Medical insurance

PolicY and Procedure

 MEDICAL INSURANCE
POLICY AND PROCEDURE

Department People & Culture Department Document No. 1

Document Type Medical Insurance Policy and Procedure Revision 0
Owner People & Culture Department Pages
Relevant to All OUC Faculty and Staff
Prepared by People & Culture Coordinator
Approved by The President and Executive Board Member
On February 2022

Date Introduced February 2022

Custodian People & Culture Department

Revision History

Revision No. Revision Date Section No. Reason of Revision

0 New Document

Dissemination

Through OUC Health & Wellbeing E-Service Portal to all OUC employees.

Internal Control and Validation

To ensure compliance with this policy and procedure:

• The People & Culture Department will control the compliance,
• The Finance Department will monitor from the internal audit, and
• The independent external auditor will validate.

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 TABLE OF CONTENTS

Section Description Page

I Policy Objective 4
II Domain of Implementation 4
III Definitions 4
IV Abbreviations 4
V Policy Items 4
5.1. Scope 4

5.2. Eligible Employees 5

5.3. Dependent Eligibility Requirements 5

5.4. Termination of Dependent’s Insurance 6

5.5. Exceptions to Medical Insurance Eligibility 6

5.6. Medical Claims 6

5.7. Abuse and Misuse of Medical Insurance 6

VI Life Events 7
VII Responsibilities 7
7.1. People & Culture Department 7

7.2. Finance Department 7

7.3. Employees 8

VIII Procedures 8
8.1. People & Culture Department 8

8.2. Employees 8

8.3. Reimbursement of Claims 9

X Update and Maintenance 9

XI Annexure 9

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I. Policy Objective
This policy aims to provide eligible employees with medical insurance and define the process of
medical insurance coverage.

II. Domain of Implementation

Monitoring the implementation of this policy is the People & Culture Coordinator’s responsibility under
the supervision of the Office of the President.

III. Definitions

Abuse It is the excessive and improper use of a medical insurance benefit or

the service of something contrary to usual practices which results in
unnecessary costs for the health care system.
Dependents They are legal spouses and up to two children of full-time employees
whose ages do not exceed 18 years old. They shall have valid Qatar
resident permits and be practically residing in Qatar.
Life Event It is a change in the employee’s personal circumstances affecting the
eligibility to receive medical insurance benefits through OUC from the
medical insurance provider.
Non-Sponsored Employee A full-time or part-time employee who is seconded to OUC or
sponsored either by spouse or parent.
Sponsored Employee An employee whom OUC sponsors.
OUC Health & Wellbeing E- A platform or interface used by employees to enrol for medical
Services Portal insurance and update their information.

IV. Abbreviations

OUC Oryx Universal College

QID Qatar ID Card

V. Policy Items

5.1. Scope
5.1.1. OUC intends to provide comprehensive medical coverage for employees sponsored
by OUC and their dependent family members in the event of an illness or injury.
5.1.2. Medical insurance benefits are effective on the first day of employment.
5.1.3. Generally, non-sponsored full-time and part-time OUC Staff are not entitled to the
medical insurance benefits.

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 5.1.4. Medical insurance benefits are available to OUC Staff members and their dependent
family members who are under the sponsorship of the employee and practically
residing in Qatar with valid QIDs.
5.1.5. All employees and the dependents of the employees sponsored by OUC must keep
OUC transparently informed about their health concerns. All health information of
employees and dependents disclosed to the People & Culture Department will be
confidential.

5.2. Eligible Employees

5.2.1. Sponsored employees of OUC are eligible for medical insurance and their spouse
and up to two children until they turn 18 years old.
5.2.2. For non-sponsored single employees to qualify for OUC medical insurance, they
must submit copies of a No Objection Letter from their parent sponsor and their
passport and QID at the OUC Health & Wellbeing E-Services Portal. The letter
declares that they are not entitled to medical insurance, in addition to a self-
declaration. The employee must submit the original letter to the People & Culture
Department.
5.2.3. Non-sponsored married employees must submit at the OUC Health & Wellbeing E-
Services Portal copies of a No Objection Letter from their spouse’s employer,
attested marriage certificate, and their spouse's passport and QID. The letter
declares that they are not entitled to medical insurance under the spouse’s
employer, in addition to a self-declaration. The employee must submit the original
letter to the People & Culture Department.

