| Category |
Individual |
Individual |
Individual |
| Family of benefits |
In & Out Patient |
In & Out Patient |
In & Out Patient |
| Annual aggregate Limit (OP+IP) |
Covered up to AED 250,000 pppy |
Covered up to AED 150,000 pppy |
Covered up to AED 150,000 pppy |
| Scope of Cover |
To Cover the
Reasonable and
customary Medical
Expenses and costs
arising due to
accidental injuries and
/ or illness occurring
During the policy
period as per
DubaiCare Group
policy wording,
provisions, terms,
conditions and
exclusions
|
To Cover the
Reasonable and
customary Medical
Expenses and costs
arising due to
accidental injuries and
/ or illness occurring
During the policy
period as per
DubaiCare Group
policy wording,
provisions, terms,
conditions and
exclusions
|
To Cover the Reasonable
and customary Medical
Expenses and costs arising
due to accidental injuries
and / or illness occurring
During the policy period
as per DubaiCare Group
policy wording,
provisions, terms,
conditions and exclusions
|
| Members covered |
Eligible Individuals |
Eligible Individuals |
Eligible Individuals |
| Area of coverage (AOC) - (Elective & Emergency) |
WW Excl. USA, Canada & Caribbean |
UAE, Arab Countries,
Sub-Asia countries,
Philippines, Korea &
Sri-lanka
|
UAE, Arab Countries, SubAsia countries, Philippines, Korea & Srilanka |
| Extension of Area of Cover (Only emergency IP) |
Worldwide |
Worldwide |
Worldwide |
| Network |
DubaiCare N2 |
DubaiCare N3 |
DubaiCare N4 |
| Deductible |
20% Subject to Max up
to AED 50 on per
doctor Visit follow up
consultation within 7
days is free for same
illness |
20% Subject to Max up
to AED 50 on per
doctor Visit follow up
consultation within 7
days is free for same
illness |
20% Subject to Max up to
AED 50 on per doctor Visit
follow up consultation
within 7 days is free for
same illness |
| WAITING PERIOD CLAUSE |
If no Certificate of
Continuity of Cover
(COC) is provided, a
waiting period of 6
months applies.
Where a pre-existing
or chronic condition
develops into an
emergency within
the 6-month
exclusion period, this
must be covered up
to the annual
aggregate limit.
If Certificate of
Continuity of Cover
(COC) is provided,
the waiting period is
waived. The above
clause is applicable
for ALL cases
including maternity.
|
If no Certificate of
Continuity of Cover
(COC) is provided, a
waiting period of 6
months applies.
Where a pre-existing
or chronic condition
develops into an
emergency within
the 6-month
exclusion period, this
must be covered up
to the annual
aggregate limit.
If Certificate of
Continuity of Cover
(COC) is provided,
the waiting period is
waived. The above
clause is applicable
for ALL cases
including maternity.
|
If no Certificate of
Continuity of Cover
(COC) is provided, a
waiting period of 6
months applies. Where a
pre-existing or chronic
condition develops into
an emergency within the
6-month exclusion
period, this must be
covered up to the annual
aggregate limit.
If Certificate of
Continuity of Cover
(COC) is provided, the
waiting period is
waived. The above
clause is applicable for
ALL cases including
maternity.
|
| MEDICAL UNDERWRITING CLAUSE |
Declared Conditions
will be priced and
substandard
premiums shall apply.
Undeclared preexisting conditions
will not be covered
during the policy
period and will be
underwritten at
renewal. The
completion of
Individual Application
Form is required for
all Individuals. |
Declared Conditions
will be priced and
substandard
premiums shall apply.
Undeclared preexisting conditions will
not be covered during
the policy period and
will be underwritten at
renewal. The
completion of
Individual Application
Form is required for
all Individuals. |
Declared Conditions will
be priced and substandard
premiums shall apply.
Undeclared pre-existing
conditions will not be
covered during the policy
period and will be
underwritten at renewal.
The completion of
Individual Application
Form is required for all
Individuals. |
|
Pre-existing & chronic conditions & consequences
|
Covered up to
Annual Aggregate
Limit for all
members being
renewed, however
Individual
Application Form is
required for all
Individuals.
|
Covered up to Annual
Aggregate Limit for
all members being
renewed, however
Individual
Application Form is
required for all
Individuals.
|
Covered up to Annual
Aggregate Limit for all
members being
renewed, however
Individual Application
Form is required for all
Individuals.
|
|
Hospital Class
|
Private Room
|
Private Room
|
Private Room
|
|
Emergency Treatment:
|
Within Network: 100% on
direct billingOutside
Network, within UAE: 100%
of actual costs subject to a
maximum of 100% of
applicable UAE Network
tariff on reimbursement
basis.Outside UAE, within
AOC: 100% of actual costs
subject to a maximum of
100% of applicable UAE
Network tariff on
reimbursement
basis.Outside AOC: 100% of
actual costs subject to a
maximum of 100% of
applicable UAE Network
tariff on reimbursement
basis.
