant
information when deciding on your complaint;
• At all times during the complaint process:
- You will be treated with courtesy;
- Your information will be treated with
confidentiality;
- You have the right to enquire about the
progress of your complaint.
<< CONTENTS 33
 1. Submission of complaints

You have a number of options to submit your

complaint:

a. The easiest way is through the app or the

member portal.

b. Or send an email (along with any supporting

material) to: Smartcare.Support@neuron.ae

c. Or call us:
Inside the UAE: 800 SMARTCARE
(800 76278 2273)
Outside the UAE: +971 4 3178485
+971 2 6940932

d. Or hand deliver/ courier to:

Neuron, IT Plaza Building, 6th Floor, Dubai
Silicon Oasis, P.O Box 72071, Dubai, UAE.

Please ensure that your complaint is properly

addressed to the Complaints Officer.

In compliance with the applicable regulations,

a Complaints Officer will be responsible for
ensuring that your complaint is acknowledged,
properly investigated, and that the company’s
response is promptly communicated to you.

2. What happens after your complaint is logged?

a. Once you have lodged your complaint, we

will acknowledge within 2 working days of
receipt of complaint;

b. The Complaints Officer will refer your

complaint to the concerned person/
department which will investigate it
thoroughly and a written response detailing
the outcome of our investigation and our
decision shall be provided to you within
15 calendar days;

c. In the unlikely event that your complaint has

not been answered within the time frame
mentioned above, we will write and let you
<< CONTENTS 34
 know the reasons why and the further
action that we will take including when
we anticipate to have concluded our
investigation;

d. In the unlikely event that you are not

satisfied with the solution provided by
us, you have the right to escalate your
complaint to Cigna Senior Manager. Your
escalation will be acknowledged as per
2.a above and a written answer shall be
provided within 2 working weeks from
the date of your escalation;

e. After receiving the Senior Manager’s

written decision, and if you are still not
satisfied, you can write directly to the
following Regulatory Authority:

- UAE:
UAE Insurance Authority
Head Office: Aldar HQ, Al Raha
Beach, P.O. Box 113332, Abu Dhabi,
United Arab Emirates
Toll Free: 800 42823 (800 IAUAE)
Tel: +971 2 4990111 Fax: +971 2 5572111
www.ia.gov.ae

- Dubai:
Dubai Health Authority
Toll Free: 800 342 (800 DHA)
Fax: +971 4 3113113
Email: regulation@dha.gov.ae
www.dha.gov.ae

- Abu Dhabi:
Health Authority of Abu Dhabi
Abu Dhabi Airport Road, Abu Dhabi,
P.O. Box 5674, United Arab Emirates
Tel: +971 2 4493333
Fax: +971 2 4449822
www.haad.ae
<< CONTENTS 35
 Data Protection
Telephone calls to and from our organisation
may be recorded to help us monitor and
improve the service we provide.

We will act as Data Controller for the personal

information we hold about you. This data will
be managed by us to carry out our obligations
under the policy and we may need to share
it with authorised third parties to fulfill the
contract, such as emergency repatriation
providers and reinsurers.

If you would like a copy of the information we

hold about you, please write to us quoting your
membership number. Please note that we may
charge a fee to provide this information.

As the main point of contact for the policy,

you will have administrative access to personal
data held about you and your dependants. In
the event of a Claim, this may include access to
some limited sensitive personal data.

We may share information related to fraudulent

activities with third parties, to the extent
allowed by applicable law.

<< CONTENTS 36
www.cigna-me.com SMARTCARE HELPFUL GUIDE - UAE.ME.EN.2021

SmartCare
by

Cigna Insurance Middle East S.A.L. with a branch in Dubai with registered office at Level 1, Building C4, ONE Central - DWTC, Sheikh Zayed Road, PO Box 3664, Dubai, UAE,
and a branch in Abu Dhabi with registered office at Office # 68, Level 04, Al Mamoura Building Block B, Mohammed Bin Khalifa Street (15th St), Abu Dhabi, UAE, is the local
insurer in the UAE, licensed by and registered with the UAE Insurance Authority as a branch of a foreign insurance company under registration No. 48 since 30 December 1984.