Applicable only for (DXB visa holders) with Gross Salary Above AED 4,000.

Transcription

1 Applicable only for (DXB visa holders) with Gross Salary Above AED 4,000. S. No. Benefits Flexi Dubai - Platinum Flexi Dubai - Diamond Flexi Dubai - Gold Flexi Dubai - Silver Flexi Dubai - Bronze Aggregate Limit 1 Under the terms and conditions of the plan, we will pay necessary, customary and reasonable expenses up to an overall maximum, per insured member per year. 2 Area of Cover AED 1,500,000/= AED 750,000/= AED 250,000/= AED 150,000/= Worldwide excluding USA & Canada UAE, GCC, ME, SEA including Indian Subcontinent UAE, GCC, ME, SEA including Indian Subcontinent UAE, GCC, ME, SEA including Indian Subcontinent AED 150,000/= UAE, Indian Subcontinent and Philippines 3 Eligibility Dubai residents (UAE Nationals & Expatriates having a Valid Dubai Residence Visa) Dubai residents (UAE Nationals & Expatriates having a Valid Dubai Residence Visa) Dubai residents (UAE Nationals & Expatriates having a Valid Dubai Residence Visa) Dubai residents (UAE Nationals & Expatriates having a Valid Dubai Residence Visa) Dubai residents (UAE Nationals & Expatriates having a Valid Dubai Residence Visa) 4 Network GN + AH Opt1: Nil. Opt2: Treatment in American Hospital *15% Co Insurance in Op only GN Opt1: Nil. Opt2: Treatment in Mediclinic Group & Al Zahra Group *15% Co Insurance in Op only RN Opt1: Nil. Opt2: Treatment in Zulekha Hospital *15% Co Insurance in Op only RN2 Opt1: Nil. Opt2: Treatment in Zulekha Hospital *15% Co Insurance in Op only RN3 (Outpatient treatment restricted to clinics only) 5 Age Limit 0 to unlimited 0 to unlimited 0 to unlimited 0 to unlimited 0 to unlimited Al Sagr National Insurance Page 1

2 Treatment Outside the Network 6 If treatment is taken outside the network for eligible medical condition covered under the policy, reimbursement would be allowed subject to 20% Coinsurance based on Usual, Customary and Reasonable (UCR) Network Charges. ( UCR charges are as per the discretion of the insurer ) 20% Co-insurance subject to UCR Network Charges 20% Co-insurance subject to UCR Network Charges Treatment out-side the Network is not allowed and will not be reimbursed. Treatment out-side the Network is not allowed and will not be reimbursed. Treatment out-side the Network is not allowed and will not be reimbursed. 7 Claims Settlement ( as per Usual, Customary and Reasonable Charges of the Network in UAE). Within the Network on Direct Billing Outside the Network on Reimbursement Within the Network on Direct Billing Outside the Network on Reimbursement Within the Network on Direct Billing Outside the Network on Reimbursement ( if eligible ) Within the Network on Direct Billing Outside the Network on Reimbursement ( if eligible ) Within the Network on Direct Billing Outside the Network on Reimbursement ( if eligible ) In-Patient Treatment a Accidents and emergencies, intensive care and theatre costs Al Sagr National Insurance Page 2

3 b c d e f g Hospital Accommodation ( Room Charges ) Nursing Fees, medical expenses and ancillary charges Surgeons', consultants, anesthetist', specialists', General Practitioners' fees Prescribed Medicine and drugs Reconstructive surgery following an accident or following surgery for an eligible medical condition Prostheses: artificial body parts surgically implanted to form permanent parts of an insured member's body Private Room Covered Private Room Covered Private Room AED 750 per day Semi Private Room AED 450 per day Semi Private Room AED 450 per day h MRI, PET, CT Scans i X-Rays, Pathology, diagnostic tests and procedures j Oncology tests, drugs and consultants' fees including cover for chemotherapy and radiotherapy Physiotherapy k recommended / referred 7 sessions per ailment/condition per person per year by a General Practitioner or a Specialist, Al Sagr National Insurance Page 3

