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STANDARD SCHEDULE OF BENEFITS (NON- ABU DHABI)

Treatment Received outside the Network within UAE is limited 60% of Network Rates

PRE-EXISTING & CHRONIC CONDITIONS Pre-existing & Chronic Conditions excluded for first 6 months of first scheme membership. Included thereafter

*Applicant is required to disclose all material facts and in case of any misrepresentation or with holding of material facts knowingly by the policy holder or any member, insurer have a right to terminate the policy

Benefit Plan Extent of Coverage EMIRATES EMIRATES PLUS INTERNATIONAL GLOBAL
Annual Benefit Limit in Dirhams   150000 250000 1000000 2000000
OUTPATIENT SERVICES  
Deductible AED 50 per week per Illness (‘Nil’ Deductible on follow- up visit within one week)
Coinsurance on Outpatient Services within Network Applies at Al Zahra Hospital, Mediclinics, Saudi German Hospital & their Affiliated Providers 20% 20%
General Out-patient Services Covered
Specialist Out-patient Services Covered `✔
Laboratory and X- rays Services Covered
Prescribed Drugs/ Pharmaceuticals Covered
Elective Out-patient Treatment outside UAE within Geographical Area Covered
Alternative Therapies: Acupuncture, Specialist Herbal Treatment Covered subject to Pre- authorization
INPATIENT SERVICES  
Hospital Room & Board Covered Semi Private Semi Private Private Private
Hospital Services (All Medically Necessary Services are covered unless specifically excluded) Covered
Emergency Ward Services Covered
Intensive Care Unit Covered
Hospital Accommodation for Parent when accompanying a Child under 15 years while admitted as In-patient Covered
Hospital Cash Benefit: Special In-patient Cash Benefit if Treatment is received free of cost or at named network hospitals Covered up to Dhs 200/- per day for maximum 7 days per policy year
Elective In-patient Treatment outside UAE within Geographical Area Covered
MISCELLANEOUS SERVICES  
Post Hospitalization Follow-up (within 13 weeks after Discharge) Covered
Nursing at Home following Hospitalization (up to 13 weeks) Covered
Post Hospitalization Accommodation- Outside UAE Dhs. 500 per day up to 7 days  
Organ Transplant (Kidney, Liver, Heart) Covered
Local Ambulance Service Covered
Accident related Dental Treatment Covered
Emergency Medical Evacuation Maximum US $ 1, 000, 000
Repatriation of Mortal Remains or Local Burial Maximum US $ 7,000
Accidental Death Dhs 50, 000
MATERNITY SERVICES 6 Month waiting period `✔
Out-patient ante-natal services
  •  10% co-insurance payable by the insured.
 
  • Requires prior approval from the NGI
  • All care provided by PHC obstetrician for low risk or specialist obstetrician for high risk referrals
Initial investigations to include:  
    • FBC and Platelets
    • Blood group, Rhesus status and antibodies
    • VDRL
    •  MSU & urinalysis
    • Rubella serology
    • HIV
    • Hep C offered to high risk patients
    • GTT if high risk
    • FBS , random s or A1c for all due to high prevalence of diabetes in UAE
  • Visits to include reviews, checks and tests in accordance with DHA Antenatal Care Protocols.
  • 3 ante-natal ultra sounds.
In-patient maternity services
  • 10% co-insurance payable by the insured

    (all limits include coinsurance)

 
  • Requires prior approval from the insurance

    company or within 24 hours of emergency

    treatment.

Normal Delivery AED 7,000 AED 7,000 AED 10,000 AED 15,000
Medically necessary C-Section, Complications &

medically necessary Termination

AED 10,000 AED 10,000 AED 15,000 AED 20,000
New Born Cover Cover for 30 days from birth (BCG, Hepatitis B & Neo-natal screening test)
  BCG, Hepatitis B and neo-natal screening tests (Phenylketonuria (PKU), Congenital Hypothyroidism, sickle cell screening, congenital adrenal hyperplasia)
PREVENTIVE SERVICES, VACCINES & IMMUNIZATIONS
  • Essential vaccinations & inoculations for newborns and children as stipulated in the DHA’s policies and its updates (currently the same as Federal MOH)
 
  • Preventive services as stipulated by DHA to include initially diabetes screening
Frequency restricted to:  
Diabetes: Every 3 years from age 30
High risk individuals annually from age 18
EXCLUDED HEALTHCARE SERVICES EXCEPT IN CASE OF MEDICAL EMERGENCIES
  • Subject to 20% co-insurance ·  

    Diagnostic and treatment services for dental & gum treatments

 
  • Hearing & vision aids, and vision correction by surgeries and laser
REMARKS:
✔  = Covered ; X = Not Covered
❶ The above benefits are for the purpose of ILLUSTRATION only and the extent of coverage are subject to the terms and conditions of HealthNet Individual Policy .
❷ Elective Treatment (non- emergency) received at non- network within UAE is limited to 60% of HealthNet Network Rates subject to pre- authorization
❸ Elective Treatment (non- emergency) received outside the UAE within Geographcial Area of coverage is covered subject to pre- authorization up to Usual, Customary & Reasonable not exceeding Network Rates
❹ Inpatient or Outpatient Treatment expense relating to Pre- existing conditions may be covered subject to policy terms & conditions.
GEOGRAPHICAL AREA OF COVERAGE:
❶ Emirates Plan: Treatement anywhere with the UAE
❷ Emirates Plus Plan: Treatment anywhere within the UAE and when traveling on business or vacation for periods not exceeding 90 consecutive days per trip in the MIDDLE EAST, Bangladesh, India, Malaysia, Nepal, Pakistan, Philippines, Singapore and Sri Lanka
❸ International Plan: Treatment worldwide excluding USA, Canada & the Caribbean
❹ Global Plan: Treatement Worldwide