Emirates Insurance Company

(PSC)

Gulf Solutions level 1

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Your policy
Gulf Solutions 1 provided by Emirates Insurance Company (PSC) for customers of
Aviva.
These are your policy details, including full terms and conditions. Please read them
carefully and then keep them in a safe, accessible place. Throughout this booklet
certain words are shown in bold type. These are defined terms and have specific
meanings when used in this booklet. The meanings are set out in the Definitions
section.

We will pay costs up to the amount specified

in the benefit table in the event that you
sustain accidental injury or contract an illness
during the policy year. We will only pay
costs that you incur whilst you are a
member on the policy for the medical
services specified in the policy if they are
provided within your selected area.
If you have worldwide cover, we will pay for
treatment in any country. If you have
worldwide cover excluding the USA and
Caribbean, we will pay for treatment in any
country except the USA and the Caribbean.

GEN4963 20/12/13

You may choose to travel within your

selected area to receive eligible elective
treatment provided that you:
are fit to travel without medical assistance;
and
make and pay for your own travel
arrangements both to and from the place
where you were injured or became ill.
We cover treatment at any hospital within
your area, but we do not cover travel costs
unless we organise an evacuation.

Before you receive any treatment covered by this policy, we strongly recommend you contact
NAS, who will administer any claims you make and advise if the treatment is eligible. They will
also help you to find a suitable hospital. This will not apply to emergency admissions.

Please note All treatment and diagnostic tests at a hospital must be by, and under the
care of specialists following referral by a general practitioner. Benefit limits apply in the
currency in which the policyholder pays the premium.

All benefit limits apply to each member each policy year unless otherwise stated.

Benefits

Amount payable

Notes

Overall annual limit

$7,500,000

$ = US dollars

Treatment as an in-patient or a day-patient at a hospital

Hospital accommodation
Intensive and high
dependency care
Nursing care
Operating theatre

In full
In full
In full
In full

Specialists fees

In full

Diagnostic tests

In full

CT, MRI and PET scans

Treatment by a
physiotherapist, dietician,
occupational therapist and
alternative therapist

In full
In full

Reconstructive surgery

In full

Internal prostheses

In full

Kidney dialysis

In full

Psychiatric treatment

In full up to 30 days

Rehabilitation

Lowest cost single en-suite

room. See hospital
accommodation benefit term

Up to 25 days

Surgeons, anaesthetists and

physicians fees
For example endoscopy,
removal of tissue for biopsy,
blood tests, X-rays, scans
and ECGs

On specialist referral
We will cover a surgical
procedure to restore your
appearance if the procedure
immediately follows an
accident or treatment for
cancer. See reconstructive
surgery benefit term
For example heart valves
and artificial joints
See kidney dialysis benefit
term
Physical therapies given as
an in-patient immediately
following treatment that is
covered by the policy, for
each medical condition every
policy year

Treatment as an out-patient by or under the care of a specialist

Consultations with a
specialist
Diagnostic tests
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In full
In full

For example blood tests,

X-rays, scans, ECGs

CT, MRI and PET scans
Radiotherapy/chemotherapy
Treatment for cancer
Surgical procedures

In full
In full
In full
In full

Emergency dental treatment

Up to $2,250

See emergency dental

treatment benefit term

Hire or purchase of medical

aids such as wheelchairs,
crutches, stoma supplies and
podiatry appliances if needed
after in-patient, day-patient
or out-patient treatment

Up to $750

Subject to appliances
exclusion

Specialist referred
treatment by a speech
therapist

In full

Up to 10 speech therapy
sessions following eligible
treatment as an in-patient
or day-patient for trauma or
a stroke

Physiotherapy following
eligible treatment as an inpatient or day-patient

In full

See physiotherapy benefit

term

Additional benefits

Organ transplant

In full for the recipient.

Harvesting costs only
for the donor

Complications of pregnancy
and childbirth

In full

Newborn cover

Up to $150,000

External prostheses

Up to $7,500 for each

condition

Parent hospital
accommodation
when staying with a child
covered by the policy

In full

Cash benefit for each night

spent as an in-patient in a
government or charitable
hospital

$225 each night

Nursing at home by a nurse

Up to 60 days

Hospice donation

$225 each day

Local ambulance

In full

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We will cover heart, lung,

pancreas, liver, kidney and
bone marrow transplants
only.
Cover is only available for the
donor if the recipient is
covered by the policy
See pregnancy complications
benefit term
Cover is only available where
the mother is covered by the
policy, for acute conditions
occurring during the first 112
days following birth. See
newborn cover benefit term
For example artificial limbs
Child aged under 18
undergoing treatment
covered by the policy, one
parent only; see parent
hospital accommodation
benefit term
Up to 28 nights when
undergoing treatment
covered by the policy; see
cash benefit benefit term
Immediately following
treatment as an in-patient
or day-patient that is
covered by the policy; see
nursing at home benefit term
Up to 90 days; see hospice
benefit term
See local ambulance benefit
term

Benefits

Amount payable

Notes

Everyday healthcare
Consultations with a general
practitioner
Minor surgery by a general
practitioner

Up to a combined limit of
$3,750

Up to 20 consultations. We
only cover home visits if they
are clinically necessary
Carried out under local
anaesthetic in the general
practitioners surgery

Tests carried out by or

referred by a general
practitioner
Physiotherapy on referral by
a general practitioner