4 l m n Parent accommodation Hospital accommodation cost in respect of a parent or legal guardian staying with an Insured member who is under 18 years of age and is admitted to a Hospital as an In-Patient. Ground transportation services in the UAE provided by an authorized party for medical emergencies Accidental Damage to Teeth Treatment received in an Emergency room in a Hospital within 48 hours of incurring Accidental damage caused to sound, natural teeth as a result of an Accident. Hospital Cash Benefit o When treatment is received as an In-Patient for an eligible Medical Condition in a Government Hospital, where no costs were incurred for accommodation and/or for treatment, then this benefit pays for a daily cash AED 300/= per day AED 300/= per day Al Sagr National Insurance Page 4

5 benefit for In-Patient stay more than 3 days. This benefit is not applicable for Accident & Emergency admissions. p q r Deductible for ( In-Patient Services ( Applicable if treatment is taken in a facility in-side/outside the Network of providers ) Medical emergencies on Hearing and vision aids, and vision correction by surgeries and laser. Accidental damage to teeth & Gum Treatment received in an emergency room in a hospital within 48 hours of incurring accidental damage caused to sound, natural teeth as a result of an accident. NIL NIL NIL NIL Cover : Emergency Treatment required to save or alleviate danger to life Cover : Emergency Treatment required to save or alleviate danger to life 20% coinsurance With a cap of 500 AED payable per encounter and an annual aggregate cap of 1000 AED. Above these caps the insurer will cover 100% of treatment Al Sagr National Insurance Page 5

6 s Maternity - In patient services. Nil waiting periods subject to declaration. 10% coinsurance payable by the insured Maximum benefit 15,000 AED per normal delivery, 20,000 AED for C-section, complications and for termination (All limits include coinsurance) 10% coinsurance payable by the insured Maximum benefit 10,000 AED per normal delivery, 15,000 AED for medically necessary C-section, complications and for termination (All limits include coinsurance) 10% coinsurance payable by the insured Maximum benefit 7,000 AED per normal delivery, 10,000 AED for C-section, complications and for termination (All limits include coinsurance) 10% coinsurance payable by the insured Maximum benefit 7,000 AED per normal delivery, 10,000 AED for medically necessary C-section, complications and for termination (All limits include coinsurance) 10% coinsurance payable by the insured Maximum benefit 7,000 AED per normal delivery, 10,000 AED for C-section, complications and for termination (All limits include coinsurance) Where any condition develops which becomes an emergency, the expenses will be covered up to - Maximum limit AED 150,000 PPPY Out-Patient & Day-care Treatment Deductible /Co insurance for ( Out-Patient Services ) Free follow up with the same doctor for the same ailment within seven days. Primary Consultation and treatment to include General Practitioners' fees, prescribed medicines, drugs and dressings X-ray, pathology, diagnostic tests and procedures Prescribed Medicine and drugs 20% coinsurance on OP consultation or AED 50/- on all OP consultation whichever is lower. 20% coinsurance on OP consultation or AED 50/- on all OP consultation whichever is lower. 20% coinsurance on OP consultation or AED 50/- on all OP consultation whichever is lower. 20% coinsurance on OP consultation or AED 50/- on all OP consultation whichever is lower. 20% coinsurance on OP consultation or AED 50/- on all OP consultation whichever is lower. Covered Covered Covered Covered 20% Coinsurance Covered Covered Covered Covered 20% Coinsurance Covered Covered Covered Covered 30% Coinsurance Maximum Limit AED 1,500 Al Sagr National Insurance Page 6

