Escolar Documentos
Profissional Documentos
Cultura Documentos
No.
Benefits
Flexi DUBAI
2015- Diamond
Flexi DUBAI
2015- Gold
AED 1,500,000/=
AED 750,000/=
AED 250,000/=
AED 150,000/=
AED 150,000/=
AED 150,000/=
UAE Only
Aggregate Limit
Worldwide
excluding USA &
Canada
Eligibility
Network
GN + AH
GN
Treatment in
American
Hospital * 20%
Co Insurance in
Op & IP
Age Limit
0 to unlimited
0 to unlimited
RN
RN2
RN3
(Outpatient
treatment
restricted to
clinics only)
0 to unlimited
0 to unlimited
0 to unlimited
*Outpatient:
Nextcare's PCP
network
(specialist visits
from RN3
network is
allowed after
referral from PCP
GPs only)
*Inpatient: RN3
hospitals (referral
from PCP doctors
only)
0 to unlimited
20% Coinsurance
subject to UCR
Network Charges
Within the
Network
on Direct Billing
Basis
Within the
Network
on Direct Billing
Basis
Outside the
Network on
Reimbursement
Basis
Outside the
Network on
Reimbursement
Basis
Within the
Network
on Direct Billing
Basis
Outside the
Network on
Reimbursement
Basis
* For emergency
treatment within
UAE covered in
full
(Life threatening
cases)
Within the
Network
on Direct Billing
Basis
Outside the
Network on
Reimbursement
Basis
* For emergency
treatment within
UAE covered in
full
(Life threatening
cases)
Within the
Network
on Direct Billing
Basis
Outside the
Network on
Reimbursement
Basis
* For emergency
treatment within
UAE covered in
full
(Life threatening
cases)
Within the
Network
on Direct Billing
Basis
Outside the
Network on
Reimbursement
Basis
* For emergency
treatment within
UAE covered in
full
(Life threatening
cases)
In-Patient Treatment
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Hospital Accommodation (
Room Charges )
Private Room
Covered
Private Room
Covered
Private Room
Coveredup to
aed 750 per day
Semi Private
Room
Coveredup to aed
450 per day
Semi Private
Room
Coveredup to aed
450 per day
Semi Private
Room
Coveredup to aed
450 per day
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
d
e
f
g
h
i
Surgeons', consultants,
anaesthetist', specialists' ,
General Practitioners' fees
Prescribed Medicine and drugs
Reconstructive surgery
following an accident or
following surgery for an eligible
medical condition
Prostheses: artificial body parts
surgically implated to form
permanent parts of an insured
member's body
MRI, PET, CT Scans
X-Rays, Pathology, diagnostic
tests and procedures
Oncology tests, drugs and
consultants' fees including
cover for chemotherapy and
radiotheraphy
Parent accommodation
Hospital accomodation cost in
respect of a parent or legal
guardian staying with an
Insured member who is under
18 years of age and is admitted
to a Hospital as an In-Patient.
Ground transportation services
in the UAE provided by an
authorized party for medical
emergencies
Accidental Damage to Teeth
Treatment recevied in an
Emergency room in a Hospital
within 48 hours of incurring
Accidental damage caused to
sound, natural teeth as a result
of an Accident.
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered up to
AED 200/= per
day
Covered up to
AED 200/= per
day
Covered up to
AED 200/= per
day
Covered up to
AED 200/= per
day
Covered up to
AED 200/= per
day
Covered up to
AED 200/= per
day
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered up to
AED 300/= per
day
Covered up to
AED 300/= per
day
Covered up to
AED 200/= per
day
Covered up to
AED 200/= per
day
Covered up to
AED 200/= per
day
Covered up to
AED 200/= per
day
20% coinsurance
With a cap of 500
AED payable per
encounter and an
annual aggregate
cap of 1000 AED.
Above these caps
the insurer will
cover 100% of
treatment
Cover :
Emergency
Treatment
required to save
or alleviate
danger to life
Cover :
Emergency
Treatment
required to save
or alleviate
danger to life
NIL
NIL
NIL
NIL
Medical emergencies on
Hearing and vision aids, and
vision correction by surgeries
and laser.
Cover :
Emergency
Treatment
required to save
or alleviate
danger to life
Cover :
Emergency
Treatment
required to save
or alleviate
danger to life
Cover :
Emergency
Treatment
required to save
or alleviate
danger to life
Cover :
Emergency
Treatment
required to save
or alleviate
danger to life
20% coinsurance
With a cap of 500
AED payable per
encounter and an
annual aggregate
cap of 1000 AED.
