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ANNEXURE : 1 FLEXI - DUBAI PLANS - OPTION 1

ANNEXURE : 1 FLEXI - DUBAI PLANS ( OPTION 1 )


Applicable only for (DXB visa holders) with Gross Salary Above AED 4,000 . -- Preexisting &
chronic conditions will be covered only for declared cases: - New
membership- 6 months waiting period for Pre-existing & Chronic conditions/ and no continuity of coverage.
- Nil waiting period for members who have continuity of coverages.
- Pre-existing & Chronic conditions will not be covered for undeclared cases even after 6 months waiting period.
- Maternity coverage- Non -working spouses who are confirmed pregnant after time of enrollment will be subject to 9 months waiting period.
- No waiting period for maternity for Working females and non-working females with continuity of cover.

S.
Benefits Flexi - Platinum Flexi - Diamond Flexi - Gold Flexi - Silver Flexi - Bronze Flexi - Steel
No.
Aggregate Limit
Under the terms and conditions of the plan,
1 we will pay necessary, customary and AED 1,500,000/- AED 750,000/- AED 250,000/- AED 150,000/- AED 150,000/- AED 150,000/-
reasonable expenses up to an overall
maximum, per insured member per year.

UAE, GCC, ME, SEA UAE, GCC, ME, SEA


Worldwide Including USA & UAE, GCC, ME, SEA including UAE, Indian Sub-continent
2 Area of Cover including Indian Sub- including Indian Sub- UAE Only
Canada Indian Sub-continent and Philippines
continent continent
All UAE residents
3 Eligibility
(UAE Nationals & Expatriates having a Valid Residence Visa)
4 Network GN + AH GN network + 20% RN RN2 RN3 *Outpatient: Nextcare's
PCP network (specialist
co-insurance on ALL (Outpatient treatment
visits from RN3 network is
OP services in restricted to clinics only)
allowed after referral
Saudi German from PCP GPs only)
hospital *Inpatient: RN3 hospitals
(referral from PCP doctors
Mediclinic Group &
only)
Al Zahra Group

5 Age Limit 0 to unlimited 0 to unlimited 0 to unlimited 0 to unlimited 0 to unlimited 0 to unlimited

Treatment Outside the Network within


Geographical scope
If treatment is taken outside the network for
eligible medical condition covered under the
20% Co-insurance subject to 20% Co-insurance subject * Treatment out-side the Network is not allowed and will not be reimbursed. *
6 policy, reimbursement would be allowed
subject to 20% Co-insurance based on Usual, UCR Network Charges to UCR Network Charges Emergency treatment within UAE covered in full (Life threatening cases)
Customary and Reasonable ( UCR ) Network
Charges.
( UCR charges are as per the discretion of the
insurer )

Claims Settlement Basis


Within the Network
Within the Network on Direct Billing Basis
7 ( as per Usual, Customary and Reasonable on Direct Billing Basis Outside the Network on Reimbursement Basis
Charges of the Network in UAE ). Outside the Network on Reimbursement Basis * For emergency treatment within UAE covered in full (Life threatening cases)
ANNEXURE : 1 FLEXI - DUBAI PLANS - OPTION 1

S.
Benefits Flexi - Platinum Flexi - Diamond Flexi - Gold Flexi - Silver Flexi - Bronze Flexi - Steel
No.

In-Patient Treatment
Accidents and emergencies, intensive care
a Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full
and theatre costs
Semi Private Room
Private Room Private Room Private Room Semi Private Room Semi Private Room
b Hospital Accommodation ( Room Charges ) Coveredup to aed 450 per
Covered Covered Coveredup to aed 750 per day Coveredup to aed 450 per day Coveredup to aed 450 per day
day
Nursing Fees, medical expenses and
c Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full
ancillary charges
Surgeons', consultants, anaesthetist',
d Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full
specialists' , General Practitioners' fees
e Prescribed Medicine and drugs Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full
Reconstructive surgery following an
f accident or following surgery for an eligible Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full
medical condition
Prostheses: artificial body parts surgically
g implated to form permanent parts of an Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full
insured member's body
h MRI, PET, CT Scans Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full
X-Rays, Pathology, diagnostic tests and
i Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full
procedures
Oncology tests, drugs and consultants' fees
j including cover for chemotherapy and Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full
radiotheraphy
Parent accommodation
Hospital accomodation cost in respect of a
Covered up to Covered up to
k parent or legal guardian staying with an Insured
AED 200/= per day AED 100/= per day
member who is under 18 years of age and is
admitted to a Hospital as an In-Patient.
Ground transportation services in the UAE
l provided by an authorized party for medical Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full
emergencies
Accidental Damage to Teeth
Treatment recevied in an Emergency room in a
m Hospital within 48 hours of incurring Accidental Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full
damage caused to sound, natural teeth as a
result of an Accident.
Hospital Cash Benefit
When treatment is received as an In-Patient for
an eligible Medical Condition in a Government
Hospital, where no costs were incurred for
Covered up to Covered up to
n accommodation and/or for treatment, then this
AED 300/= per day AED 200/= per day
benefit pays for a daily cash benefit for In-
Patient stay more than 3 days.
This benefit is not applicable for Accident &
Emergency admissions.