|
Within Network: 100% on
direct billingOutside
Network, within UAE: 100%
of actual costs subject to a
maximum of 100% of
applicable UAE Network
tariff on reimbursement
basis.Outside UAE, within
AOC: 100% of actual costs
subject to a maximum of
100% of applicable UAE
Network tariff on
reimbursement
basis.Outside AOC: 100% of
actual costs subject to a
maximum of 100% of
applicable UAE Network
tariff on reimbursement
basis.
|
Within Network: 100% on
direct billingOutside Network,
within UAE: 100% of actual
costs subject to a maximum of
100% of applicable UAE
Network tariff on
reimbursement basis.Outside
UAE, within AOC: 100% of
actual costs subject to a
maximum of 100% of
applicable UAE Network tariff
on reimbursement
basis.Outside AOC: 100% of
actual costs subject to a
maximum of 100% of
applicable UAE Network tariff
on reimbursement basis.
|
|
Elective Treatment
|
Within Network: 100% on
direct billing
Outside Network, within UAE:
With prior approval: 80% of
actual costs subject to a
maximum of 80% of
applicable UAE Network tariff
on reimbursement basis.
Outside UAE, within AOC:
With prior approval: 100% of
actual costs subject to a
maximum of 100% of
applicable UAE Network tariff
on reimbursement basis.
Outside AOC– Not covered
All costs of services not
incurred on direct billing shall
be considered on
reimbursement basis as
above.
|
Within Network: 100% on
direct billing
Outside Network, within UAE:
With prior approval: 80% of
actual costs subject to a
maximum of 80% of
applicable UAE Network tariff
on reimbursement basis.
Outside UAE, within AOC:
With prior approval: 100% of
actual costs subject to a
maximum of 100% of
applicable UAE Network tariff
on reimbursement basis.
Outside AOC– Not covered
All costs of services not
incurred on direct billing shall
be considered on
reimbursement basis as
above.
|
Within Network: 100% on direct
billing
Outside Network, within UAE:
With prior approval: 80% of
actual costs subject to a
maximum of 80% of applicable
UAE Network tariff on
reimbursement basis.
Outside UAE, within AOC: With
prior approval: 100% of actual
costs subject to a maximum of
100% of applicable UAE
Network tariff on
reimbursement basis.
Outside AOC– Not covered
All costs of services not incurred
on direct billing shall be
considered on reimbursement
basis as above.
|
| Out Patient Benefits |
|
General Out-Patient Services
|
Covered*
|
Covered*
|
Covered*
|
|
Specialist fees and consultations
|
Covered*
|
Covered*
|
Covered*
|
|
Follow up consultations
|
Covered*
|
Covered*
|
Covered*
|
|
Second opinion consultation
|
Covered*
|
Covered*
|
Covered*
|
|
Outpatient (X-ray and Pathology and Diagnostic tests)
|
Covered*
|
Covered*
|
Covered*
|
|
MRI & CT Scans received as an outpatient and preauthorized.
|
Covered*
|
Covered*
|
Covered*
|
|
MRI & CT Scans received as an outpatient and preauthorized.
|
Covered*
|
Covered*
|
Covered*
|
|
Out-Patient Prescribed Drugs
|
Covered*
|
Covered*
|
Covered*
|
|
Outpatient Physiotherapy (which is medically necessary and prescribed by a specialist)
|
Full refund at Network Hospital,
if necessary and prescribed by
the treating physician.
|
Full refund at Network Hospital,
if necessary and prescribed by
the treating physician.
|
Full refund at Network Hospital,
if necessary and prescribed by
the treating physician.
|
|
Routine maintenance
of chronic illness– For
non pre existing
illnesses only
|
Covered*
|
Covered*
|
Covered*
|
|
Materials, Injections
and dressing
|
Covered*
|
Covered*
|
Covered*
|
|
Accidental Damage to
Natural Teeth
following an accident
(Only initial treatment
is covered. Follow up
not covered. No cover
for treatment resulting
from consumption of
food or drink or any
foreign bodies
contained in such
food/drink)
|
Covered for treatment
required immediately (within
7 days of accident) following
accidental damage to natural
teeth by external trauma and
when treatment is given by
medical practitioner.
|
Covered for treatment
required immediately (within
7 days of accident) following
accidental damage to natural
teeth by external trauma and
when treatment is given by
medical practitioner.
|
Covered for treatment
required immediately (within
7 days of accident) following
accidental damage to natural
teeth by external trauma and
when treatment is given by
medical practitioner.
