FAQ - HEALTH INSURANCE
What is Health Insurance?
- Health insurance (also known as Medical Insurance) is a type of insurance coverage that pays for your medical and surgical expenses incurred at any private medical clinic and hospital or medical practitioner, as a result of an injury or sickness contracted during the period of insurance, in line with the provisions of your policy.
What does my Health Insurance cover?
- Your Health Insurance cover will depend on the policy you choose, and may include:
- In-patient Benefits
- Outpatient Benefits
- Catastrophe Cover Benefits (optional)
What is In-patient cover?
- In-patient benefits cover expenses incurred for any medical treatment or surgical procedure that requires admission into a private clinic and hospital for one or more days of overnight stay, as per the coverage limits in line with the provisions of your policy.
What is Out-patient cover?
- Outpatient benefits cover expenses incurred for routine medical services including doctors’ and specialists’ services, consultations, prescribed drugs, injections, therapies and clinical tests (e.g. X-ray), as per the coverage limits in line with the provisions of your policy.
What is Catastropher cover?
- Catastrophe cover is an optional benefit that provides greater coverage limits than an inpatient cover, covering high cost and/or major medical treatment or surgical procedure for severe illnesses or serious accidents.
Does my health insurance cover for treatment abroad?
- If the required medical treatment or surgical procedure is not available in Mauritius, your health insurance covers for in-patient treatment abroad (excluding USA and Canada), as per the coverage limits in line with the provisions of your policy.
Can I use my health insurance at any doctor, dentist, clinic or is it limited to particular medical service providers?
Your NIC health insurance is valid at any private medical clinic and hospital, and medical practitioner, licensed or authorised by law to practice, and duly registered with the Medical Council/Dental Council of Mauritius, or overseas equivalents.
If you are unsure of whether you are covered or not, simply call us on 602 3000 during working hours, and we will provide you with the necessary clarifications. You may also send us an email at email@example.com
What are the requirements to be eligible for a health insurance plan?
- Medical check-up and tests may be required based on your age and state of health as per the coverage limits chosen in your policy.
If I already have an ailment, or suffering from a disease, can I take a health insurance?
- Our health insurance provides coverage for "pre-existing medical conditions" subject to waiting periods, exclusions and provisions as detailed in the policy.
What is considered as a pre-existing condition?
- A pre-existing condition is a health problem arising from a disease or sickness or injury which you have, and for which you are seeking treatment from a doctor for at least 12 months, before the insurance application date.
Why should a pre-existing medical condition be disclosed? Isn't this information confidential?
- It is essential that you disclose all information and any pre-existing medical condition to ensure proper evaluation of the insurance risk and avoid the possibility of rejection of any future claims. Any omission may be construed as a material non-disclosure.
- The Company adheres to strict confidentiality in line with the Data Protection Act.
Can I insure my dependents on my health insurance policy?
- Yes, you can include your children and spouse (aged under 65) as dependents on your health insurance policy subject to waiting periods, exclusions and provisions as detailed in your policy.
Are the premiums that I pay for my health insurance tax deductible?
- Yes, health insurance premiums paid for yourself and your dependents are tax deductible, as per the prevailing Income Tax legislation (refer to the MRA section for more details on tax benefits).
- In the event of any changes in the Income Tax legislation, the applicable tax deductions will apply.
What does "prise en charge" mean?
- “Prise en charge” means that your insurance company bears either the full claim amount or part of the claim amount of your medical and surgical expenses incurred at a private medical clinic and hospital, or medical practitioner, as per your coverage limits in line with the provisions of your policy.
Does NIC offer a "prise en charge" facility?
- Yes, we do offer a “prise en charge” facility to our clients:
- In the event of a planned admission for medical treatment or surgical procedure, we bear your medical costs up to the pre-authorised amount, as per your coverage limits in line with the provisions of your policy, subject to at least 48 hours prior notification.
- In the event of an emergency admission, the service provider will contact us for the cover details. The medical authorisation operates on a 24/7 basis.
