
Document Type | Service Type | Country | Description |
Reimbursement Claim Form |
In Patient Out Patient Medicine Consultation Dental Optical |
GCC Lebanon Egypt Tunisia |
Claim Form completely filled in and signed by you and stamped by the Attending Physician. For Dental treatments, please ask the Dentist to mention the number of the affected teeth with the corresponding service done on each tooth. |
Detailed Medical Report |
In Patient Out Patient Medicine Consultation Dental Optical |
GCC Lebanon Egypt Tunisia |
A detailed report completed and signed by your Attending Physician and stamped by the Service Provider. The report should include: the history of the present illness, the past medical history, the clinical history and the prescribed medical tests and/or medicines. |
Medical Results | Out Patient |
GCC Lebanon Egypt Tunisia |
Your laboratory test results, radiology reports, etc… as provided by the Healthcare provider. |
Detailed Invoice |
In Patient Out Patient Medicine Consultation Dental Optical |
GCC Lebanon Egypt Tunisia |
Your healthcare provider bill that lists all the services itemized you received and the total amount for each. For dental treatments, please ask the Dentist to mention the number of the affected teeth. |
Discharge Summary | In Patient |
GCC Lebanon Egypt Tunisia |
A clinical report prepared by your Attending Physician at the conclusion of a hospital stay or series of treatments. It should include your diagnostic findings, the therapy administered and your response to it, intra-operative notes and findings if surgery was carried out and recommendations on discharge. |
Prescription |
Medicine Optical |
GCC Lebanon Egypt Tunisia |
Prescription signed and stamped by the Attending Physician and the Service Provider. For Egypt cardholders, a Pharmacy stamped invoice is also required. |
Medication boxes stamped by the pharmacy (when applicable to be presented to the Payer upon Cheque reception) |
Medicine |
Lebanon Tunisia |
For Lebanon cardholders, your prescribed medication boxes that were stamped by the Pharmacist during the purchase. For Tunisia cardholders, the prescribed medications price labels (vignettes) or the leaflets (prospectus) if the price label is not available. If both are not available, a stamp from the Pharmacist “Sans vignette, sans prospectus” is required. |
Copy of your Insurance Card |
In Patient Out Patient Medicine Consultation Dental Optical |
GCC Lebanon Egypt Tunisia |
A scanned copy of the front side of your Insurance Card. |
Copy of your Identity Card |
In Patient Out Patient Medicine Consultation Dental Optical |
GCC Lebanon Egypt Tunisia |
A scanned copy of your Identity Card or Passport. |
Social Security Forms & detailed invoice |
In Patient Out Patient Medicine Consultation Dental Optical |
Lebanon Tunisia |
Applicable only for Insured Members who have the National Social Security Fund coverage and who are seeking a complementary treatment. Social Security forms should be filled as per the Social Security rules by your Treating Physician. |
Copy of the Passport Pages and Airline Ticket |
In Patient Out Patient Medicine Consultation Dental Optical |
GCC Lebanon Egypt Tunisia |
Applicable only for treatments / services outside the country of residence. A copy of the Passport pages showing the Exit/Entrance Date from/to the country of residence as well as a copy of the airline ticket related to the same trip. |
Card No | is the 16 digits number printed on the front side of the card. This number is generated by NEXtCARE as your personal unique number which would be used for all your transactions. |
Network |
is a code that represents a group of healthcare facilities (hospitals, clinics, laboratories, pharmacies, etc.) contracted NEXtCARE allowing you to benefit from direct settlement of bills. For more information about your network, visit the Healthcare Providers Partners’ page on www.nextcarehealth.com |
Ded: Deductible Co-Pay: Co-payment Co.Ins: Coinsurance |
represents the amount you have to pay for the healthcare provider as your share of the claim. This number can be either a percentage of the claim cost or a predefined flat amount. |
Category | is a code that represents your insurance policy eligibility and table of benefits. |
Class | defines the room you are entitled to have in case of hospitalization. |
Effective Expiry | represents the starting and ending dates of your insurance policy. |
Optical Dental Maternity |
are your additional benefits. If No is mentioned on the card, it means that you are not entitled for these benefits. |