Download Personnel Policy For GROUP MEDICAL INSURANCE SCHEME For

KUWAIT PETROLEUM CORPORATION
Corporate Risk Management Department
Personnel Policy
For
GROUP MEDICAL INSURANCE SCHEME
For KPC and ‘K’ Companies Employees
Article One: Definition of Group Medical Insurance Scheme
This scheme is designed to provide medical treatment availed from the Private Medical
Sector in the State of Kuwait on an optional basis. It is a temporary scheme for a
duration of 5 – 6 years till the new hospital is constructed in Ahmadi.
Article Two: This Scheme
This Scheme is subject to the approved Personnel Policies of KPC and the ‘K’
Companies and, the issued and approved Terms and Conditions of the Insurance Policy.
Article Three: Categories of Employees covered under this Scheme
Kuwaitis
-
Kuwaiti Employees (males and females)
Spouses of Kuwaiti Employees
Sons of Employees less than 26 years of age and not registered with the Public
Institution for Social Security
Daughters (unmarried, divorced or widows) of Employees if they are living with
them and not registered with the Public Institution for Social Security
Sons of Employees
Handicapped children of Employees and not registered with the Public Institution for
Social Security
Non-Kuwaitis
-
Employees (males and females)
Wives of male Employees
Sons of Employees less than 26 years of age and possessing valid residency (Article
22 – Dependant)
Daughters (unmarried, divorced or widows) of Employees and possessing valid
residency (Article 22 – Dependant)
Age of Covered Persons
For Adults the maximum age limit is 65 years.
For Children the age limit is from date of birth of the child.
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KUWAIT PETROLEUM CORPORATION
Corporate Risk Management Department
Article Four: Covered Benefits / Maximum Limits
1.
-
BENEFITS / LIMITS (PER PERSON PER YEAR)
Maximum In-Patient benefits per person per year
Daily room, board & nursing care
Surgeon’s and Anesthetist’s fees
Attending Physician’s and Consultant’s fees
Pathology & Radiology
Local Ambulance
Medicines and drugs related to the same disease and
prescribed by the treating doctor.
2. Maximum sub-limit for Out-Patient benefits per person per
year
- Consultation at clinic
- Medicines and drugs as prescribed by a registered medical
practitioner
- Diagnostic X-ray and laboratory tests
- Minor procedures such as suturing, fractures etc
- Day care surgery
3. Maximum sub-limit per person per year for Dental
treatment
Dental Treatment consists of:
- Extraction and Filling
- Neurectomy
- Gum treatment
- Root Canal Treatment
- Extraction of Children’s teeth
- Treatment received in respect of bridges, crowns, dentures,
orthodontics
- Dental cleaning (once a year)
- General dental inspections or routine check-ups, or any
fluoride treatment given (once a year)
- Treatment related to jaw shrinkage or loss as a result of
dental extractions and/or the provision of implants.
- The Scheme shall pay
1. For a surgical operation carried out by a
consultant to put a natural tooth back into a jaw
bone after it is knocked out or dislodged in an
accident.
2. Immediate relief of pain.
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AMOUNT (KD)
10,000
1,750
750
KUWAIT PETROLEUM CORPORATION
Corporate Risk Management Department
4. Maximum sub-limit per female member per year for
Pregnancy & Maternity treatment
Pregnancy & Maternity benefits include:
- Pre and post natal care from commencement of pregnancy
- Prescribed drugs and tests
- Normal delivery
- Caesarian
- Miscarriage, Legal Abortion, Hospital Services and nursing
care of mother.
1,500
5. Maximum sub-limits per person per year for treatment of
Chronic conditions
The Scheme shall pay for the treatment of Chronic conditions. By
this, we mean a disease, illness or injury, which has at least one of
the following components:
- Has no known cure, or recurs
- Is caused by changes to your body which cannot be
reversed
- Require you to be specially trained or rehabilitated
- Needs prolonged supervision, monitoring and
treatment
Examples: Hypertension and Diabetes
2,000
Article Five: Exclusions
This scheme does not cover Medical Expenses related to the following:
1. AIDS/HIV
2. Addictive Conditions/Disorders
3. Sexual Problems, i.e., Infertility, Impotence, Sexual dysfunction and Sexually
transmitted diseases
4. Contamination, Wars, Riots and Terrorism
5. Congenital Conditions, i.e. abnormality, deformity, disease, illness or injury
present at birth whether diagnosed or not.