- For outpatient cases, we offer a "prise en charge" facility at designated service providers only. We will provide the authorisation to the service provider as per your coverage limits in line with the provisions of your policy. You will only need to settle your excess or any disallowed expenses.
- We have a broad network of designated medical service providers across the island where we offer a “prise en charge” facility to our clients. Please refer to the NIC Service Providers Network list for more details.
Can I make a claim as soon as my healthcare policy is issued?
- Your cover may be subject to waiting periods, exclusions and provisions as detailed in your policy, except for accident related claims that can be made immediately after policy issuance.
How do I make an In-patient claim?
For all in-patient treatments, you must at all times present your NIC Health Card and ID card at the private medical clinic or hospital.
In the event of a planned in-patient treatment you must notify and provide us with the following documents, at least 48 hours prior admission:
A detailed medical report from your treating doctor or surgeon specifying the diagnosis and the treatment plan.
A cost estimate from the private medical clinic or hospital including doctors’ fees.
We will then issue a pre-authorisation for admission to the private medical clinic or hospital to carry out the medical treatment and/or surgical procedure, and settle your medical bills for you, as per the pre-approved amount, and as per the coverage limits in line with the provisions of your policy.
In the event of an emergency in-patient treatment, you must notify us at the earliest possible, or within 24 hours of admission to the private medical clinic or hospital.
We will then provide a pre-authorisation to the private medical clinic or hospital, and settle your medical bills for you, as per the coverage limits in line with the provisions of your policy.
Alternatively you can also pay your bills directly to the private medical clinic or hospital, and submit to us your completed Health Claim Form and original supporting documents, including your hospital discharge documents, final bill and receipts, within 30 days from the date you are discharged. We will reimburse you once your claim is approved, as per your coverage limits in line with the provisions of your policy.
How do I make an Out-patient claim?
- To make an out-patient claim, you must submit the following original documents:
- Completed Health Claim Form
- Physician’s receipt & report stating the diagnosis and treatment
- Physician’s prescription
- Pharmacy’s receipts
- You can send us the completed Health Claim Form with the original supporting documents by post or drop it at your nearest NIC branch office.
Where can I get a Health Claim Form?
- You can download your Health Claim Form from our online Claims centre
- You may also request for a claim form by calling us on 602 3000 or by sending us an email at firstname.lastname@example.org
Is there a time frame for submitting a claim?
All claims must be submitted within 30 days from the date of treatment/service, and/or hospital discharge date.
How long does it take to get reimbursed?
- Accepted claims will be refunded within thirty (30) days from the date you submitted your claim with the complete set of required original supporting documents.
I want to know the reasons why my claim has not been accepted?
You can email us at email@example.com or call us on 602 3000 during working hours. We will provide you with the necessary information.
I want to renew my Health Insurance policy. What should I do?
- You can drop in at any NIC branch office or NIC Post Assurance booth with your ID card and renewal notification letter, and effect payment for your renewal, prior to the expiry date of your current policy.
How do I make a complaint?
- Excellent customer service is our top priority. If you are not satisfied with our services with respect to the issuance of your policy; handling of your claims, or any other service issue in relation to your health insurance policy, call us on 602 3000 or email us at firstname.lastname@example.org
You may also write to our Complaint’s Coordinator on the following address:
NIC General Insurance Co. Ltd
217 Royal Road
When lodging your complaint, please provide us with the following information:
your personal and contact details (name, address, telephone number, email)
your policy number
full particulars of your complaint
We will assess and investigate your complaint, and may contact you if we require more information or clarifications.
We will endeavour to resolve your concerns and revert to you within 21 working days from the date you lodged your service request.
If you have received our final response and you are still not satisfied with it, you have the right to refer your case to the Office of Ombubdsperson for Financial Services.
Will I have a waiting period if I was previously insured with another insurer?
- Waiving of waiting periods may be considered subject to the provisions of the policy.