PREMIER HEALTHCARE PLANS FOR GROUP Schedule of Benefits

Transcription

1 PREMIER HEALTHCARE PLANS FOR GROUP Schedule of Benefits Types of Plans Designated Healthcare Providers Area of Cover Yearly maximum limit per Member In-Patient Daycare Treatment Accidental Emergencies Operating atre ancillary, surgical appliances used by Specialist/Consultant during surgery, intensive care unit, nursing care Surgeons /Anestists / Physicians /Consultants' for procedures or surgeries Prescribed drugs dressings Reconstructive surgery following an accident/surgery of an eligible medical condition happened during cover was in force Prosses (artificial body parts) designed to form permanent parts of an Member s body if required surgically or as a result of an accident. MRI CT scan, nuclear scan, ultrasound pathology. Diagnostic tests procedures Accidental dental treatment to natural teeth at a hospital or at an emergency room of a hospital Physiorapy by a Registered Therapist, when referred by a Medical Practitioner/Consultant/ Specialist PLAN A PLAN B PLAN C Worldwide BD 25,000 BD 15,000 BD 10,000 Covered 12 sessions Worldwide excluding USA & Canada 1 G.C.C, Middle East, India, Pakistan, Sri- Lanka, Bangladesh, Nepal, Vietnam, Bhutan, Philippines, Thail Korea Covered Covered Covered Covered Covered Covered Covered 12 sessions PLAN D Bahrain only BD 5,000 Covered Covered Covered 12 Covered 12 sessions sessions NOTES Note 1 Note 2 Note 3 Note 7

2 Hospital accommodation (room board) for an Member Parent accommodation (room & board) Hospital accommodation costs in respect of a Parent/Legal Guardian staying with an Child (under 18 s) is admitted to a hospital as inpatient Out-Patient Treatment Primary treatment, Family / General Practitioners fees within Designated Healthcare Providers Prescribed drugs dressings x-rays, pathology, diagnostic tests procedures Specialists /Consultants fees for consultation Complementary medicine treatment by a Therapist, limited to osteopathic, chiropractic, homeopathic acupuncture treatment when referred by a Medical Practitioner/ Consultant/ Specialist MRI, CT scan, PET & isotope scan Out-patient surgical procedures operations Out-patient home visits by a Medical Practitioner for emergency cases out of regular working hours Physiorapy by a Registered Therapist, when referred by a Medical Practitioner/Consultant/ Specialist Psychiatric treatment as a result of an accident or sickness covered by Policy Or Benefits Chronic Conditions - maintenance treatment of chronic conditions including routine checkups, prescribed drugs, dressings stabilization of acute exacerbation of chronic medical conditions Prexisting Conditions Stard 100 per day) BD BD 5,000 per Stard 60 per day) BD BD 3,000 per Stard 50 per day) BD per Stard 50 per day) BD per after 12 months continuous cover BD 2,500 per after 12 months continuous cover BD 1,500 per after 12 months continuous cover per BD 500 per Note 3 Note 5 2

3 Local Road Ambulance Emergency Service Licensed Ambulance Services to nearest emergency hospital. Coverage is only provided in event of an emergency medical condition BD 50 per trip BD 50 per trip BD 50 per trip BD 50 per trip Kidney Failure/Dialysis Renal dialysis related expenses up to 14 sessions if it forms part of renal transplant Cancer Treatment Oncology tests, Consultation fees, drugs, chemorapy radiorapy Organ Transplant Costs of surgical procedures treatment in relation to an organ transplant of eir; kidney, liver, heart, lung, or heart lung, in respect of an Member as recipient not organ donor In hospital cash benefit Lump sum cash payment for each night spent as an in-patient or daycare case, as a Non-Paying Patient in a government/charity hospital BD 50 per BD 25 per BD 25 per BD 25 per Nursing at home Primary care services of a Registered Nurse, under direction of a Specialist, in Member s home immediately after, or instead of, inpatient or daycare treatment per per per per Repatriation of mortal remains In event of death of an Member outside Bahrain, cost of transportation of mortal remains or body of an Member, from place of death to country of origin or to Bahrain Emergency in-patient medical treatment abroad Cover extended to reimburse emergency medical expenses whilst Member is on vacation, leisure or business trips subject to a maximum of 45 per trip, or in annual aggregate 3

4 Treatment or than emergency abroad Treatment is subject to territorial limit prauthorization from bnl. Coverage excludes USA Canada Additional Benefits (Optional) Maternity Care Normal routine maternity comprising prnatal treatments examinations, normal delivery, cesarean delivery, legal abortion, post natal treatments examinations for female members over 18 s under 45 s of age with following sub-limit Waiting Period Coinsurance for Maternity Treatment (after out-patient maternity limit maternity limit maternity limit maternity limit treatment excess) Dental Treatment Emergency routine dental examinations, extractions, x-rays, routine fillings (amalgam, resin, plastic, temporary) to natural teeth, root canal treatment gum treatment once in a, excluding mouthguards, dentures, bridges, crowns any cosmetic treatments Coinsurance for Dental Treatment (after out-patient treatment excess) Optical Treatment Vision tests for errors of refraction (eye examinations), one set of lenses for spectacles (eye glasses) excluding frames contact lenses Coinsurance for Optical Treatment (after out-patient treatment excess) Telemedicine Service Provides world-class second medical opinions treatment plans electronically from best medical centers in North America for life threatening illnesses (serious critical) utilizing advanced secured telecommunications technology. This service can be requested Covered Covered Covered Covered Notes 4 & 6 4