In full

Vaccinations

Up to $750

Child vaccinations (for

members aged 17 or under)

In full

Child development
assessments
Prescription drugs and
dressings, supports and
appliances (including
prostheses)

In full

Up to $4,500

Up to 10 sessions each
condition; maximum of 30
sessions each policy year
In line with World Health
Organisation guidelines for
your country of nationality
and country of residence.
This does not cover
vaccinations for leisure travel
In line with World Health
Organisation guidelines for
your country of nationality
and country of residence.
This does not cover
vaccinations for leisure travel
See child development
assessments benefit term
See prescription drugs and
dressings benefit term

Routine maintenance of
chronic conditions

Up to $30,000

Hormone replacement
therapy (HRT)

In full

Routine sight examinations

Up to $150 for each

examination

For all chronic conditions

except cancer. We do not
apply this limit to cancer
treatment; see chronic
conditions benefit term
If menopause is due to
medical intervention and
treatment is medically
necessary. Up to 18 months
in total whilst you are a
member of the policy, not
each policy year
We cover one examination
every two years

Prescription glasses,
sunglasses or contact lenses

Up to $150

See optical benefit term

Benefits

Amount payable

Notes

Condition management
Treatment for HIV/AIDS
Treatment for acute phases
of chronic conditions
Treatment for acute phases
of congenital conditions
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Up to $15,000
Up to a combined limit of
$75,000

We will cover unexpected

acute flare-ups of a chronic
condition or a congenital
condition until your

after diagnosis

Benefits

condition is re-stabilised

Amount payable

Notes

Evacuation and emergency assistance

Costs for your evacuation to
a place where you can
receive treatment that the
policy covers
Worldwide extension for
emergency evacuation and
treatment
Payment for accommodation
costs (other than at a
hospital) needed in
connection with an
evacuation. This benefit is
not available if you choose
repatriation
Local burial or transport of
mortal remains

Benefits

In full

See evacuation benefit term

In full up to 60 days

See areas of cover benefit

term

Up to $150 each night

Up to $3,000 each
evacuation

Up to $11,250

See local burial benefit term

Amount payable

Notes

Repatriation and compassionate travel

Repatriation in the event of
an evacuation
Economy return flight (or
equivalent) following the
death of a close relative
Economy return flight (or
equivalent) for a close
relative or legal guardian to
supervise your dependent
children in their country of
residence following your
evacuation or repatriation

In full

See repatriation benefit term

Up to $1,500

See compassionate travel

benefit term

Up to $1,500 each policy

year

You can choose from either

option each time an
evacuation or repatriation
takes place

OR
Economy return flight (or
equivalent) for your
dependent children to stay
with a close relative or legal
guardian following your
evacuation or repatriation
Accommodation and
subsistence costs in the area
you have been evacuated to
for your husband or wife
following an evacuation
Costs for local travel each
way between
accommodation and a
hospital for your husband or
wife following an evacuation
Economy return flight (or
equivalent) for a members

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Up to $1,500 for each child

each policy year

Up to $150 for each night up

to 30 nights

Up to $37.50 each day up to

30 days

Up to $1,500

Cover is only available if

your husband or wife is in
the same country of
residence
Cover is only available if you
are receiving treatment as
an in-patient and your
husband or wife is in the
same country of residence
Cover is only available if
your husband or wife is in

the same country of

residence

husband or wife to
accompany them following
an evacuation

Return home to recuperate

Up to $1,500

Covers cost of an economy

return flight (or equivalent)
following eligible evacuation.
See compassionate travel
benefit term

Option to increase cover

Please see your policy schedule to see if this option applies to you.

Maternity option
Benefit limits shown below apply to each member each policy year unless otherwise stated.

Benefits

Amount payable

Notes

The following benefits are subject to a combined limit of $15,000 for each member every
policy year; see maternity benefit term
Antenatal care
See antenatal benefit term
Postnatal care
See postnatal benefit term
Midwife led birth
Hospital led birth
Birth under charitable or
$750
See funded birth benefit term
nationally funded care
Newborn cover

Routine medical care for the

baby during the first seven days
after the birth

Investigations into the cause

of infertility

See infertility benefit term

Benefit Terms
The benefit tables tell you which benefit terms apply to you.
Antenatal
We cover antenatal costs for example:
consultations with a mid-wife
tests carried out in the first trimester for example mucal translucency test, dating scan
and blood tests
scans for abnormalities
medication to prevent complications of pregnancy, for example blood thinning
anti-D injections.
We do not cover the costs of antenatal classes, 4d or 5d scans or mother massages.
Areas of cover
If you have worldwide cover we will cover you for treatment in any country.

