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Table of benefit for family health insurance

from Bupa Arabia


R 0 R 135
G 106 G 195
B 86 B 65

Description Extent of Cover

Level of cover Gold Silver Bronze Blue

Maximum benefit limit per member per


SR 250,000 SR 150,000 SR 100,000 SR 75,000
policy period

In-patient / day-case coverage

Covered
Appropriate medical treatment, surgical &
medical procedures, medical supplies & No Deductible Amount
services, nursing & doctor›s fee, ER, ICU
and theatre charges, medication

Standard Shared
Accommodation Single Room Single Room
Suite Room

Companion charges (up to 12 yrs old) Covered Covered Covered Covered

Out-patient coverage

Appropriate diagnosis and treatment in


outpatient clinics including the cost of the Covered
General Physical/ Specialists, radiology,
chemotherapy, laboratory exams, other 20% up to SR 100
diagnostic tests and medication

Out-patient Deductible (per visit)

Pre-existing & Chronic conditions * SR 30,000 SR 25,000 SR 20,000 SR 15,000

Network of Providers NW7 NW6 NW5 NW3

Covered Covered Covered Covered


Physiotherapy** up to 12 up to 12 up to 12 up to 12
sessions sessions sessions sessions

Maternity***(each year up to) SR 15,000 SR 12,500 SR 10,000 SR 7,500

MOH vaccines Covered Covered Covered Covered

Dental (each year up to)**** SR 3,000 SR 2,000 SR 1,000 SR 1,000

Optical (each year up to)***** SR 1,000 SR 600 SR 400 SR 250

Local road ambulance for emergency


SR 3,000 SR 1,000 SR 1,000 SR 1,000
cases only

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