You can view the list of providers in your plan’s network through the “Find Hospital” feature in the Daman mobile app. You may also search for your preferred provider within the UAE or abroad by clicking on “Find a Healthcare Provider” in the Quick Links on the Daman website. Alternatively, you can call Daman’s customer service centre at 600 5 32626 if you are in the UAE, or +971 2 6149555 if you are outside the UAE.

Your Schedule of Benefit (SOB) lists all the services and treatments you are covered for under your policy. You may view your SOB through the “Insurance Documents” feature in the Daman mobile app or online account.

You can check the status of your claim through the “My Claims” feature in the Daman mobile app or your online account.

You can submit your claim under the upgraded plan (UG) by choosing the UG policy in the Daman app or website. Services covered under the UG plan are those not covered under your base plan. Please refer to the UG plan’s schedule of benefits for more details on covered services.

Co-payments and deductibles are covered under the UG plan through direct billing from the provider only and are not payable on reimbursement.

If your claim has been rejected or partially approved and you wish to resubmit your claim, you may use the “Resubmit Claims” option in the Daman mobile app or through your online account on the Daman website. Please ensure that you attach the necessary documents to support your claim.

You can submit your claim either through your Daman app or your online member account in the Daman website, along with the basic document requirements mentioned above. In addition, travel documents should also be submitted with the claim.

You must submit your reimbursement claim within 180 days of the date of service.

Planned treatment/services cannot be claimed in advance. Only performed services are reimbursed.

In addition to the basic document requirements, you also need to submit a clinician referral (doctor’s order), and a detailed medical report from the physiotherapist indicating the number of sessions undertaken as well as the objective of the treatment.

A prescription copy is required if you are submitting a claim for medications, optical services such as glasses and/or lenses, and medical appliance services.

You may be asked to provide additional documents depending on the nature of your claim. This could include a pharmacy prescription, police reports, a death certificate, a referral form, a visa copy, or an airline ticket.

The basic documents required when you submit a claim include:

1. A final itemised invoice with a breakdown of medical services and the specific amount for each medical service availed. This is required for every claim submission, as it indicates each of the services you have taken, the date they were availed and the cost for each service.
2. A proof of payment, which can be a credit card receipt, or a hospital receipt (with a “paid” stamp). These act as a guarantee that the member has settled the cost for the services received.
3. A medical report containing a discharge summary is required for all hospital admissions and some out-patient services, such as therapy (e.g. physiotherapy, speech therapy, infertility services, rehabilitation, etc.).

If a hospitalisation involves a surgical procedure, it is essential to include supplementary documents such as operative notes and anaesthesia records. The medical report must detail the diagnosis and explain the necessity of the procedure, describing the associated signs and symptoms.

You can submit a claim through the Daman app or via your online account in the Daman website. Here you can also upload the documents relevant to your claim.

Local benchmarks are used for quartile placement of the providers for comparison with the market and likely peers. They’re challenging, but achievable to motivate improvement in certain areas for providers who fall behind in performance and wish to keep up with other providers who are performing well.

International benchmarks are used for comparison purpose only and are not used to rank provider performance. International benchmarks are obtained from clinical data registries, payers such as the CMS MIPS quality benchmarks(www.cms.gov) and accreditors such as the National Committee for Quality Assurance NCQA (www.ncqa.org) and Healthcare Effectiveness Data and Information Set HEDIS.

We calculate and aggregate scores at the market level. However, our reports provide the ability to view provider performance not only by provider ‘Type’ but also by ‘Cluster’ (based on similar facility characteristics).

The physician has the responsibility to take the time to educate the patient about his/her medical condition. With proper education, there will be a very few cases in which they will not be compliant. These exceptions would not impact the scoring.

The risk adjustment methodology is detailed in the Medical Quality & Performance (MQP) Metric Specification Manual. Important variables that affect the risk adjusted outcome for any specific metric can be shared on request. However, it will not be possible to recreate exact provider specific results without the results of other providers.

Risk adjustment allows for an “apples-to-apples” comparison between providers by adjusting for differences in patient mix. The goal is to isolate provider performance in a metric from other patient risk factors, like age and gender composition of the patient mix.

All details related to measure specifications, risk adjustment methodology, scoring aggregation and other important details are available in the Medical Quality & Performance (MQP) Metric Specification Manual.

Yes, the metrics are selected from internationally recognized quality assurance systems such as National Committee for Quality Assurance (US), Agency for Healthcare Research and Quality (US), Care Quality Commission (UK) etc. All clinical metrics have been validated by the latest evidence in literature through Advisory Board, Cochrane Reviews. Outcome metrics are risk adjusted using a reliable tested methodology.

We have a standardized process for Metric Selection, Development, Measurement, Review & maintenance cycle, and the data is refreshed biannually. Addition of new metrics and retirement of the old ones continue to happen throughout the life of the programme based on the current practice and market need.

The emphasis is on making the performance transparent (i.e., the “Evidence-Based”) to providers and help them identify their areas of improvement.

We monitor providers' performance through a wide range of clinical, structural, and financial parameters in different care settings. We share and discuss the performance results on a bi-yearly basis. The purpose is to give timely feedback on Quality Improvement areas, thereby supporting the gradual increase of quality in the Abu Dhabi health system. Providers participate in this programme as it provides useful insights to their performance, gives them an opportunity to provide feedback and take suitable action.

R&C charges refer to the average price of a particular treatment across the network of providers for a specific plan.  Daman applies R&C rates to claims incurred out of the plan’s network as non-network prices could be quite high and will impact the policy’s renewal premium.  So to maintain a balance between treatment access and cost, payment will be on a R&C basis and not on the actual out of pocket cost of the member.

You may be asked to provide additional documents depending on the nature of your claim such as Prescription, police reports, death certificate, referral form, visa copy, airline ticket.

You may be asked to provide additional documents depending on the nature of your claim such as Prescription, police reports, death certificate, referral form, visa copy, airline ticket.

You can submit your reimbursement claim either through Daman app or Daman website.

We encourage members to seek treatments at Network Providers to receive the maximum benefits of your policy.  However, in the event that going to non network providers is non-avoidable, the member might not receive the full share of the cost at a non-network provider if the cost of a specific service of this provider is higher than other providers in your plan’s network.

The below scenarios can assist you in understanding:

• Scenario 1 – If the R&C rate is less than the actual price charged by the Non-Network Provider, the R&C rate is applied in calculating the reimbursed claim payment.
• Scenario 2 – If the actual price charged by the Non-Network Provider is less than the R&C rate, the actual price rate is applied in calculating the reimbursed claim payment.

This has been illustrated below, for a case where 20% co-insurance applies for all covered services in Non-Network Provider: Example – R&C: Consider that a cost for a particular surgery is AED 1000 at a network hospital.