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Coverage Information

Daman Adjudication Rules make transparent how and when Daman covers and show under what conditions healthcare services are payable. This decision making process is called 'Adjudication Process'.

Daman Adjudication Rules

The Daman Adjudication Rules (AR's) are written mainly for healthcare professionals with a short summary for readers without a medical background. These AR's are drafted based on international best practice guidelines and evidence-based medicine in conjunction with Daman's schedules of benefits and UAE regulations.

Daman is to date the only insurance company in the region that publishes its rules in the public domain. We believe such transparency will help our stakeholders to understand Daman's coverage criteria and will improve the consistency in adjudication process across the region.

The adjudication rules should only be used for the purpose of reference or guidance for the adjudication process (refer to the disclaimer below).

Adjudication rule categories: 
MEDICAL | PHARMACEUTICAL | DENTAL | BILLING | HEALTH TECHNOLOGY ASSESSMENT

Adjudication rules are published on a quarterly basis, tentatively in March, June, September and December and are effective one month after publication to allow market consultation. Stakeholders are invited for feedback at any time, ideally during the above mentioned advisory period. For all your questions and comments, please contact our customer services at 800-432626.

Disclaimer

By accessing these Daman Adjudication Rules (the “AR”), you acknowledge that you have read and understood the terms of use set out in the disclaimer below: The information contained in these ARs is intended to outline the procedures of adjudication of medical claims as applied by the National Health Insurance Company – Daman PJSC (hereinafter “Daman”). The ARs are not intended to be comprehensive, should not be used as treatment guidelines and should only be used for the purpose of reference or guidance for adjudication procedures and shall not be construed as conclusive. Daman in no way interferes with the treatment of patient and will not bear any responsibility for treatment decisions interpreted through Daman AR. Treatment of patient is and remains at all times the sole responsibility of the treating Healthcare Provider. These ARs do not grant any rights or impose obligations on Daman. These ARs and all of the information they contain are provided "as is" without warranties of any kind, whether express or implied which are hereby expressly disclaimed.
Under no circumstances will Daman be liable to any person or business entity for any direct, indirect, special, incidental, consequential, or other damages arising out of any use of, access to, or inability to use or access to, or reliance on these ARs, including but without limitation to, any loss of profits, business interruption, or loss of programs or information, even if Daman has been specifically advised of the possibility of such damages. Daman also disclaims all liability for any material contained in other websites linked to Daman website.
These ARs are subject to the laws, decrees, circulars and regulations of Abu Dhabi and UAE. Any information provided herein is general and is not intended to replace or supersede any laws or regulations related to the ARs as enforced in the UAE issued by any governmental entity or regulatory authority, or any other written document governing the relationship between Daman and its contracting parties.
These ARs are developed by Daman and are the property of Daman and may not be copied, reproduced, distributed or displayed by any third party without Daman’s express written consent. These ARs incorporate the Current Procedural Terminology and Current Dental Terminology (CPT® and CDT®, which is a registered trademark of the American Medical Association (“AMA”), and the American Dental Association (“ADA”) respectively), and the CPT and CDT codes and descriptions belong to the AMA. Daman reserves the right to modify, alter, amend or obsolete these ARs at any time by providing one month prior notice.
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