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Sl.No
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Premier
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Global
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International
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Regional
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UAE
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Abu Dhabi
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(1)
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Annual Limit
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5,000,000
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5,000,000
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2,500,000
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500,000 / 1,000,000
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250,000 / 500,000
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250,000
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| |
Geographical Cover
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Worldwide
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Worldwide
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Worldwide excluding USA, Canada
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Worldwide excluding USA, Canada & Europe
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UAE
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Abu Dhabi
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| |
Worldwide coverage for medical emergencies
|
P
|
P
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P
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P
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UAE, South East Asia, Arab Countries, Indian Subcontinent, selected countries from East Europe, Africa & South America
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UAE
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|
(2)
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Pre-existing Conditions
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P
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P
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P
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P
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P
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Covered with a 6 months waiting period.
The waiting period applies to Inpatient treatment only.[See Note below]
No waiting period if pre-requisition of uninterrupted (pre-) coverage with governmental health card is fulfilled
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(3)
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Network
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1
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1
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1
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1
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2
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3
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|
(4)
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Inpatient accommodation type
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Standard Suite
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Standard Suite
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Deluxe
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First Class
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Shared room
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General Ward
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| |
Accommodation for Parent accompanying child (For age limit of child, refer to SOB)
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5,000
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500
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300
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150
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100
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100
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| |
Companion Accommodation for Critical Illness
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500
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500
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300
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150
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100
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100
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(5a,b)
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Physician Consultation
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P
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P
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P
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P
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P
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P
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(6)
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Diagnostics & Laboratory
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P
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P
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P
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P
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P
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P
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(7)
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Pharmaceuticals
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100%
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100%
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100%
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100%
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80%
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70%
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(8)
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Physiotherapy
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P
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P
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P
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P
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P
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P
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(9)
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Maternity
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P
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P
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P
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P
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P
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P
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(10)
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Dental
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15,000
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5,000 (optional)
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3,500 (optional)
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3,500 (optional)
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2,500 (optional)
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O
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| |
Second Opinion service VIPmed almeda
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P
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P
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P
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P
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P
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O
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| |
Global emergency assistance service by Assist America
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P
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P
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P
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P
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O
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O
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|
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Other Benefits
(medical appliances and equipment, psychiatric treatment, medical checkup, dietician, alternative medicine, chiropractic, vaccinations, contraceptives and birth control ... etc)
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P
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O
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O
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O
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O
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O
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| |
Repatriation of Mortal Remains
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12,500
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12,500
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10,000
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10,000
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7,500
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O
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[Note] Applicable to the following medical conditions: Diabetes mellitus, Arterial diseases, COPD (Chronic Obstructive Pulmonary Disease), All cancers cases, Neurosurgery, Cerebro Vascular diseases, All delivery cases (Maternity).
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1
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|
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Annual limit for the UAE and Regional Plans is lower for individual & small groups than the coverage limit for standard groups, the variation is half
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Top
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2
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|
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Coverage for individual and small groups shall be subject to declarations of known medical conditions at enrollment
Coverage for standard groups shall commence on member enrollment/policy
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Top
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3
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|
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Network1 for the regional plan excludes SKMC, Tawam Hospital - Abu Dhabi and American Hospital - Dubai
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Top
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4
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Inpatient
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|
Premier Plan:
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100% coverage for inpatient services in private room within and outside network
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Global Plan:
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100% coverage for inpatient services in private room within network, and 80% coverage outside network
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|
International Plan:
