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 |
|
✔ | ✔ | ✔ | ✔ |
|
✔ | ✔ | ✔ | ✔ | |
|
✔ | ✔ | ✔ | ✔ | |
Initial investigations to include: | |||||
|
✔ | ✔ | ✔ | ✔ | |
|
✔ | ✔ | ✔ | ✔ | |
|
✔ | ✔ | ✔ | ✔ | |
|
✔ | ✔ | ✔ | ✔ | |
|
✔ | ✔ | ✔ | ✔ | |
|
✔ | ✔ | ✔ | ✔ | |
|
✔ | ✔ | ✔ | ✔ | |
|
✔ | ✔ | ✔ | ✔ | |
|
✔ | ✔ | ✔ | ✔ | |
|
✔ | ✔ | ✔ | ✔ | |
|
✔ | ✔ | ✔ | ✔ | |
In-patient maternity services |
|
✔ | ✔ | ✔ | ✔ |
|
✔ | ✔ | ✔ | ✔ | |
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 |
|
✔ | ✔ | ✔ | ✔ |
|
✔ | ✔ | ✔ | ✔ | |
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 |
|
✔ | ✔ | ✔ | ✔ |
|
✔ | ✔ | ✔ | ✔ |
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 |
The form was submitted successfully!