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If you have worldwide cover excluding the USA and Caribbean we will cover you for treatment
in any country except the USA and Caribbean.
You will be covered in the USA and Caribbean:
in the event of an emergency if you are there for holidays and business trips for a
maximum cumulative total of 60 days in any one policy year. We will only cover
emergency evacuation benefit, emergency in-patient hospitalisation and emergency
treatment, administered by a general practitioner, and
for in-patient or day-patient treatment following an evacuation from your area, if we
pre-authorise that treatment.
Cash benefit
We will pay cash benefit if:
accommodation and all treatment is provided by a government or charitable hospital with
no charge, and
you do not claim any other benefit under the policy for the same hospital stay.
We only pay cash benefit for a condition that we would pay for if the hospital charged you for
the treatment.
Child development assessments
We cover costs for one of each of the following assessments once only at age up to 18 months:
speech and language,
height and weight,
fine motor skills,
sight and
hearing.
We will also cover costs for one of each of the following assessments once only at pre-school
age for:
fine and gross motor skills,
height and weight,
basic hearing and
visual acuity.
All tests must be carried out by a general practitioner or paediatrician.
Chronic conditions
We will cover:
treatment by a specialist of a chronic condition, follow-up consultations and diagnostic
tests with a specialist to monitor you when you have finished treatment for an acute
condition and
drugs prescribed by your specialist for the routine maintenance of a chronic condition.
We cover drugs which are only available on prescription. We do not cover medication,
vitamins or homeopathic treatments which are available over the counter unless they are
needed to work in conjunction with your overall prescription.
The costs of palliative treatment for all conditions except cancer will fall within the chronic
conditions benefit limit.
We only cover treatment for conditions that are not excluded on your policy.
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Compassionate travel
We cover:
travel costs to return home to recuperate following an evacuation we will cover
economy class travel costs from:
the place where you received treatment to your country of nationality, and
back to your country of residence (or the place where you were evacuated to, or
the place where you were before the evacuation if that is where you want to go)
after your recuperation.
We will cover these costs only when you are medically discharged and fit to travel on
commercial transport.
We do not cover the costs of treatment related to the recuperation.
the cost of one economy return flight (or equivalent), up to the benefit limit specified, for
each member, to travel to attend the funeral of a close relative.
Emergency dental treatment
We cover costs for treatment which you need as a result of an accidental dental injury caused
by external trauma, for example a fall or accidental impact, to teeth. This includes the initial
relief of pain, treatment necessary to preserve your natural dental structure, and any related
permanent reconstruction work. The damage must become apparent within 7 days of the
external trauma taking place. We cover treatment carried out up to a month after the accident.
BUT:
We do not cover treatment if the damage is caused by;
normal wear and tear,
food or drink, whether or not it contains a foreign body, or
participation in a contact sport if the appropriate mouth protection is not used.
Evacuation
If you are ill or injured, and the place where you are does not have either the facilities or
equipment to treat you, we will discuss the situation with your general practitioner or
specialist and decide whether or not there is a medical need for an evacuation. If you do
need to be evacuated, we will make all arrangements for that evacuation through our
assistance service. An evacuation will take you to the nearest appropriate facility for
treatment as an in-patient or day-patient which you need.
We, together with our assistance service, will decide whether it is safe for you to fly and
whether you need an air ambulance, or whether an economy class commercial flight is more
appropriate. If we, or our assistance service, give specific written authorisation, this benefit will
include the cost of one other member or close relative travelling with, staying with or escorting
you if it is necessary. For example, if you cannot conduct your own affairs and the member or
close relative holds power of attorney authorising them to act for you.
We do not cover:
any form of mountain rescue,
any evacuation from or to any seagoing vessel, or offshore installations such as oil rigs,
or
any evacuation from or to any area or country if our assistance service consider it
would endanger their safety for them to do so.
Funded birth

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If a member gives birth and all costs for the birth are paid by national or charitable funding we
pay the policyholder a bonus of $750.
Hospice
We will pay a donation directly to the hospice when:
you receive care as a patient of a hospice, and
we have previously covered treatment for the condition.
Hospital accommodation
We will pay for your accommodation as an in-patient or day-patient in the lowest cost single
en-suite hospital room. If you are accommodated in a higher cost room we will only pay the
cost of the lowest cost room and this could leave you with a shortfall that the policy does not
cover.
Infertility
We cover consultations and diagnostic tests for infertility where you were unaware of your
infertility when you joined the maternity option.
Kidney dialysis
We cover short-term kidney dialysis:
if you are admitted to hospital for eligible treatment as an in-patient for another
condition and you need your regular kidney dialysis during this admission, or
if required as a result of secondary kidney failure during eligible treatment as an
in-patient, or
immediately before or after a surgical procedure to transplant a kidney as part of
treatment as an in-patient.
BUT:
We do not cover kidney dialysis as part of long-term treatment of a chronic condition.
Local ambulance
Road or air ambulance transport needed out of medical necessity to take you to the next
available and appropriate hospital or licensed medical facility. We will only pay for an air
ambulance if a road ambulance is not suitable and (unless it is an emergency) it is arranged by
us.
Local burial
If a member dies, we will cover (up to the benefit limit specified) either:
burial or cremation at the place of death, or
the cost of transportation of body or ashes to the country of nationality.
In either case, the policy does not cover the costs of a religious practitioner.
Maternity
If you pay for any maternity costs upfront, before you receive the treatment, we will only
reimburse you for treatment that is covered by the policy after it has taken place.

