Posted on June 25, 2014

The National Health Insurance Company announced that as of June 26th dental services will be covered under Seha – the National Health Insurance Scheme.  This means that all Qataris covered under the Seha Scheme can now get the full range of medically necessary dental treatments at a large number of hospitals, clinics and specialised dental centers within the authorised provider network. All basic dental services and emergency treatments are fully covered within the Seha provider network and do not require any co-payments from members.

However, a small number of specified procedures require prior authorization by NHIC and a second opinion from a member of the Panel of Experts nominated by the Qatar Council of Health Practitioners. These treatments include indirect veneers, tooth implants, and orthodontic procedures. If, based on the international expert guidelines, the treatment in question is medically necessary then it is fully covered without any co-payments.

In cases where a treatment is medically necessary but an equally effective yet lower-cost alternative exists, members are free to choose the higher-cost treatment, provided this is not for cosmetic purposes. Lower-cost treatments will be covered in full by Seha in such cases. Should a member select a higher-cost procedure, Seha will cover such treatments up to a total of QAR 5,000 per year. Treatments above this limit will be subject to a 10% member co-payment for amounts above QAR 5,000.

Purely cosmetic procedures and teeth whitening are not covered by Seha.

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Seha Dental Coverage Summary

Fully medically necessary intervention according to evidence-based best-practice guidelines

Fully covered

Medically justified, but alternative (cheaper) procedure available (cosmetic indication for the more expensive option)

* 10% copayment required for these specific services after QAR 5,000 annual spending is exceeded.

Medically not necessary intervention; discretionary cosmetic procedure

Not covered. Out-of-pocket payment required

Seha members are able to access dental treatment at all network providers with dental clinics, which include Al Ahli Hospital, Al Emadi Hospital, Al Esraa Medical Center, Doha Clinic Hospital, Al Hayat Medical Center, Al Jazeera Medical Center, Apollo Clinic, Atlas Medical Center, Atlas Polyclinic, Bin Muftah Medical Center, Future Dental Center, Future Medical Center and Ocean Medical Centre.

A number of specialized dental clinics have been added to the Seha network, giving members more choice when seeking dental treatment. These are three branches of the Gulf Dental Center and four branches of Madina Dental Center in addition to Teba Specialized Dental Center, Dr. Marwan Kalla Denter Center, Doha Specialized Dental Center and Najat Dental Center. Members may also visit three new providers that have joined the Seha network – Al Shefa Polyclinic, Al Salam Medical Polyclinic Center and Al Shorook Medical Center – to access both dental treatment and broader healthcare services.

Additional providers, both specialized dental clinics and broader health clinics, will be added to the Seha network over the coming days and weeks, including Magrabi Eye, Ear and Dental Center which is scheduled to join the network on 1 July 2014. A full list of service providers is available at www.seha.qa. Hamad Medical Corporation and Primary Health Care Corporation facilities will not offer dental services under the Seha health insurance scheme at this point in time although patients may still seek treatment these providers using the HMC health card.

“Our aim is to provide Seha beneficiaries access to the best possible healthcare services, of which dental forms an important component. We have developed Seha’s dental coverage based on best practices from around the world with a comprehensive set of services included within the scheme,” explained Dr Faleh Mohamed Hussain Ali, Acting CEO of the NHIC.

Currently in its second stage, Seha provides Qatari nationals with comprehensive health insurance coverage for the full range of basic health services and forms a key component of the National Health Strategy 2011-2016 and the nation’s longer-term development goals as set out under the Qatar National Vision 2030. Coverage includes both in-patient and out-patient services through a quality network of public and private providers, including, in addition to dental, preventative care, emergency treatment, physiotherapy, occupational therapy, speech therapy, long-term care, radiology, ophthalmology, laboratory testing and prescription medicines.

Qatari nationals who wish to use Seha’s services need only to present their Qatar ID when visiting a network provider and, during their first visit, provide details of their residential address. The address details can be found on the plate installed by the Centre for Geographical Information System (CGIS) on all buildings across the country.

Information and updates about Seha and the Seha provider network are available at www.seha.qa and through social media at facebook.com/SehaQatar and twitter.com/SehaQatar. Members can also contact the Seha call centre on telephone 4020 8444 or visit the customer contact centre on the sixth floor of Amwal Tower in West Bay, Doha.

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