7 5 6 Physiotherapy recommended / referred by a General Practitioner or a Specialist, Oncology tests, drugs and consultants' fees including cover for chemotherapy and radiotherapy 7 sessions per ailment/condition per person per year 6 sessions per ailment/condition per person per year Covered Covered Covered Covered 20% Coinsurance 7 MRI, PET, CT Scans Covered Covered Covered Covered 20% Coinsurance 8 Out-Patient Surgical Operations Covered Covered Covered Covered 20% Coinsurance 9 Post - Hospitalization Treatment Covered Covered Covered Covered 20% Coinsurance Other Benefits ab ac ad Pre-existing Conditions & Chronic Medical Conditions ( Where any condition develops which becomes an emergency, the medically necessary expenses will be covered up to the annual aggregate limit. ) - For declared cases only Maternity - Outpatient services. New born cover -Maximum limit AED 150,000 PPPY - Treatment for chronic Or pre-existing conditions excluded for first 6 months of first membership. Included thereafter 10% Copay, Maximum 8 visits checks and tests in accordance with DHA Antenatal Care Protocols _Cover for 30 days from birth. _BCG, Hepatitis and neo-natal screening tests. (Phenylketonuria (PKU), Congenital Hypothyroidism, sickle cell screening, congenital adrenal hyperplasia) Al Sagr National Insurance Page 7

8 ae Life threatening congenital conditions ( life - threatening birth defects, deformities and congenital diseases for new born children only ) Nursing at Home - Maximum limit AED 150,000 PPPY af Immediately following Hospital discharge on the recommendation of a specialist and must be provided by a qualified nurse. All treatments under this benefit must be pre-authorized by us. Reconstructive Surgery a limit of AED 5,000/= for a period not exceed 30 days in aggregate. a limit of AED 4,000/= for a period not exceed 30 days in aggregate. a limit of AED 2,500/= for a period not exceed 30 days in aggregate. a limit of AED 1,000/= for a period not exceed 30 days in aggregate. Not covered ag ah Reconstructive surgery following an Accident or following surgery for an eligible medical conditions, which is not pre-existing and the incident has not occurred prior to commencing this cover under the policy. Dental Cover Below dental procedures excluding any surgeries. Root Canal, Fillings, Extractions, Antibiotics for Infection of Gums Consultation and X-ray. a limit of AED 2,000/= with AED 100/= as deductible Not Covered Not Covered Not Covered Not Covered Al Sagr National Insurance Page 8

9 ai Optical Cover Cover for a pair of lenses only. a limit of AED 200/= for a pair of lenses Not Covered Not Covered Not Covered Not Covered aj ak al Preventive services Vaccines and immunizations Essential vaccinations and inoculations for newborns and children as stipulated in the DHA s policies and its updates in the assigned facilities from age 0-6 years. Return Air Fare to Patient for Surgery in Home Country (if treatment is not available in the country of residence or the treatment expense is up to 50% of the cost in UAE). Pre-approval from ASNIC required *Preventive services as stipulated by DHA to include initially diabetes and Papanicolaou test. *Frequency restricted to: Diabetes: Every 3 years from age 30 High risk individuals annually from age 18 Papanicolaou: Every 3 years for married female Covered - Only available for services administered at DHA facilities with 10% Copay on Reimbursement basis only AED 2,000/= Plus AED 2,000/= for accompanying Family Member AED 2,000/= Insured patient only AED 2,000/= Insured patient only AED 2,000/= Insured patient only AED 2,000/= Insured patient only Al Sagr National Insurance Page 9

10 am Global Emergency services - Assist America Key services: Covered (Refer to Global Emergency Services brochure for complete information on coverage, conditions and exclusions) Medical Consultation, Evaluation & Referral, Hospital Admission Assistance, Emergency Medical Evacuation, Medical Monitoring, Medical Repatriation, Prescription Assistance, Compassionate Visit, Care of Minor Children, Return of Mortal Remains, Lost Luggage or Document Assistance, Interpreter & Legal Referrals, Pre-trip Information. an Second Medical Opinion (International Medical Consultation) Covered (Refer to Global Emergency Services brochure for complete information on coverage, conditions and exclusions) - Confirmation of Diagnosis - Evaluation of cases where diagnosis has not been possible - Determination of the most appropriate course of treatment - Follow up on a previously reported case. Al Sagr National Insurance Page 10