Yearly Cover
AED 2,750,000.00
Deductible
10% co-pay on all out-patient services (maximum annual cap AED 7,500)
Coverage
South East Asia, Middle East & North Africa
Chronic Conditions
Up to AED 150,000 (with pre-existing conditions) within the UAE & up to AED 5,000 (with pre-existing conditions) outside the UAE; pre-authorization required for in-patient treatment (insurer will reduce the amount by 20% if prior approval is not obtained); 6 months waiting period (excluding emergency treatment); waiting period in the UAE waived for members who have been previously insured
Pre-Existing Conditions
Not Covered
In-Patient
Ambulance Coverage
Local road ambulance covered with pre-authorization (insurer will reduce the amount by 20% if prior approval is not obtained)
Hospital Accomodation
Standard Private Room with pre-authorization (insurer will reduce the amount by 20% if prior approval is not obtained)
Hospital Cash Benefit
Up to AED 400 per night (maximum 30 nights) with pre-authorization (insurer will reduce the amount by 20% if prior approval is not obtained)
Parent Accomodation
Up to AED 500 per night with pre-authorization (insurer will reduce the amount by 20% if prior approval is not obtained)
Out-Patient
Vaccination
Covered 100% for children up to 17 years & up to AED 2,000 for adult vaccinations, with 10% co-pay (maximum annual co-pay of AED 7,500 for all OP benefits)
Physiotherapy
Covered with pre-authorization (insurer will reduce the amount by 20% if prior approval is not obtained); maximum 15 visits for out-patient treatment with 10% pay (maximum annual co-pay of AED 7,500 for all OP benefits)
Scans
Covered with pre-authorization (insurer will reduce the amount by 20% if prior approval is not obtained); 10% co-pay on out-patient treatment (maximum annual co-pay of AED 7,500 for all OP benefits)
Health Checks
Diabetes screening as per DHA; up to AED 9,000 for well child tests; up to AED 9,000 for annual routine tests (eye & hearing) for children up to 15 years; 10% co-pay applicable (maximum annual co-pay of AED 7,500 for all OP benefits)
Psychiatric Treatment
Covered 100% for emergency treatment & up to AED 5,500 for non-emergency treatment; 10% co-insurance for out-patient treatment (maximum annual co-pay of AED 7,500 for all OP benefits); pre-authorization required for in-patient non-emergency treatment (insurer will reduce the amount by 20% if prior approval is not obtained)
Alternative Medicine
Covered 100% for osteopathy & chiropractic treatment (maximum 10 visits combined); up to AED 3,500 for acupuncture; 10% co-pay applicable (maximum annual co-pay of AED 7,500 for all OP benefits)
Prescription Drugs
Not Covered
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Network
Network Coverage
89 Hospitals
998 Clinics
74 Laboratories
1582 Pharmacies
83 Dentals
201 Optics
Treatment Outside Area of Cover
Covered for emergency treatment up to AED 180,000
Treatment Outside Network
100% of covered non-emergency costs (80% within the UAE) subject to network rates on reimbursement basis; 100% of emergency costs on reimbursement basis
Maternity
Pregnancy Cover
Covered 100% for out-patient maternity (maximum 8 visits to obstetrician); up to AED 18,000 for normal delivery or medically necessary C-section, with 10% co-insurance; covered with pre-authorization (insurer will reduce the amount by 20% if prior approval is not obtained); waiting period of 12 months for treatment outside the UAE
Newborn Baby Cover
Covered for 30 days from birth (including congenital or other defects) with pre-authorization (insurer will reduce the amount by 20% if prior approval is not obtained)
Natal Complications
Covered with pre-authorization (insurer will reduce the amount by 20% if prior approval is not obtained); waiting period of 12 months for treatment outside the UAE
Dental
Dental Coverage
Not Covered
Accidental Damage to Teeth
Covered for emergency treatment