5.3. Dependent Eligibility Requirements

5.3.1. The legal spouse of the employee sponsored by OUC is eligible, unless the spouse
has medical insurance provided by his/her employer. The People & Culture
Department requires a No Objection Letter from the legal spouse’s employer if the
spouse is working in Qatar. OUC does not allow dual coverage for employees and
employees' dependents.
5.3.2. In the case of legal spouses who are not under the sponsorship of employees
sponsored by OUC, Clause 5.2.3. is applicable.
5.3.3. Children of the employee sponsored by OUC, up to the age of 18 years practically
residing in Qatar with valid QID, are eligible for medical insurance unless the OUC
employee’s spouse's employer covers the medical insurance of the dependent
children.
5.3.4. Widowed employees must submit a Custodian Certificate from the Court for their
children to be eligible for medical insurance along with a legal declaration that their
children are not covered under any other medical insurance schemes.

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5.4. Termination of Dependent’s Insurance
5.4.1. Employees’ children exceeding 18 years of age will become ineligible, and they will
be automatically removed from employee benefits at the end of the month following
the 18th birthday.
5.4.2. If the employee resigns, the employee benefits including own, and dependents'
medical insurance benefits and coverage shall end on the employee’s last working
day along with all other benefits.
5.4.3. If OUC terminates the employee's services, the employee's medical insurance
benefits and coverage, along with his/her other benefits, shall end on the termination
effective date mentioned in the termination letter, including the benefits for the
employee's dependents.

5.5. Exceptions to Medical Insurance Eligibility

5.5.1. Any exceptions to medical insurance eligibility require prior written approval from the
President.

5.6. Medical Claims

5.6.1. Reimbursement of medical claims may occur due to the following reasons:
• Loss of insurance card.
• Forget to bring the insurance card, or unable to produce the card during a
physician's appointment.
• The employee is availing of a hospital or clinic's medical facility outside the
insurance provider's network in Qatar and overseas as allowed in the
insurance policy.
• Medical insurance is expired or under renewal.

5.7. Abuse of Medical Insurance

5.7.1. Medical insurance is an employee benefit and deserves to be well-protected. Any
employee's abuse of medical insurance benefits may significantly impact OUC's
ability to provide the best medical insurance package to all employees, resulting in
higher premiums from the insurer.
5.7.2. OUC reserves the right to request copies of the invoices and other medical
documents for all claims made under the insurance scheme provided by OUC if
deemed necessary by the Management. All documents and information obtained
will be treated with the strictest confidentiality as per the confidentiality clause in
terms of employment.
5.7.3. In the case of non-essential treatments such as optical or dental claims under the
OUC medical insurance scheme, pre-approval from the People & Culture
Department should be sought by the employee using the portal.
5.7.4. Suppose such serious abuse is proven, to have made a questionable claim or
breached the terms or abused the medical insurance scheme for reimbursement of
medical services, such offence could be considered grounds for the following
options:
5.7.4.1. Disciplinary action with a written warning,

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 5.7.4.2. termination of employment, without notice period and end of service
benefits.
5.7.4.3. legal action for breach of contractual obligations in addition to any
other action deemed necessary.

VI. Life Events

6.1. Change of circumstances related to dependents due to change in age or any other relevant
events shall be immediately notified to the People & Culture Department by the employee.
The changes will be considered effective from the first day following the event or the date of
the formal notification.
6.2. Any change of circumstances related to an employee due to marriage or divorce should be
immediately notified to the People & Culture Department by the employee. The change will
be applicable on the first calendar day of the following month after the employee enrols his
spouse and submits copies of the attested marriage certificate, spouse's passport, and QID.
6.3. Change of circumstances due to a baby's birth are effective one month after the birth,
provided that the employee has enrolled the dependent child with the People & Culture
Department and submitted copies of the attested birth certificate and child's passport QID.
6.4. If an employee resigns or the employer terminates employment, the medical insurance
benefits and coverage shall end on the employee's last working day or the effective date of
termination, whichever occurs later.

