Enaya Program

Enaya & Nextcare

SMS Service
- Have you ever received an SMS upon obtaining medical services for you (or any of your family members)?
  - – Receiving an SMS upon obtaining these medical services allows you to track the track the status of authorization requests sent from in-network provider from the time Nextcare received until time of approval issued.
- Why do you not always receive SMS upon receiving medical services from provider?
  - – Some services don’t require authorization from insurance, hence no SMS will be sent to you. If the medical services recommended for you require prior approval from your insurance, then you will be updated via SMS on the status of the request.
- Have you ever received an SMS on a day that you (or any of your family members) do not recall going to a facility?
  - Here are some of the possible reasons:
    
    1) The registered Mobile Number is linked to all family members and one of them has obtained the service.
    
    2) Provider has resubmitted a previously authorized request for revision after providing the required services.
    
    3) Provider requested for authorization prior to service date based on treatment plan agreed on recommended by your treating doctor.
    
    4) Mobile Number is incorrectly linked
- What are other types of SMS’s that I might receive other than authorization related under the ENAYA program?
  - You might receive:
    
    1. Benefits update
    
    2. Update on program information
    
    3. Others
Second Medical Opinion (SMO)
- Have you ever been requested to attend a SMO prior to receiving authorization?
  - Second medical opinion referrals are usually requested in specified medical conditions under the ENAYA protocol, as well as in complex medical scenarios where the ENAYA program requires recommendations as per the best practiced medical guidelines about a member’s medical condition.
- Will SMO be mandated if I have been requested for it?
  - Yes, an SMO is typically mandatory if you’ve been requested for it under the ENAYA protocol according to best practices.
- How is a SMO arranged and how can I make an appointment?
  - ➞ Arrangements for your SMO will be made through Nextcare by scheduling an appointment with a specialty doctor aligned with your condition.
    
    ➞ SMO doctors are carefully chosen by the ENAYA program based on their strong expertise and extensive clinical experience.
    
    ➞ A Nextcare customer service representative will contact you and inform you of the appointment details,
    including the specialty, doctor, hospital, and date & time. Therefore, we highly recommend keeping your contact information updated at all times.
- Is it important to adhere to a scheduled appointment arrange with a SMO doctor?
  - ➞ Yes, it is always recommended to adhere to scheduled appointments as cancellations or re-scheduling could lead to delays, which may lead to further deterioration of your condition.
    
    ➞ In case you are unable to attend the SMO appointment due to unforeseen circumstances, please make sure to notify a representation from the Nextcare customer service team 24 hours prior to your scheduled
    appointment, so that someone else can benefit from your available slot.
- What documents do I need during SMO visit?
  - You will need to bring all your medical documents and your radiology CD (including MRI, CT scan, X-ray, or ultrasound images) as these documents and images provide important information about your medical condition and will be reviewed by the specialist during your SMO appointment.
Medical Authorization
- Have you ever been requested to wait for authorization before proceeding with medical services?
  - Prior authorization is required for specific medical services set under program for the purpose of monitoring; such as but not limited to inpatient services, dental services, maternity services, physiotherapy services, etc.
- How long does it take until I receive an authorization response?
  - Response time will depend on the type of service and their complexity, however in case of emergency you can contact Nexcare customer service toll free number (800- 436292) for immediate assistance.
- How can I get an update on prior authorization request status?
  - Option 1: SMS service is available to notify you on request time submission time from provider to Neuron and update you with second SMS on final status of the processed request from Nextcare. Hence please ensure that your registered mobile number is updated. (You can refer to SMS FAQ sector for further clarification on service)
    
    Option 2: Enaya Mobile Application available for download on apple and google play stores
    
    Option 3: Check with you provider (clinic, Hospital), as it is common protocol on provider end to update you once insurance authorization has been.
    
    Option 4: contact Nextcare customer service toll free number (800- 436292) to obtain an update or assist you in any manner.
Enrollment under Enaya Program
- Who is eligible Under ENAYA Program?
  - Citizens of Emirate of Dubai who do not benefit from any other government insurance.
    
    Employees of government departments in the Emirate of Dubai and their families
- If my ENAYA policy has been deleted due to duplication with other government program, can I cancel my existing scheme and re-activate ENAYA?
  - As long as you are still eligible under a current scheme then you can’t re-activate ENAYA. As per for Dubai Health Insurance Law(16) 2013. Click here
- How can I get enrolled under ENAYA program if I’m eligible?
  - Citizens of Emirate of Dubai who do not benefit from any other government insurance. Enrollment can be done through:
    - Enrollment can be done through: Online registration (please contact the Nextcare toll
      free line for guidance 800 436292)
      
      Kiosk registration using Emirates ID through following steps:
      
      Proceed to the nearest Enaya Kiosk within Dubai in one of the following locations:
      
      Al Barsha Health Center
      
      Nad Al Hamar Health Center
      
      Al Mizhar Health Center
      
      Hatta Hospital
      
      Dubai Festival Tower
      
      Press start on the digital screen
      
      Insert the Emirates ID card into designated reader
      
      Complete entry of required details
      
      Enroll remaining family members
      
      Confirm registration
      
      Note: You can’t be enrolled with ENAYA without a valid original Emirates ID card
    Please note that kiosk registration is only available for nationals of Dubai who are not covered under any government insurance schemes
    
    For Employees of government departments in the Emirate of Dubai and their family’s enrollment request should be received from the HR at place of work.

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FAQ

Enaya & Nextcare

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