Above these caps
the insurer will
cover 100% of
treatment
Cover :
Emergency
Treatment
required to save
or alleviate
danger to life
Cover :
Emergency
Treatment
required to save
or alleviate
danger to life
Cover :
Emergency
Treatment
required to save
or alleviate
danger to life
Cover :
Emergency
Treatment
required to save
or alleviate
danger to life
Cover :
Emergency
Treatment
required to save
or alleviate
danger to life
Cover :
Emergency
Treatment
required to save
or alleviate
danger to life
( Applicable if treatment is
taken in a facility
in-side/outside the Network of
providers )
10% coinsurance
payable by the
insured
Maximum
benefit 15 ,000
AED per normal
delivery, 20 ,000
AED for
medically
necessary Csection,
complications
and for medically
necessary
termination (All
limits include
coinsurance)
10% coinsurance
payable by the
insured
Maximum
benefit 10 ,000
AED per normal
delivery, 15 ,000
AED for medically
necessary Csection,
complications
and for medically
necessary
termination (All
limits include
coinsurance)
10% coinsurance
payable by the
insured
Maximum
benefit 7 ,000
AED per normal
delivery, 10 ,000
AED for
medically
necessary Csection,
complications
and for medically
necessary
termination (All
limits include
coinsurance)
10% coinsurance
payable by the
insured Maximum
benefit 7 ,000
AED per normal
delivery, 10 ,000
AED for medically
necessary Csection,
complications and
for medically
necessary
termination (All
limits include
coinsurance)
10% coinsurance
payable by the
insured Maximum
benefit 7 ,000
AED per normal
delivery, 10 ,000
AED for medically
necessary Csection,
complications and
for medically
necessary
termination (All
limits include
coinsurance)
10% coinsurance
payable by the
insured Maximum
benefit 7 ,000
AED per normal
delivery, 10 ,000
AED for medically
necessary Csection,
complications and
for medically
necessary
termination (All
limits include
coinsurance)
20% coinsurance
on OP
consultation or
AED 50/- on all
OP
consultation
whichever is
lower.
20% coinsurance
on OP
consultation or
AED 50/- on all
OP
consultation
whichever is
lower.
20% coinsurance
on OP
consultation or
AED 50/- on all
OP
consultation
whichever is
lower.
20% coinsurance
on OP
consultation or
AED 50/- on all
OP
consultation
whichever is
lower.
20% coinsurance
on OP
consultation or
AED 50/- on all
OP
consultation
whichever is
lower.
20% coinsurance
on OP
consultation or
AED 50/- on all
OP
consultation
whichever is
lower.
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
30% Coinsurance
Maximum Limit
30% Coinsurance
Maximum Limit
3
4
AED 2,000
6
7
8
9
Physiotherapy recommended /
referred by a General
Practitioner or a Specialist,
Oncology tests, drugs and
consultants' fees including
cover for chemotherapy and
radiotheraphy
MRI, PET, CT Scans
Out-Patient Surgical Operations
Post - Hospitalization
Treatment
AED 1,500
Covered up to 6
Covered up to 6
sessions per
sessions per
ailment/condition ailment/condition
per person per
per person per
year
year
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Covered
Other Benefits
ab
ac
ad
10% Copay , Maximum 8 visits checks and tests in accordance with DHA Antenatal Care Protocols
ae
af
ag
Covered upto a
limit of
AED 5,000/=
Covered upto a
limit of
AED 4,000/=
Covered upto a
limit of
AED 2,500/=
Covered upto a
limit of
AED 1,000/=
Covered upto a
limit of
AED 1,000/=
Covered upto a
limit of
AED 1,000/=
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered in Full
Covered up to a
limit of
AED 2,000/=
with AED 100/=
as deductible
Not Covered
Not Covered
Not Covered
Not Covered
Not Covered
Covered up to a
limit of
AED 200/= for a
pair of lenses
Not Covered
Not Covered
Not Covered
Not Covered
Not Covered
Dental Cover
ah
ai
Cover for a pair of lenses only.
aj
ak
al
am
Preventive services
*Preventive services as stipulated by DHA to include initially diabetes and Papanicolaou test.
*Frequency restricted to:
Diabetes: Every 3 years from age 30
High risk individuals annually from age 18 Papanicolaou: Every 3 years for married female
AED 2,000/=
Plus
AED 2,000/= for
accompanying
Family Member
Covered
(Refer to Global
Emergency
Services
brochure for
complete
information on
coverage,
conditions and
exclusions)
AED 2,000/=
Insured patient
only
AED 2,000/=
Insured patient
only
AED 2,000/=
Insured patient
only
AED 2,000/=
Insured patient
only
AED 2,000/=
Insured patient
only
Covered
(Refer to Global
Emergency
Services brochure
for complete
information on
coverage,
conditions and
exclusions)
Covered
(Refer to Global
Emergency
Services
brochure for
complete
information on
coverage,
conditions and
exclusions)
Covered
(Refer to Global
Emergency
Services brochure
for complete
information on
coverage,
conditions and
exclusions)
Not Covered
Not Covered
an
ao
Covered
(Refer to Global
Emergency
Services
brochure for
complete
information on
coverage,
conditions and
exclusions)
- Confirmation of
Diagnosis
- Evaluation of
cases where
diagnosis has not
been possible
- Determination
of the most
appropriate
course of
treatment
- Follow up on a
previously
reported case.
Covered
(Refer to Global
Emergency
Services brochure
for complete
information on
coverage,
conditions and
exclusions)
- Confirmation of
Diagnosis
- Evaluation of
cases where
diagnosis has not
been possible
- Determination
of the most
appropriate
course of
treatment
- Follow up on a
previously
reported case.
Covered
(Refer to Global
Emergency
Services
brochure for
complete
information on
coverage,
conditions and
exclusions)
- Confirmation of
Diagnosis
- Evaluation of
cases where
diagnosis has not
been possible
- Determination
of the most
appropriate
course of
treatment
- Follow up on a
previously
reported case.
Covered
(Refer to Global
Emergency
Services brochure
for complete
information on
coverage,
conditions and
exclusions)
- Confirmation of
Diagnosis
- Evaluation of
cases where
diagnosis has not
been possible
- Determination
of the most
appropriate
course of
treatment
- Follow up on a
previously
reported case.
Not Covered
Not Covered
Covered Max
AED 25,000.
Covered Max
AED 20,000.
Covered Max
AED 15,000.
Covered Max
AED10,000.
Not Covered
Not Covered