VII. Responsibilities

7.1. People & Culture Department

7.1.1. Oversee the medical insurance procedure and process and be the point of contact
with employees for all insurance-related matters.
7.1.2. Keep updated records of all employees and the dependents of sponsored
employees eligible for medical insurance.
7.1.3. Compile the list of eligible employees for medical insurance for each Financial Year.
7.1.4. Inform medical insurance provider of new employees to be insured and deletion of
employees.
7.1.5. Keeping a record of all claims made by all employees through the OUC Health
Insurance.
7.1.6. Manage the OUC Health & Wellbeing E-services portal for medical insurance.
7.1.7. All liaisons with the medical insurance provider on behalf of OUC.

7.2. Finance Department

7.2.1. Access the updated information of eligible employees for medical insurance from
the People & Culture Department for audit and other statutory requirements.
7.2.2. Manage the yearly budget for medical insurance.

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 7.3. Employees
7.3.1. Provide the required documents to the People & Culture Department for insurance
enrolment and claims.
7.3.2. Update the People & Culture Department regarding changes in employee’s details
as necessary, including the dependents of the sponsored employees.
7.3.3. Report medical insurance card lost, where relevant.

VIII. Procedures

8.1. People & Culture Department

8.1.1. Send the link of the OUC Health & Wellbeing E-Services portal to all the eligible
employees for medical insurance enrolment.
8.1.2. Review the employees’ medical insurance enrolment.
8.1.3. Return the forms to employees in case of incomplete information and/or missing
documents.
8.1.4. Send the final list of eligible members for the scheme to the insurance provider with
the required supporting documents.
8.1.5. Notify the medical insurance provider if an employee resigns or is terminated.

8.2. Employees
8.2.1. Update their information on the medical insurance enrolment form and/or verify their
previous details.
8.2.2. For enrolment of a spouse, submit copies of the attested marriage certificate,
passport and valid QID to the People & Culture Department. For enrolment of a
dependent child, submit a copy of the attested birth certificate, passport and valid
QID. If the dependent child is adopted or has a legal custody situation, submit a copy
of the attested legal adoption and custody papers along with the attested birth
certificate, passport and QID.
8.2.3. The newly hired eligible employees who have changes in their life events, e.g. single
to married or birth of a child, are required to submit complete information of their
dependents.
8.2.4. In case of reimbursement requests, the employee shall provide the reimbursement
form, original invoices, and all the requirements requested by the insurance and
submit them to the medical insurance representative.
8.2.5. All employees must submit copies of invoices, medical reports and any other
relevant documents with regards to all medical claims made from the OUC medical
insurance scheme to the People & Culture Coordinator.
8.2.6. If an employee is intending to claim benefits for any included non-essential services,
prior approval shall be sought from the People and Culture team by demonstrating
the need and relevance of the benefit. Non-essential benefits include cosmetic,
dental and optical benefits.

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 8.3. Reimbursement of Claims
8.3.1. Employees and insured dependents must complete all the sections of the online
reimbursement claim form at the website of the medical insurance provider to submit
medical claims no later than 90 days from the date the treatment starts.
8.3.2. The claim must include copies of the following items when submitting online:
• Medical Insurance Card to identify the insured employee or dependent and
the policy number
• Official Receipt and medical documents issued by the hospital or clinic
8.3.3. The medical insurance provider’s authorized administrator will contact you for your
bank details to deposit the approved amount of the claim.

IX. Update and Maintenance

9.1.1. The Policy and Procedure for Medical Insurance shall be subject to periodical review
to update, improve and introduce required modifications that may arise.
9.1.2. Usually, a request for modification is the function of one or more of the following
factors, for example:
• Changes in laws and instructions issued by the Qatar government where
OUC operates.
• Changes in the OUC's activities and work domains.
• Changes in the methods of performing and implementing works at OUC.
• Changes in the direction of OUC due to external factors.
• Changes in any strategic plan inputs included in this Policy and Procedure.

X. Annexure

• Direct Billing Form

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