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100%coverage for inpatient services in private room within network, and 80% coverage outside network
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Regional Plan:
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100% coverage for inpatient services in private room within network, and 80% coverage outside network
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UAE Plan:
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100% coverage for inpatient services in shared room within network, 0% coverage outside network unless it is an emergency
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Abu Dhabi Plan:
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100% coverage for inpatient services in general ward within network , 0% coverage outside network unless it is an emergency
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Top
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5.a
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Outpatient
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Premier Plan:
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100% coverage for physician consultation within and outside network
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Global Plan:
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100% coverage for physician consultation within network, and 80% coverage for physician consultation outside network
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International Plan:
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100% coverage for physician consultation within network, and 80% coverage for physician consultation outside network
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Regional Plan:
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100% coverage for physician consultation within network, and 80% coverage for physician consultation outside network
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UAE Plan:
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100% coverage for physician consultation within network, 0% coverage for physician consultation outside network
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Abu Dhabi Plan:
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100% coverage for physician consultation within network, 0% coverage for physician consultation outside network
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Top
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5.b
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Deductible
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Premier Plan:
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Deductible of AED Nil
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Global Plan:
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Deductible of AED Nil/50 options offered to both small and large groups
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International Plan:
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Deductible of AED Nil/50 options offered to both small and large groups
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Regional Plan:
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Deductible of AED Nil/30/50 options offered to large groups and Deductible of AED 30/50 offered to small groups
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UAE Plan:
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Deductible of AED Nil/30/50 options offered to large groups and Deductible of AED 30/50 offered to small groups
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Abu Dhabi Plan:
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Deductible of AED 20 for GP consultation and Deductible of AED10 for Specialist consultation
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Top
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6
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Diagnostics & Laboratory
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Premier Plan:
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100% coverage within and outside network
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|
Global Plan:
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100% coverage within network, 80% coverage outside network
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International Plan:
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100% coverage within network, 80% coverage outside network
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Regional Plan:
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100% coverage within network, 80% coverage outside network
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UAE Plan:
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100% coverage within network, 0% coverage outside network
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Abu Dhabi Plan:
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100% coverage within network ; AED 10 Deductible/test, 0% coverage outside network
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Top
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7
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Pharmaceuticals
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Premier Plan:
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100% coverage within network and outside network
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Global Plan:
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100% coverage within network , 80% coverage outside network
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International Plan:
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100% coverage within network, 80% coverage outside network
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Regional Plan:
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100% coverage within network, 80% coverage outside network
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UAE Plan:
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80% coverage within network (max AED 100 out of pocket), 0% coverage outside network
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Abu Dhabi Plan:
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70% coverage within network, 0% coverage outside network
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Top
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8
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Physiotherapy
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Premier Plan:
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100% coverage within network, and outside network
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Global Plan:
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100% coverage within network, 80% coverage outside network
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International Plan:
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100% coverage within network, 80% coverage outside network
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Regional Plan:
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100% coverage within network, 80% coverage outside network
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UAE Plan:
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100% coverage within network , 0% coverage outside network
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Abu Dhabi Plan:
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100% coverage within network, 0% coverage outside network
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Top
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9
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Maternity (180 days waiting period applies for individuals and small groups only)
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Premier Plan:
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100% coverage within and outside network, coverage outside UAE max. AED 75,000 annually
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Global Plan:
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100% coverage within network, 80% coverage outside network, coverage outside UAE max. AED 15,000 annually
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International Plan:
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100% coverage within network, 80% coverage outside network, coverage outside UAE max. AED 10,000 annually
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Regional Plan:
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100% coverage within network, 80% coverage outside network, coverage outside UAE max. AED 10,000 annually
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UAE Plan:
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100% coverage within network, outside UAE max. AED 8,000 annually, 0% coverage outside network
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Abu Dhabi Plan:
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100% coverage within network after 180 days waiting period with AED 20 Deductible/ physician consultation and AED 500 upon delivery, 0% coverage outside network
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Top
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10
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Dental (with Pre-authorization)
Covered services include X-rays, anesthesia, assistance, extractions, amalgam/composite fillings, root canal treatments, prescribed drugs)
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Premier Plan:
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Additionally, the following services are covered at 80% (equals a co-insurance of 20%)
Consultations, surgical interventions, bridgework, crowns, periodontist, orthodontics, dentures, tooth scaling and bleaching, gum treatment up to AED 15,000. Offered to both small and large groups
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Global Plan:
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Optional coverage for Dental at 80% (equals a co-insurance of 20%) up to AED 5,000 offered to both small and large groups
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International Plan:
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Optional coverage for Dental at 80% (equals a co-insurance of 20%) up to AED 3,500 (optional) offered to both small and large groups
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Regional Plan:
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Optional coverage for Dental at 80% (equals a co-insurance of 20%) up to AED 3,500 for standard groups (not applicable for individuals and small groups)
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UAE Plan:
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Optional coverage for Dental at 80% (equals a co-insurance of 20%) up to AED 2,500 for standard groups (not applicable for individuals and small groups)
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Abu Dhabi Plan:
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No Dental coverage
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Top
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For specific details please refer to the Schedule of Benefits.
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