Compare Plans - National General Insurance - NGI

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