Understanding Direct Settlement and Claims in the UAE: A Guide to MembersWorld
A guide to direct settlement and claims through MembersWorld.
Managing your health insurance should be straightforward, especially when you need medical treatment. Understanding how direct settlement works, when you may need to submit a claim and how to manage your healthcare plan can make the process much easier.
We offer a range of premium international health insurance plans in the UAE. MembersWorld provides a convenient way to manage your healthcare plan, access important policy information, submit and track claims, request pre-authorisation, and connect with support whenever you need it.
What is direct settlement?
Direct settlement or direct billing is a way of paying for eligible healthcare treatment where the healthcare provider settles the covered costs directly with your insurer, meaning you do not have to pay upfront and claim a refund for most planned treatments.
In practical terms, direct settlement can help simplify the healthcare experience. Instead of handling the full cost of eligible treatment upfront, the insurer and healthcare provider can manage the covered portion of the bill between them, subject to your policy terms, benefits, limits and any applicable approvals.
What should you do before receiving treatment?
Understanding your health insurance arrangements before treatment can help you avoid surprises. Before receiving planned treatment, consider checking:
- Whether your healthcare provider offers direct settlement.
- Whether your treatment requires pre-authorisation.
MembersWorld allows you to submit pre-authorisation requests and, for certain treatment pathways, receive real-time decisions. - What your policy covers.
Review your benefits and policy documents through MembersWorld. - Whether you need to pay anything yourself.
- Whether you need to submit a claim.
If you pay for eligible treatment yourself, MembersWorld provides a simple way to submit and track your claim.
Direct settlement vs making a claim
Where direct settlement is available and the provider handles the billing directly with the insurer, you may not need to submit a reimbursement claim yourself.
However, there may be situations where you pay for healthcare yourself and subsequently need to submit a claim for reimbursement. Understanding this distinction can help you know what to expect before receiving treatment and avoid unnecessary delays.
How do healthcare claims work in the UAE?
If you have paid for eligible medical treatment yourself, you may need to submit a claim to request reimbursement. MembersWorld makes this process easier by allowing members to submit and track claims online.
Depending on the circumstances, members may be asked to provide documents such as invoices, receipts, medical reports or other information relating to their treatment.
Once submitted, MembersWorld allows you to follow the progress of your claim and receive updates about its status. You can also access up to 36 months of claim history, giving you a convenient record of previous claims.
Manage claims through MembersWorld
MembersWorld is designed to bring key healthcare and insurance services together in one place. Available on the web and through the app stores, it allows members to manage their health plan quickly and conveniently.
With MembersWorld, you can:
- Submit and track your claims
- View up to 36 months of claim history
- Request pre-authorisation for treatment
- Receive real-time decisions for certain treatment pathways
- View your benefit information and policy documents
- Access your digital membership card, both online and offline
- Contact the customer support team securely through 24/7 messaging
- Manage your cards and payments
For individual customers, MembersWorld also allows you to make one-off payments and update your card details quickly and securely, although some regional limitations may apply. Adult policyholders can also set up an account, manage dependants’ policies and, where applicable, grant their insurance broker permission to view policy and claims information.
Adult dependents can create their own account and grant permission to the policyholder to view and manage their policy and/or allow their insurance broker to view policy and claims details.
Members under 16 cannot access MembersWorld directly. However, customer support is available by phone, and where a policyholder is over 16, their details will appear within the policyholder’s account so their activity can be managed online.
What is pre-authorisation and why does it matter?
Pre-authorisation is another important part of managing your healthcare plan. Depending on your treatment and policy, you may need to obtain approval before receiving certain types of medical care. MembersWorld allows you to request pre-authorisation in minutes, with real-time decisions available for certain treatment pathways.
This can give you greater clarity about your cover before treatment takes place.
It’s important not to assume that receiving pre-authorisation means every cost associated with treatment is automatically covered. Your policy terms and benefits continue to apply.
Your digital membership card
MembersWorld also gives you easy access to your digital membership card when you need treatment. The card can be viewed online and offline, making it convenient when visiting a healthcare provider.
Having your membership information readily available can help make accessing healthcare simpler, particularly when you are travelling or away from home.
Making healthcare easier with MembersWorld
Whether you are checking your benefits, requesting pre-authorisation, accessing your digital membership card or managing claims UAE members may need to make, MembersWorld brings essential health insurance services together in one place.
For members using eligible healthcare providers, direct settlement can simplify the payment process by allowing covered healthcare costs to be handled between the provider and insurer, subject to the terms of your plan. When you do need to pay for treatment yourself, MembersWorld provides a convenient way to submit and track your claim.