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Newborn cover
This benefit covers treatment for:
all acute conditions which occur during the first 112 days following birth,
up to a combined maximum total of $150,000 during the life of the policy.
If the child is added as a member of the policy, conditions which occur after the 112th day
following birth will not be subject to this benefit limit.
Nursing at home
We cover home nursing if:
your specialist recommends and supervises it,
it takes place in your home,
it immediately follows treatment as an in-patient or day-patient that is covered by the
policy,
it is carried out by a nurse and is the type of treatment that only a nurse can provide, and
you need it for medical reasons.
We do not cover nursing at home to help with your mobility, personal care or preparation of
meals.
Optical
We pay up $150 for each set of contact lenses, glasses or sunglasses bought as a result of a
change in your optical prescription. You must buy the contact lenses or glasses within three
months of the eye test which discovered the change in prescription.
We do not cover the cost of optical solutions and accessories (for example cases,
cleaning cloths) or contract schemes (for example monthly disposable contact lens schemes).
Parent hospital accommodation
We will pay for hospital accommodation for one parent only staying with a child aged under 18
undergoing treatment covered by the policy as an in-patient or day-patient. We will pay for
accommodation in the lowest cost single en-suite hospital room. If the parent is
accommodated in a higher cost room we will only pay the cost of the lowest cost room and this
could leave you with a shortfall that the policy does not cover.
Physiotherapy
If you need more than 10 sessions of physiotherapy for the same medical condition in the
same policy year we will require full clinical details from your specialist before we can make
a decision about cover. If your condition has become chronic further treatment will be covered
under the routine maintenance of chronic conditions benefit of your policy.
Postnatal
We will cover postnatal care including:
tests by a paediatrician within 24 hours of birth, including a hearing test,
heel prick test,
one consultation for the mother with a specialist or midwife up to 10 weeks after the
birth.
We will also cover regular visits to a clinic or health centre for the baby to be weighed and
measured during the first six months following birth. If these visits are carried out as home visits

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we will not pay for more than six and any additional tests will need to be carried out in a clinic
or health centre.
We do not cover the costs of postnatal classes, or mother or baby massages.
Pregnancy complications
The conditions which we cover as complications for the purposes of this benefit are:
ectopic pregnancy (development of foetus outside the womb)
miscarriage (if you have miscarried, but not investigations into the cause of repeated
miscarriages)
still birth
hydatidiform mole (cell growth abnormality in the womb)
retained placenta (afterbirth retained in the womb)
pre-eclampsia (a condition with a number of symptoms, including high blood pressure and
fluid retention)
eclampsia (a coma or seizure during pregnancy and following pre-eclampsia)
gestational diabetes (if diabetes begins in pregnancy, but not before)
caesarean sections in specific clinical circumstances (we will need full clinical details
from your specialist before we can make a decision about your cover)
termination of pregnancy if medically necessary.
Prescription drugs and dressings
We will cover drugs, dressings, supports and appliances (including prostheses) which are only
available on prescription.
We do not cover medication, vitamins or homeopathic treatments which are available over the
counter unless they are needed to work in conjunction with your overall prescription.
We do not pay for pre-payment prescription cards.
Reconstructive surgery
We will cover a surgical procedure to restore your appearance if:
the surgical procedure immediately follows an accident, or treatment for cancer, and
the accident or cancer treatment took place when you were covered under the policy and
you have had no break in cover since then.
Repatriation
If evacuation is medically necessary for your circumstances, you can choose repatriation.
This means that, instead of taking you to the nearest appropriate facility, we will pay to
transport you from the country where you are to:
your country of nationality, or
your country of residence.
We will only authorise and arrange repatriation if:
our assistance service and the doctors treating you agree that it is safe to do so
the country where you wish to travel to (either your country of nationality, or your
country of residence) is in the area which the policyholder selected for the policy. For
example, if:
your country of nationality is the USA
the policys area for you is worldwide excluding USA and Caribbean, and
your country of residence is Germany

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we will only be able to repatriate you to your country of residence because that is in the area
covered by the policy.
If you choose repatriation, we will not cover the accommodation costs element of the
evacuation benefit.

Benefits for cancer treatment

This section explains what we will pay for cancer treatment.

Benefits

Amount payable

Notes

Hospital charges for surgery

and medical admissions

In full

Lowest cost single en-suite

room See hospital
accommodation and
preventative treatment
benefit terms

Nursing care
Operating theatre

In full
In full

Specialists fees

In full

Reconstructive surgery

In full

Post-surgery services

In full

Chemotherapy

In full

Radiotherapy

In full

Bisphosphonates (bone
strengthening drugs)

In full

Treatment for side effects of

chemotherapy and
radiotherapy

In full

Wigs

Up to $150

External prostheses

Up to $7,500

Bone marrow transplants

In full for the recipient.

Harvesting costs only
for the donor

Monitoring

Up to 5 years

Ongoing medical needs

Up to 5 years

Preventative treatment for

cancer

In full

End of life care

In full

Hospice donation

$225 each day, up to 90 days

Take home medication for

oncology treatment

Up to $7,500

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Surgeons, anaesthetists and

physicians fees
For example, specialist
nursing, feeding. See postsurgery services benefit term
See chemotherapy benefit
term
See radiotherapy benefit
term
We pay for bisphosphonates
when they are being used to
treat metastatic bone disease
See side effects benefit term
In total whilst you are a
member of the policy (not
each policy year).See wigs
benefit term
See prostheses benefit term
See bone marrow transplants
benefit term.
Cover is only available if the
recipient is covered by the
policy
See monitoring benefit term
See ongoing needs benefit
term
See preventative treatment
benefit term
We will pay for end of life
care in a hospital if it is
medically necessary for
you to be there
See hospice benefit term
Prescribed by your
specialist. This includes
hormone therapy