Deductible for ( In-Patient Services )


( Applicable if treatment is taken in a facility 20% coinsurance
in-side/outside the Network of providers ) With a cap of 500 AED payable per encounter and an annual
o NIL
aggregate cap of 1000 AED. Above these caps the insurer
will cover 100% of treatment
ANNEXURE : 1 FLEXI - DUBAI PLANS - OPTION 1

S.
Benefits Flexi - Platinum Flexi - Diamond Flexi - Gold Flexi - Silver Flexi - Bronze Flexi - Steel
No.
Medical emergencies on Hearing and vision
aids, and vision correction by surgeries and
p Cover : Emergency Treatment required to save or alleviate danger to life
laser.

Accidental damage to teeth & Gum


Treatment recevied in an emergency room in a
q hospital within 48 hours of incurring accidental Cover : Emergency Treatment required to save or alleviate danger to life
damage caused to sound , nutural teeth as a
result of an accident.

10% coinsurance payable by 10% coinsurance payable by


the insured Maximum the insured Maximum
benefit 15 ,000 AED per benefit 10 ,000 AED per
Maternity - In patient services. normal delivery, 20 ,000 AED normal delivery, 15 ,000
10% coinsurance payable by the insured Maximum benefit 7 ,000 AED per normal delivery, 10 ,000 AED for medically
Waiting Period: Nil - Non -working spouses for medically necessary C- AED for medically necessary necessary C-section, complications and for medically necessary termination (All limits include coinsurance)
r who are confirmed pregnant after time of section, complications and C-section, complications
enrollment will be subject to 9 months for medically necessary and for medically necessary
waiting period. termination (All limits include termination (All limits
coinsurance) include coinsurance)

Where any condition develops which becomes an emergency, the medically necessary expenses will becovered up to -Maximum limit AED 150,000 PPPY

Out-Patient & Day-care


Deductible /Co insurance for ( Out-Patient
20% coinsurance on OP consultation or AED 50/- on all OP
Services ) consultation whichever is lower.
1
Free follow up with the same
doctor for the same ailment within seven days.

Primary Consultation and treatment to


2 include General Practitioners' fees, Covered Covered Covered Covered Covered Covered
prescribed medicines, drugs and dressings
X-ray, pathology, diagnostic tests and
3 Covered Covered Covered Covered Covered Covered
procedures
30% Coinsurance Maximum 30% Coinsurance Maximum
4 Prescribed Medicine and drugs Covered Covered Covered Covered
Limit AED 2,000 Limit AED 1,500
Covered up to 6 sessions per
Covered up to 6 sessions per
Physiotherapy recommended / referred by ailment/condition per
5 Covered up to 7 sessions per ailment/condition per person per year ailment/condition per person
a General Practitioner or a Specialist, person per year with 20%
per year
coinsurance
Oncology tests, drugs and consultants' fees
6 including cover for chemotherapy and Covered Covered Covered Covered Covered Covered
radiotheraphy
7 MRI, PET, CT Scans Covered Covered Covered Covered Covered Covered
8 Out-Patient Surgical Operations Covered Covered Covered Covered Covered Covered
9 Post - Hospitalization Treatment Covered Covered Covered Covered Covered Covered
ANNEXURE : 1 FLEXI - DUBAI PLANS - OPTION 1

S.
Benefits Flexi - Platinum Flexi - Diamond Flexi - Gold Flexi - Silver Flexi - Bronze Flexi - Steel
No.
Other Benefits
Pre-existing Conditions & Chronic Medical
Conditions ( Where any condition develops
which becomes an emergency, the medically
necessary expenses will be covered up to the
-Maximum limit AED 150,000 PPPY
ab
- Treatment for chronic Or pre-existing conditions excluded for first 6 months of first membership. Included thereafter
annual aggregate limit. )
- For declared cases only

Maternity - Out patient services. Waiting


Period: Nil - Non -working spouses who are
10% Copay , Maximum 8 visits checks and tests in accordance with DHA Antenatal Care Protocols
ac confirmed pregnant after time of
enrollment will be subject to 9 months
waiting period.

