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Plan Name
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Global with Dental & Optical
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Annual Benefit Limit per person
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AED 5,000,000
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Territorial Limit
Please note:
1) Coverage outside UAE is limited to 90 days per treatment
2) A single holiday- or business trip may not exceed 90 days
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Worldwide
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Network
(allowing direct billing at designated Providers)
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In & Out-patient: UAE (Daman Network including American Hospital), GCC and Jordan
In Patient Only: Daman Network
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Pre-existing conditions
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Standard Group*: Fully Covered
Individuals & Small Group**: Fully Covered; subject to Individual Underwriting for Groups less than 10 employees.
Waiting Period of 180 Days for Maternity (No waiting period if pre-requisition of uninterrupted (pre-) coverage with governmental health card is fulfilled)
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Inpatient & Day Treatment
(up to the relevant Annual Benefit Limit per person; per policy year with pre-approval only)
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Accommodation Type
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Private Room (Standard Suite)
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Hospital Accommodation & Services
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100% at Network Providers
80% at Non-Network Providers (equals a Co-insurance of 20%)
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Consultant’s, Surgeon’s & Anesthetist’s Fees, etc
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100% at Network Providers
80% at Non-Network Providers (equals a Co-insurance of 20%)
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Home Nursing
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AED 0
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Ambulance (in Medical Emergency only, subject to Standard Exclusions)
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100%
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Parent Accommodation for accompanying an Insured Child under 10 years of age
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Maximum AED 500 per day
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Companion Accommodation for Critical Illness
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Maximum AED 500 per day
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Outpatient Treatment
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Physician Consultation
Standard Group: Deductible/consultation options AED 50/0
Individuals & Small Group: Deductible/consultation options AED 50//0
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100% at Network Providers
80% at Non-Network Providers (equals a Co-insurance of 20%)
Deductible not applicable for follow up within 7 days
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Diagnostics (X-Ray, MRI, CT-Scan, Ultra Sound, etc.), Laboratory
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100% at Network Providers
80% at Non-Network Providers (equals a Co-insurance of 20%)
MRI, CT and Endoscopies with pre-authorization only
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Pharmaceuticals
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100% at Network Providers
80% at Non-Network Providers (equals a Co-insurance of 20%)
Long term medication above 60 days with pre-authorization only
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Physiotherapy
(with pre-authorization only)
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100% at Network Providers
80% at Non-Network Providers (equals a Co-insurance of 20%)
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Emergency Treatment
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100% Emergency Cover Worldwide
Exception: For in- and outpatient maternity treatment at Non-Network Provider:
- 80% Emergency Cover Worldwide
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Repatriation of Mortal Remains to the Country of Origin
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AED 12,500 per policy year
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Diagnostic and treatment services for dental and gum treatments
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Medical Emergency cases
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Hearing and vision aids, and vision correction by surgeries, and laser
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Medical Emergency cases
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Maternity
All in-patient Maternity Treatments are subject to pre-authorization
Maximum annual limit per person out of UAE (Inpatient & Outpatient Maternity): AED 15,000
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Inpatient Maternity
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100% at Network Providers in UAE
80% at Non-Network Providers (equals a Co-insurance of 20%)
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Outpatient Maternity
Standard Group: Deductible/consultation options AED 50/0
Individuals & Small Group: Deductible/consultation options AED 50//0
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100% at Network Providers
80% at Non-Network Providers
(Equals a Co-insurance of 20%)
Deductible not applicable for follow up within 7 days
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Dental
(Optional)
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80% with pre-authorization only
(Equals a Co-insurance of 20%)
Maximum annual limit per person AED 5,000
Covered services are restricted to the following:
a) X-Rays
b) Extractions
c) Amalgam / Composite Fillings
d) Root Canal Treatments
e) Prescribed Drugs for the above mentioned (a,b,c,&d)
covered dental services
(Accidental dental treatment covered at 100%)
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Optical
(Optional)
(Available only in combination with Dental)
(Applicable only for Standard Group)
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Limited to 2 vision tests per year and maximum coverage AED 500 PPPY including Prescribed Eye glasses, Frames and /or contact lenses
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Other Services
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International Assistance Service
Second Opinion facility through Europ Assistance GCS
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Annual Screening
(applicable for females >35)
(At designated Providers with pre- approval only)
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Breast cancer screening
For females above 35 years, including
a) Clinical Exam
b) Mammogram
c) Pelvic Sonogram (if medically indicated) and
d) CA 15.3 (if medically indicated)
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Annual Screening
(applicable for males>45)
(At designated Providers with pre- approval only)
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Prostate cancer screening
For males above 45 years, including
a) Clinical exam
b) PSA
c) Rectal sonogram
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* Group comprising of more than 10 employees.
** Group comprising of less than or equal to 10 employees.
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