Benefit Terms
Bone marrow transplants
We will pay for:
the collection of
storage of, and
implantation of
bone marrow.
If the bone marrow comes from another person, we will pay for its collection. We do not pay for
search costs to find a donor for a transplant.
We will pay for drugs for you to take home at the time you are discharged from hospital
following a bone marrow transplant.
Chemotherapy
We will pay for chemotherapy in full if you have the treatment:
as a day-patient or an in-patient
as an out-patient, or
at home.
We will pay for hormone therapy in full if you need it to shrink a tumour before you have
surgery or radiotherapy. Hormone therapy prescribed at any other time will be taken from the
take home medication benefit.
Hospice
We will pay a donation directly to the hospice when:
you receive care as a patient of a hospice, and
we have previously covered treatment for the condition.
This benefit is the same as that available under core cover and is not an additional benefit.
Monitoring
We will pay for monitoring for up to five years after your treatment for cancer has finished.
This includes diagnostic tests, consultations and one complex scan each policy year. We do
not pay for monitoring after treatment for non-melanoma skin cancer.
Ongoing needs
If you have any ongoing medical needs, such as regular replacement of tubes, drains or stents,
we will pay for up to five years after your treatment for cancer has finished.
Post-surgery services
Medical services
Following surgery for cancer there are a number of different specialist services that you may
need, depending on the type of cancer you have and the surgery you have had. We will pay
for consultations immediately following surgery with, for example, a:

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dietician in order to stabilise your diet following surgery or chemotherapy

stoma nurse to show you how to care for your stoma
nurse to show you how to manage lymphoedema.
Artificial feeding
If, due to your cancer or treatment of your cancer, you have problems eating and need
artificial feeding, we will pay for the insertion and replacement of a tube (for example, a
central line, PICC line or PEG) to deliver the food (called nutrition). Whilst you are receiving
treatment for cancer we will pay for the nutrition itself, although once your cancer treatment
has finished we will no longer pay for the nutrition itself, or maintenance of the line (for example
cleaning of the line).
Preventative treatment
We will pay for surgery to prevent further cancer only if you have already had treatment for
cancer that we have paid for for example, we will pay for a mastectomy to a healthy breast in
the event that you have been diagnosed with cancer in the other breast. We will not pay for
surgery where you have no symptoms of cancer, for example where you have a strong family
history of cancer such as breast cancer, or bowel cancer.
Prostheses
We will pay in full for prostheses that are inserted into the body.
For external prostheses following surgery for cancer for example arms, legs, breasts, ears
we will contribute up to $7,500 towards the cost of the first prosthesis after your surgery. This
includes any cost for fitting the prosthesis.
This benefit is the same as that available under core cover and is not an additional benefit.
Radiotherapy
We will pay for radiotherapy in full as:
a day-patient or an in-patient if you need it for medical reasons, or
an out-patient.
Side effects
Whilst you are receiving chemotherapy or radiotherapy, we will pay for treatment prescribed
by your specialist that you need to deal with their side effects, for example:
antibiotics
anti-sickness drugs
steroids
pain killers
drugs to boost your immune system, and
blood transfusions.
Wigs
We will pay up to $150 towards the cost of a wig if you need one due to hair loss caused by
cancer treatment.

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Exclusions
Addictions and substance abuse
We do not cover treatment of any illness or injury which is wholly or partially a result of any
addiction (for example alcohol addiction or drug addiction), or substance abuse (for example
alcohol abuse or solvent abuse), or which you need as a direct or indirect result of any such abuse
or addiction.
Allergy testing
We do not cover any diagnostic tests or treatment for allergies.
Appliances
We do not cover hearing aids or neurostimulators.
BUT: We do cover
hand, back and knee braces required immediately after surgery,
heart pacemakers and implantable cardioverter defibrillators.
Areas of cover
We do not cover non-emergency treatment outside your area of cover. This exclusion does not
apply if you have worldwide cover.
Birth control
We do not cover birth control, for example contraceptive pills and devices, or sterilisation.
Circumcision
We do not cover circumcision.
Complementary treatment
We do not cover alternative or complementary treatments and medicines, for example pilates,
colonic irrigation, ayurvedic medicine, Chinese medicine, acupuncture or homeopathy.
Cosmetic treatment
We do not cover treatment, or any consequence of treatment, that is intended to change your
appearance (for example a tummy tuck, facelift, tattoo, ear piercing), whether or not this is carried
out for psychological or medical reasons.
We do not cover treatment, or any consequence of treatment, to remove undiseased tissue.
BUT: We will cover a surgical procedure to restore your appearance if:
the surgical procedure immediately follows an accident, or treatment for cancer, and
the accident or cancer treatment took place when you were covered under the policy and
you have had no break in cover since then.
We advise that you contact us before treatment begins so that we can confirm if you are
covered.