_Cover for 30 days from birth.


ad New born cover
_BCG, Hepatitis and neo-natal screening tests. (Phenylketonuria (PKU), Congenital Hypothyroidism, sickle cell screening, congenital adrenal hyperplasia)

- Maximum limit AED 150,000 PPPY ( life - threatening birth defects, deformities and
ae Life threatening congenital conditions
congenital diseases for new born children only )

Nursing at Home
Covered upto a limit of Covered upto a limit of Covered upto a limit of Covered upto a limit of Covered upto a limit of Covered upto a limit of
Immediately following Hospital discharge
AED 5,000/= AED 4,000/= AED 2,500/= AED 1,000/= AED 1,000/= AED 1,000/=
on the recommendation of a specialist and
af
must be provided by a qualified nurse. All
for a period not exceed 30 for a period not exceed 30 for a period not exceed 30 for a period not exceed 30 for a period not exceed 30 for a period not exceed 30
treatments under this benefit must be pre-
days in aggregate. days in aggregate. days in aggregate. days in aggregate. days in aggregate. days in aggregate.
authorized by us.

Reconstructive Surgery
Reconstructive surgery following an
Accident or following surgery for an eligible
ag medical conditions, which is not pre- Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full Covered in Full
existing and the incident has not occurred
prior to commencing this cover under the
policy.
Dental Cover
Below dental procedures excluding any Covered up to a limit of
surgeries. AED 2,000/= with AED 100/=
ah Not Covered Not Covered Not Covered Not Covered Not Covered
Root Canal, Fillings, Extractions, Antibiotics as deductible. Reimbursement
for Infection of Gums Consultation and X- basis only
ray.

Covered up to a limit of
Optical Cover
ai AED 200/= for a pair of lenses. Not Covered Not Covered Not Covered Not Covered Not Covered
Cover for a pair of lenses only.
on Reimbursement basis only

Preventive services
*Preventive services as stipulated by DHA to include initially diabetes and Papanicolaou test. *Frequency restricted to:
aj Diabetes: Every 3 years from age 30
High risk individuals annually from age 18 Papanicolaou: Every 3 years for married female
ANNEXURE : 1 FLEXI - DUBAI PLANS - OPTION 1

S.
Benefits Flexi - Platinum Flexi - Diamond Flexi - Gold Flexi - Silver Flexi - Bronze Flexi - Steel
No.
Vaccines and immunizations
Essential vaccinations and inoculations for Covered - according to DHA price list
ak newborns and children as stipulated in the on Reimbursement basis only
DHA’s policies and its updates in the assigned
facilities from age 0-6 years .
Return Air Fare to Patient for Surgery in AED 2,000/=
Home Country Plus AED 2,000/=
( if treatment is not available in the country of Insured patient only
al AED 2,000/= for
residence or the treatment expense is up to 50%
accompanying Family
of the cost in UAE ). Pre-approval from ASNIC
Member
required
Global Emergency services - Assist America
Key services:
Medical Consultation, Evaluation & Referral, Covered Covered Covered Covered
Hospital Admission Assistance, Emergency (Refer to Global Emergency (Refer to Global Emergency (Refer to Global Emergency (Refer to Global Emergency
Medical Evacuation, Medical Monitoring, Services brochure for Services brochure for Services brochure for Services brochure for
am Medical Repatriation, Prescription complete information on complete information on complete information on complete information on Not Covered Not Covered
Assistance, Compassionate Visit, Care of coverage, conditions and coverage, conditions and coverage, conditions and coverage, conditions and
Minor Children, Return of Mortal Remains, exclusions) exclusions) exclusions) exclusions)
Lost Luggage or Document Assistance,
Interpreter & Legal Referrals, Pre-trip
Information.

Covered Covered Covered Covered


(Refer to Global Emergency (Refer to Global Emergency (Refer to Global Emergency (Refer to Global Emergency
Services brochure for Services brochure for Services brochure for Services brochure for
complete information on complete information on complete information on complete information on
Second Medical Opinion (International coverage, conditions and coverage, conditions and coverage, conditions and coverage, conditions and
Medical Consultation) exclusions) exclusions) exclusions) exclusions)
- Confirmation of Diagnosis - Confirmation of Diagnosis - Confirmation of Diagnosis - Confirmation of Diagnosis - Confirmation of Diagnosis
- Evaluation of cases where diagnosis has - Evaluation of cases where - Evaluation of cases where - Evaluation of cases where - Evaluation of cases where
an Not Covered Not Covered
not been possible diagnosis has not been diagnosis has not been diagnosis has not been diagnosis has not been
- Determination of the most appropriate possible possible possible possible
course of treatment - Determination of the most - Determination of the most - Determination of the most - Determination of the most
- Follow up on a previously reported case. appropriate course of appropriate course of appropriate course of appropriate course of
treatment treatment treatment treatment
- Follow up on a previously - Follow up on a previously - Follow up on a previously - Follow up on a previously
reported case. reported case. reported case. reported case.

Death due to accident (


for Principal only )
(Refer to addendum for complete Covered Max AED 25,000. Covered Max AED 20,000. Covered Max AED 15,000. Covered Max AED10,000. Not Covered Not Covered
information on coverage, conditions and
ao exclusions)