6. Convalescence, Rehabilitation and General nursing
7. Experimental Drugs & Treatment
8. Learning Difficulties, Behavioral & Developmental Problems
9. Physical Aids & Devices
10. Self-Inflicted Injuries
11. Sleep, Speech &/or Psychiatric Disorder
12. Artificial Parts of Human Body, Organ Transplantations
13. Diet/Nutrition
14. General Lab tests/Medical Check up
15. Vitamins & Minerals
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KUWAIT PETROLEUM CORPORATION
Corporate Risk Management Department
16. Ageing and Puberty
17. Cosmetic, Reconstructive or Remedial Surgery
18. Health Hydros
19. Deafness caused by congenital abnormality
20. Preventive Treatment
21. Hair Loss
22. Unrecognized Consultant, Hospital, Therapist,
Complementary Medicine Practitioner
23. Epilepsy
Dental
Practitioner
or
Article Six: Method of Payment of Medical Expenses
1. Direct Billing System
In this mode of claims settlement, claims are settled with the approved list of Medical
Service Providers using the cards issued by the Insurance Company.
-
Upon presenting the card to any of the approved Medical Service Providers, the
insured members shall be provided with the necessary medical services following
which, they have to sign the Claim Form and invoices for the respective medical
services they have received. This would not include the following:
a. In case the total medical expenses exceed the Maximum Limit stipulated
in the Insurance Policy.
b. Any treatment not covered under the Insurance Policy.
-
The cards issued by the Insurance Company are subject to the terms and
conditions of the Insurance Policy.
2 . Reimbursement Mode
In the following cases, the insured members shall pay for their medical expenses in
the first instance and then claim for reimbursement, abiding by the following
procedures:1. Where the medical expenses exceed the Maximum Limit stipulated in the
Insurance Policy.
2. If the treatment is availed in Medical Centres which are not on the approved
list of Medical Service Providers.
-
The insured member must fill the Insurance Company provided
Claim Form and the treating physician should sign and stamp the
form.
-
The member shall pay the incurred expenses to the medical
provider and should retain the original bills, prescriptions and
medical reports, and attach it to the Claim Form.
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KUWAIT PETROLEUM CORPORATION
Corporate Risk Management Department
-
Submit the completed Claim Form with all supporting documents
to the Human Resources Department of his/her Company for
onward submission to Medical Insurance Team of Ahmadi
Hospital.
-
The concerned ‘K’ Company will pay these amounts following
approval by Ahmadi Hospital.
Article Seven: Medical Services which Ahmadi Hospital will continue to offer to
Insured Members
1.
2.
3.
4.
5.
6.
7.
Preventative Medical Treatment, Routine health checks, Vaccinations and
Occupational Health Treatment.
Emergency Treatment Services in Ahmadi Hospital
Emergency Medical Clinics in various ‘K’ Companies’ sites and KPC Head
Office
Referral Medical Treatment outside the State of Kuwait
Eye Treatment by laser (Keratectomy)
Infertility Treatment
Approval of medical expenses exceeding maximum limit stipulated in the
Policy.
Article Eight: Geographical Limits of Insurance Coverage
Inside the State of Kuwait only
Article Nine: Joining the Group Medical Insurance Scheme
-
-
Existing Employees who wish to join the Scheme must sign the relevant declaration
form after having read and understood the rules and conditions of the relevant
Personnel Policy sections pertinent to this scheme and will undertake to abide by
them.
New Employees may join this Scheme from the date of their employment with KPC
or the ‘K’ Companies.
Article Ten: Transfer from Ahmadi Hospital to Group Medical Insurance Scheme
and vice versa
In case the Employee wishes to transfer from one Scheme to the other, he/she must
declare his/her wish in writing at least 3 months before the commencement date of the
following Insurance Policy Period. In no case would the employee be allowed to transfer
from one scheme to the other in the middle of the Policy Period.
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KUWAIT PETROLEUM CORPORATION
Corporate Risk Management Department
Article Eleven: Non compliance
In case the covered Employee does not abide by the terms and conditions of the Group
Medical Insurance Scheme, disciplinary action in accordance with the Personnel Policy
will be initiated.
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