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Dental treatment
We do not cover:
non medical items such as mouthwash, toothpaste, dental floss and teeth whitening agents
dental treatment performed for cosmetic reasons such as teeth whitening and veneers
or
treatment carried out by a dentist or dental surgeon
treatment of gum disease or treatment carried out to help you wear dentures, bridges or
implants.
BUT: We do cover treatment which you need as a result of an accidental dental injury caused by
external trauma, as described in the emergency dental treatment benefit term.
Developmental delay
We do not cover treatment in relation to the developmental delay of children, for example mobility,
learning, continence and social and behavioural disorders, for example attention deficit
hyperactivity disorder (ADHD).
Dialysis
We do not cover kidney dialysis as part of long-term treatment of a chronic condition.
Epidemics
We do not cover treatment directly or indirectly arising from or required as a consequence of
epidemics which have been put under the control of local public health authorities.
Experimental treatment
We do not cover experimental treatment, unless it meets the criteria set out below.
We only pay for treatment that is:
proven or established within common UK practice, for example, a drug used within the terms
of its licence or approved by NICE for use in the NHS, or
supported by peer reviewed and published clinical evidence which proves that the treatment
has positive clinical outcomes, and
is acceptable clinical practice, practised widely by specialists in your country of residence.
If your treatment meets these requirements, we will not exclude treatment on the basis that it is
experimental.
Before we can decide if your proposed treatment is eligible, we must receive all the clinical
details we need from your specialist. We must confirm your cover in writing before any
treatment begins.
BUT:
Even if we consider your treatment to be experimental because it does not satisfy all the
requirements listed above, we will still pay for the lowest cost of either:
the experimental treatment or
the equivalent established treatment usually provided for your condition, if this is available.
Please note: No payment will be made if there is no established treatment available for your
condition (for which the experimental treatment is being proposed). If you undergo experimental
treatment that is not successful, we will not pay towards further treatment of your condition or for
any other condition that you develop as a result of undergoing experimental treatment.
GEN4963 20/12/13

Eyesight
We do not cover treatment for:
short sight or long sight, such as laser eyesight correction surgery, or
macular degeneration.
Fertility
We do not cover:
any treatment related to gender selection,
the freezing of eggs or sperm following treatment for cancer,
sterilisation or any other form of family planning,
the reversal of sterilisation, or
vasectomy reversal.
General practitioner charges
We do not cover charges or fees for:
registering with a general practitioner or medical facility,
completion of a claim form or referral letter by a general practitioner,
a general practitioner to write a prescription, or
home visits by a general practitioner unless they are clinically necessary.
Genetic conditions
We do not cover genetic conditions.
Growth hormone therapy
We do not cover any growth hormone therapy.
Hair loss and dandruff
We do not cover treatment or associated expenses for hair loss including:
treatment for alopecia, or
wigs or hair pieces.
BUT: We will pay up to $150 towards the cost of a wig if you need one due to hair loss caused by
cancer treatment.
We do not cover treatment for dandruff.
Health hydros
We do not cover treatment received in health hydros, nature care clinics or similar
establishments.
Infertility - please see your policy schedule to see which options your policy includes
We do not cover treatment directly or indirectly arising from or required in connection with:
infertility, or
any form of assisted reproduction.
OR
GEN4963 20/12/13

If your policy includes the maternity option, the exclusion that applies to you is:
We do not cover treatment directly or indirectly arising from or required in connection with:
infertility (although we do cover investigations into the causes of infertility), or
any form of assisted reproduction.
Multiple consultations
We do not cover more than one consultation with a medical specialist in any 24 hour period
unless you are referred by a general practitioner.
Natural Disasters
We do not cover treatment for illness or injury arising directly or indirectly from a natural disaster
such as earthquakes, flood or tornado.
Non-medical admissions
We do not cover treatment received in private beds registered as nursing homes or a hospital
where the hospital has effectively become your home or place where you live permanently or if
the reason you have been admitted is that you need help with mobility, personal care and
preparation of meals. We only pay if you have been admitted to hospital for medical reasons.
Nonmedical services
We do not cover treatment that is not medically necessary, or any treatment not directly related
to medical care. This includes:
nursing at home to help with your mobility, personal care, preparation of meals or nursing
care whilst travelling,
television, barber or beauty services or services for your guests whilst they are visiting you in
hospital,
non-medical treatment such as mouthwash, toothpaste, lozenges, antiseptics, milk formula,
food supplements, skin-care products, shampoos and multi-vitamins (unless they are
prescribed as replacement therapy for known vitamin deficiency symptoms), and all
equipment not intended to improve a medical condition or injury including but not limited to air
conditioners or air purifying systems, arch supports, convenience items/options, exercise
equipment and sanitary supplies,
supplies, treatment and services for smoking cessation programmes and treatment for
nicotine addiction,
any treatment or diagnostic tests for purposes other than medical treatment and/or
diagnosis such as for employment, travel, licensing or insurance purposes, or
any additional services or educational programmes related to disability.
Organ transplants
We do not cover:
mechanical implants, unless they are used whilst awaiting an organ transplant,
animal organs,
donor purchase, or
the costs associated with searching for an organ.
BUT: We will cover the cost of transporting an organ within the country of treatment/transplant to
the medical facility where the transplant is to take place.

GEN4963 20/12/13

Pregnancy and childbirth please see your policy schedule to see which options your policy
includes
We do not cover pregnancy and childbirth.
BUT: we do cover the specific complications of pregnancy listed under the treatment for
complications of pregnancy and childbirth benefit.
OR
If your policy includes the maternity option the exclusion that applies to you is:
We do not cover:
surrogacy or the associated costs of surrogacy including ante-natal care and delivery and
artificial fertilisation for surrogates, or
termination of pregnancy unless it is medically necessary.
Preventative treatment
We do not cover treatment, for example drugs or surgery, which aims to prevent a disease or
illness.
BUT: We do cover:
surgery to prevent further cancer if you have already had treatment for cancer that we have
paid for, and
vaccinations in line with World Health Organisation guidelines for your country of
nationality and country of residence.
Psychiatric
We do not cover treatment of
psycho-geriatric conditions of any kind, or
eating disorders
.
or any related conditions.
Rehabilitation
We do not cover rehabilitation unless it takes place as an in-patient immediately following
treatment covered by the policy, and then only for a maximum of 25 days for each medical
condition every policy year.
Routine medical examinations and screening
We do not cover routine physical examinations by a general practitioner, for example
gynaecological investigations and tests, prostate screening, hepatitis, HIV or STI tests, or hearing
tests.
BUT: We do cover child development assessments.
Self-inflicted injury
We do not cover treatment directly or indirectly arising from or required as a result of self inflicted
injury.

