Health insurance is concerned with providing a pre-payment plan and providing services or cash compensation to obtain the necessary medical care in times of illness or disability, according to a legal document issued by the insurance company that specifies the terms and conditions of insurance, which differ from one country to another according to the country's system and its economic, scientific and health development at the same time, as governments in some countries are responsible for health insurance in cooperation with health insurance companies that are responsible for implementing health insurance operations, monitoring cases, assessing conditions and holding hospitals, pharmacies and other various health centers accountable. Health insurance has enhanced access to health care in hospitals at the appropriate time, and has increased the ability to provide services and care in various health institutions.

Who Should Attend?

• Employees of health insurance institutions.
• Individuals who benefit from insurance operations.
• Those interested in the field of health insurance.
• Workers in health administration.

Knowledge and Benefits:

After completing the program, participants will be able to master the following:

• Characteristics of medical insurance in the ability to bear medical expenses and being a necessity of life.
• Criteria for selecting clients and determining prepayment plans.
• Cases in which diseases are fully covered as well as the choice of treatment.
• Specific cases and conditions or circumstances available in the policy that are not covered by insurance.
• Incorrect practices in health insurance operations.
• The role of medical insurance in increasing the efficiency of health quality.

• Introduction to Health Insurance
  • Definition of health insurance and its importance.
  • The difference between private and government health insurance.
  • The role of health insurance in improving health care.
• Components of a health insurance policy
  • Key terms: coverage, deductible, and maximum benefits.
  • Understanding the different types of plans (HMO, PPO, EPO)
  • How to choose the most appropriate plan according to individual needs.
• Laws and regulations
  • Overview of local and international laws.
  • The impact of legislation on beneficiaries’ rights.
  • Regulatory impact on providers.
• Claims filing process
  • Steps in filing claims: preparation, submission, and follow-up.
  • The importance of accurate documentation and required documents.
  • Important deadlines and timings.
• Dealing with providers
  • How to choose the right providers.
  • Negotiation strategies for better services.
  • Understanding the provider network and the rights associated with it.
• Resolving disputes
  • Strategies for dealing with denial or delay in claims.
  • How to escalate issues effectively.
  • Submitting complaints to the competent authorities.
• Education and awareness
  • The importance of education in understanding health insurance.
  • Available resources to improve knowledge (books, websites, workshops).
  • The role of education in improving the beneficiary experience.
• Using technology
  • Digital tools to facilitate health insurance management.
  • How to use mobile applications to track claims.
  • The impact of big data and artificial intelligence in improving Services.
• Building relationships with service providers
  • Effective strategies for building sustainable professional relationships.
  • The importance of effective communication with service providers.
  • Sharing information to improve user experience.
• Challenges of the health insurance industry
  • Economic and social challenges.
  • The impact of demographic changes on health insurance.
  • How to overcome these challenges through innovation.
• The future of health insurance
  • Future trends and their impact on beneficiaries.
  • How technology can reshape the health insurance experience.
  • The importance of sustainability in health insurance policies.
• Health insurance data analysis
  • The importance of data collection in the health insurance industry.
  • Data analysis tools and reports used.
  • How to use analysis to improve services and anticipate trends.
• Evaluating the performance of service providers
  • Criteria for evaluating the quality of service provided by insurance providers.
  • How to measure customer satisfaction and analyze feedback.
  • Strategies for improving performance based on evaluation results.
• Financial management in health insurance
  • Understanding the costs associated with health insurance.
  • Financial management strategies to reduce expenses.
  • The role of health insurance in personal financial planning.