5 when your you decide a second medical opinion would be helpful in situations like: 1. You have a serious diagnosis want to be reassured 2. When your you have additional medical questions 3. When you have a choice of treatment options 4. When you are facing a high-risk surgery 5. When you have multiple medical problems 6. When your wants to be certain that re is no better solution available 2 per 2 per 2 per 2 per International Emergency Evacuation Cover In event of a medical emergency outside Bahrain or outside country of origin arrangements to pay for necessary expenses of air or surface transportation medical, to nearest hospital where appropriate medical care is available, which may be a location or than members country of residence or country of origin USD 1,000,000 USD 1,000,000 USD 1,000,000 Note 8 Routine Vaccination Cover Routine vaccination for children (as per Ministry of Health s approved vaccination chart) Wellness Checkup Cover One wellness checkup per Member Spouse BD 150 per annum BD 150 per annum per annum Excess (out-patient treatment only) within 7 for same same within 7 for same same within 7 for same same within 7 for same same Bahrain National Life Assurance Company, P.O. Box 843, Manama, Kingdom of Bahrain Tel: , Fax: , Healthcare Hotline No , Website: 5

6 PREMIER HEALTHCARE PLANS FOR GROUP NOTES 1. This cover is only applicable to Members being residents of Bahrain or working for a company with branches within GCC. 2. All correspondences concerning this Policy including settlement of Claims must be in English language. Benefits are in Bahraini Dinars/US Dollars settlement of eligible medical expenses will be subject to Policy Terms Conditions. 3. consultation for in-patient out-patient treatment is limited to BD 20 only, at any one Provider. Treatment with visiting s are not covered. 4. Our prauthorization is required for treatment of all non-emergency in-patient daycare cases, treatment expenses exceeding BD 75, MRI, CT scan, physiorapy, hormone profiles, dental, optical maternity treatment. 5. 's home visits emergency (out of regular working hours) for General Practitioner is BD 25 per visit for a Specialist/Consultant is BD 30 per visit (please Schedule of Benefits). 6. Under maternity benefit we cover up to 12 routine anti-natal visits during term of pregnancy no more than 3 routine anti-natal ultrasound scans (1 in each trimester). If any more ultrasound scans are needed by treating Medical Practitioner, a detailed medical report will be required for our review (please Schedule of Benefits). 7. We will pay for any kind of in-patient treatment received following an accident, we will pay for initial dental treatment required immediately following dental damage to natural teeth but not for any follow up treatment. Subject to applying definition of "accidental i.e. any involuntary, sudden, unexpected or unforeseen external event resulting in bodily injury to an Member treatment received as an outpatient or in an emergency room in a hospital. 8. Terms Conditions applicable to evacuation emergency assistance cover. This service is rendered in association with Asia Medical Assistance Co. (please Schedule of Benefits). 9. Treatments at International Hospital of Bahrain, Dr Tariq Saeed Clinic, Dr Nabil Rizqalla, Bahrain Gynecology Infertility Centre, British Infertility Center, Al Noor Dental Clinic Al Baraka Fertility Clinic are not covered. 10. Treatment at Dr Najah Al Zayani Clinic is subject to referral by a Consultant preauthorization from bnl. 11. Client reimbursement Claims from Designated Healthcare Providers are subject to 20% coinsurance. 6

7 12. Treatment outside Designated Healthcare Providers is reimbursed subject to Royal Bahrain Hospital Bahrain Defense Force Hospital subject to 20% coinsurance. 13. Claims from Ibn Al Nafees Medical Complex are subject to 20% coinsurance including prescribed medicines. 14. Treatment at following s will be on reimbursement basis only: Dr Jehad Al Qamish Dr Sameer M Al-Arrayed from Ibn Nafees Medical Complex, Dr Affaf M El- Shafei from Noor Specialist Hospital, Dr Najah Al Zayani Dr Enas Al Alawi from Bahrain Specialist Hospital Dr Yaser Ahmed (Dental) from Al Kindi Hospital. 15. In-patient Surgical Treatment at German Orthopedic Hospital is subject to 30% coinsurance. 16. All dental optical treatment will be on direct billing only, no reimbursement Claims will be settled. Bahrain National Life Assurance Company, P.O. Box 843, Manama, Kingdom of Bahrain Tel: , Fax: , Healthcare Hotline No , Website: 7