GEN4963 20/12/13

Sexual dysfunction
We do not cover treatment of sexual dysfunction, such as impotence.
BUT: We do cover investigations, including diagnostic tests, to find the cause of sexual
dysfunction.
Sexually transmitted disease
We do not cover venereal disease or any other sexually transmitted diseases. This exclusion does
not apply to treatment for HIV/AIDS.
Sleep disorders and sleep problems
We do not cover treatment directly or indirectly related to sleep disorders and sleep problems,
such as snoring, insomnia or sleep apnoea (when breathing stops temporarily during sleep).
Sport hazardous sports
We do not cover treatment of an injury sustained whilst you are taking part in hazardous sports
including aerial flight, power vehicle racing, water sports, horse riding, mountaineering, martial arts
such as judo, boxing, wrestling and bungee jumping.
Sport professional sports
We do not cover treatment of an injury sustained whilst you are:
training for, or
taking part in
sport for which you are paid or funded by sponsorship or grant (unless you receive travel costs
only). This exclusion does not apply if you are coaching the sport.
Stem cell transplants
We do not cover stem cell transplants.
Travelling against medical advice
We do not cover treatment if it is needed after travelling against medical advice.
War and hazardous substances
We do not cover treatment directly or indirectly arising from or required as a consequence of:
war, invasion, acts of foreign enemy hostilities (whether or not war is declared), civil war,
rebellion, revolution, insurrection or military or usurped power, mutiny, riot, strike, martial law
or state of siege, attempted overthrow of government or any acts of terrorism, or
chemical contamination or contamination by radioactivity from any nuclear material
whatsoever or from the combustion of nuclear fuel
when
you have entered a known area of conflict identified by an EU government department, such
as the British Foreign and Commonwealth Office, or
you were an active participant.
Warts / verrucas
We do not cover treatment of warts or verrucas.
GEN4963 20/12/13

Weight loss surgery

We do not cover treatment that is directly or indirectly related to:
bariatric surgery (weight loss surgery), such as gastric banding or a gastric bypass, or
the removal of surplus or fat tissue.

Underwriting
Medical History Disregarded (MHD)
We do not apply any personal medical exclusions to your policy as a result of pre-existing
conditions.

Conditions
Who can be a member?
The policy covers everyone named on the policy schedule.
The policyholder
the policyholders husband or wife and
their children
can all be members.
Adding members
The policyholder may add new members to the policy at any time by contacting us.
Newborn babies
A member can add his or her newborn baby to the policy without underwriting if the
policyholder applies to us within three months of the babys birth.
Policy duration and premiums
The policy lasts for one year and (if we still offer Gulf Solutions) we will automatically renew it
unless the policyholder notifies us that they do not wish to renew it. We also have the option not
to renew the policy, for example if trade sanctions were imposed or legislation passed which
meant that we could no longer offer cover. If we do not renew the policy, we will tell the
policyholder.
We reserve the right to close the Gulf Solutions product at the renewal date. If this happens, we
will contact the policyholder to discuss the options.
The policy schedule shows how much to pay, when and by which payment method. We will advise
the policyholder if the premium changes. We will collect premiums:
in advance of the date they are due
unless the policyholder tells us to cancel the policy in time for us to stop collecting the
payment.

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We do not pay any claims if premiums are not paid to date at the time your treatment takes place.
Each annual premium payment is for one years cover.
Compliance with policy terms
We shall not be liable under this policy if you fail to comply with its terms and conditions, except where the
circumstances of any claim are unconnected with that failure and no fraud is involved.

Change of risk
The policyholder must tell us as soon as possible about:
any changes relating to members, for example a change of name, address, if somebody
works for the diplomatic service or a foreign embassy, or
of any other changes that affect information given to us relating to the application for cover
under this policy, such as a change of country of residence or area.
We reserve the right to alter the premiums or policy terms or cancel cover for a member of the
policy following a change of risk, to the extent permissible by the laws of your country of
residence.
We will always write to your last known address with details of any changes to your cover.
Changes to cover
We may change the terms and conditions of the policy at the renewal date. If there are changes
to the policy, we will let you know before the next renewal date. If the policyholder decides to
cancel the policy as a result of those changes, they must let us know in writing. Only we can
make changes to the terms and conditions of the policy.
Territorial limits
Territorial limits under this policy are arranged into two geographical areas. The policyholder
selects the area that they need at the start date and can change this:
at any renewal date, or
at any time if they can show us that a member will live in a different area for 6 months or
more.
Benefit under this policy is limited to that described in the areas of cover benefit term.
Payments for ineligible treatment
If we agree to pay for treatment that is not normally eligible on the policy, this does not mean that
we will make another payment for treatment in the same or similar circumstances.
Any payments we do make towards the cost of ineligible treatment will count towards any benefit
limit listed in the policy terms and conditions.
Second opinions
We will only pay for a second (or subsequent) opinion from a general practitioner or specialist in
respect of the same condition if we authorise it. If we ask for a second opinion, we will make and
pay for the arrangements.

GEN4963 20/12/13

Definitions
Acute condition
A disease, illness or injury that is likely to respond quickly to treatment which aims to return you
to the state of health you were in immediately before suffering the disease, illness or injury, or
which leads to your full recovery.
Advice
Any
consultation,
advice or
prescription
from a general practitioner or specialist.
Area
The area of the world for which the policyholder has selected cover. These are identified as:
worldwide - any country
worldwide excluding the USA and Caribbean - any country except the USA and the
Caribbean.
Cancer
A malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of
malignant cells and invasion of tissue.
Chemotherapy
Drugs that are used to treat cancer. These include:
drugs used to destroy cancer cells or prevent tumours from growing (these could be cytotoxic
drugs, targeted or biological therapy drugs), and
drugs used to strengthen bones (these are called bisphosphonates).
For this policy, hormone therapy is not chemotherapy.
Chronic condition
A disease, illness or injury which has one or more of the following characteristics:
it needs ongoing or long-term monitoring through consultations, examinations, check-ups
and/or tests
it needs ongoing or long-term control or relief of symptoms
it requires your rehabilitation or for you to be specially trained to cope with it
it continues indefinitely
it has no known cure
it comes back or is likely to come back.
Close relative
A members:
husband or wife
GEN4963 20/12/13

child or step-child
brother
sister
parent
parent-in-law
grandparent
brother-in-law or
sister-in-law.
Congenital conditions
A medical condition that is present at birth, acquired at the foetal development stage.
Country of nationality
For the purposes of the policy, this will be the country for which you hold a passport. If you hold
more than one passport, the country of nationality will be the country you were born in.
Country of residence
The country in which you normally live and for which you hold a visa enabling you to work or
reside there at the time the policy is first taken out, or at each subsequent renewal date.
Day-patient
A patient who is admitted to a hospital or day-patient unit because they need a period of
medically supervised recovery but does not occupy a bed overnight.
Diagnostic tests
Investigations, such as X-rays or blood tests, to find or to help to find the cause of your symptoms.
Evacuation
The transportation of a member from the country of residence, or country of incident (if
different), to the nearest appropriate facility, as determined by a members general
practitioner or specialist in conjunction with our medical advisers and the prescribed assistance
service for the sole purpose of receiving treatment as an in-patient or day-patient.
General practitioner
A general medical practitioner who:
holds a primary degree in medicine or surgery recognised by the World Health Organisation
and
is legally licensed to practice in the country where treatment is provided.
Hospice
A hospital or part of a hospital recognised as a charitable or government funded hospice by us
which is devoted to the care of patients with progressive disease (where curative treatment is no
longer possible) on an in-patient or domiciliary basis.
Hospital
An establishment which is legally licensed as a medical or surgical hospital under the laws of the
country in which it is situated.

GEN4963 20/12/13

In-patient
A patient who is admitted to hospital and who occupies a bed overnight or longer, for medical
reasons.
Medically necessary
Treatment or a medical service which is needed for your diagnosis and is appropriate in the
opinion of a qualified general practitioner or specialist. By generally accepted medical
standards, if it is withheld your condition or the quality of medical care you receive would be
adversely affected.
Member / you / your
A person named as the policyholder or a member on the policy schedule.
Midwife
A practitioner who has:
completed a midwifery education program based on the ICM Essential Competencies for
Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery
Education, recognised in the country in which he/she is resident and
has the required qualifications to be registered and/or legally licenced to practice midwifery in
the country in which he/she is resident.
Newborn
Any child from birth up to 112 days old.
Nurse
A qualified resident or daily nurse whose name is currently on any register of nurses maintained by
any statutory nursing registration body within the country in which he/she is resident.
Out-patient
A patient who attends a hospital, consulting room, or out-patient clinic and is not admitted as a
day-patient or an in-patient.
Policy
Our contract of insurance with the policyholder providing cover as detailed in the policy
document. The application and policy schedule form part of the contract and you should read
these together with the policy document (as amended from time to time).
Policyholder
The person named as the policyholder in the policy schedule.
Policy year
The period of time from the date the policy began or renewed until the day before the next
renewal date.
Rehabilitation
Physical therapies given with the aim of restoring health and mobility after illness or injury, until the
member can be self-sufficient.

GEN4963 20/12/13

Related
Illnesses or injuries are related if, in our medical opinion, one is a result of the other or if each is a
result of the same illness or injury.
Renewal date
The annual anniversary of the start date.
Specialist
A registered medical or dental practitioner who:
has at any time held, and is not precluded from holding, a substantive consultant appointment
in that specialty in the United Kingdom in a National Health Service hospital, or
has at any time held and is not precluded from holding a substantive consultant appointment
which we on professional advice accept as being of equivalent professional status, or
is recognised as a specialist by the statutory bodies of the country in which he/she practices
and who is recognised by us to provide the treatment you require for your condition.
Start date
The start date shown on the policy schedule. Cover starts at 00.01am UK time on that date.
Treatment
Surgical or medical services (including diagnostic tests) that are needed to diagnose, relieve or
cure a disease, illness or injury.
You/your
See member.
We/our/us
Emirates Insurance Company who administer the policy and who underwrite and provide the
contract of insurance.
Emirates Insurance Company (PSC)
Abu Dhabi Office: PO Box 3856, UAE

GEN4963 20/12/13