|
| Outpatient Oncology
tests and drugs. |
Covered* |
Covered* |
Covered* |
| Outpatient surgical
operations |
Covered* |
Covered* |
Covered* |
| In Patient Benefits |
| Hospital accommodation
(Room and Board) |
Covered* |
Covered* |
Covered* |
| Intensive care unit
(Room and Board) |
Covered* |
Covered* |
Covered* |
| IInpatient Physiotherapy
(which is medically
necessary and
prescribed by a
specialist) |
Covered* |
Covered* |
Covered* |
| IInpatient Physiotherapy
(which is medically
necessary and
prescribed by a
specialist) |
Covered* |
Covered* |
Covered* |
| Emergency ward services |
Covered* |
Covered* |
Covered* |
| Organ Transplant cost -
Kidney, Heart & Liver |
Covered* |
Covered* |
Covered* |
| MRI & CT Scans received
as an inpatient and preauthorized.
|
Covered* |
Covered* |
Covered* |
| X rays, Pathology and
diagnostic tests
|
Covered* |
Covered* |
Covered* |
| Oncology test, Drugs and
consultant's fee
(including cover for
chemotherapy and
radiotherapy)
|
Covered* |
Covered* |
Covered* |
| Surgical fees, including
anesthesia & theatre
charges
|
Covered* |
Covered* |
Covered* |
| Physician, surgeon, &
anesthetist fees
|
Covered* |
Covered* |
Covered* |
| Prescribed Medicines and
Drugs.
|
Covered* |
Covered* |
Covered* |
| Emergency road
ambulance services to
and from hospital by
registered ambulance
services provider
|
Covered* |
Covered* |
Covered* |
| Organ Transplant cost
(cost of surgical
procedures in performing
an organ transplant of
either: Kidney, Heart &
Liver in respect of the
insured person as
recipient and not the
organ donor)
|
Covered* |
Covered* |
Covered* |
| Surgical appliances and
prostheses`
|
Covered* |
Covered* |
Covered* |
| Parent accommodation
(Hospital accommodation
cost in respect of a parent
or legal guardian staying
with an insured person who is under 18 years of
age and is admitted to a
hospital).
|
Covered up to AED 200 / day |
Covered up to AED 200 / day |
Covered up to AED 200 / day |
| The cost of
accommodation of a
person accompanying an
in-patient in the same
room in cases of medical
necessity at the
recommendation of the
treating doctor and after
the prior approval of the
insurance company
providing coverage
|
Covered up to AED 200 / day |
Covered up to AED 200 / day |
Covered up to AED 200 / day |
| Cash Indemnity for
Inpatient Treatment
|
AED 200/- up to 180 days for
all inpatient hospitalization
that are not submitted to the
insurance company. |
AED 200/- up to 180 days for
all inpatient hospitalization
that are not submitted to the
insurance company. |
AED 200/- up to 180 days for
all inpatient hospitalization
that are not submitted to the
insurance company. |
| Maternity:
(Normal vaginal delivery,
Medically necessary
abdominal delivery
(Caesarian section),
Dilatation & Curettage
(D&C) for
miscarriage/legal
abortion, all complication
of delivery/maternity
cases)
Note: Where any
condition develops which
becomes life threatening
to either the mother or
the new born, the
medically necessary
expenses will be covered
up to the policy Limit
Nil waiting period
Ongoing cases covered
Elective Caesarian – not
covered
|
Out Patient ante-natal
services
-10% Co-insurance payable
by the insured
In-patient Maternity
Services
-10% Co-insurance payable
by the insured
-Maximum of AED 7,000 per
normal delivery, AED 10,000
for medically necessary CSection, Complication and
for medically necessary
termination |
Out Patient ante-natal
services
-10% Co-insurance payable
by the insured
In-patient Maternity
Services
-10% Co-insurance payable
by the insured
-Maximum of AED 7,000 per
normal delivery, AED 10,000
for medically necessary CSection, Complication and
for medically necessary
termination |
Out Patient ante-natal
services
-10% Co-insurance payable
by the insured
In-patient Maternity
Services
-10% Co-insurance payable
by the insured
-Maximum of AED 7,000 per
normal delivery, AED 10,000
for medically necessary CSection, Complication and
for medically necessary
termination |
| New Born cover
|
Cover for 30 Days from birth
BCG , Hepatitis B and NeoNatal Screening test
(Phenylketonuria ,Congenital
Hypothyroidism ,sickle cell
screening, Congenital adrenal
hyperplasia)
|
Cover for 30 Days from birth
BCG , Hepatitis B and NeoNatal Screening test
(Phenylketonuria ,Congenital
Hypothyroidism ,sickle cell
screening, Congenital adrenal
hyperplasia) |
Cover for 30 Days from birth
BCG , Hepatitis B and NeoNatal Screening test
(Phenylketonuria ,Congenital
Hypothyroidism ,sickle cell
screening, Congenital adrenal
hyperplasia)
|
| Dental |
Not Covered |
Not Covered |
Not Covered |
| Optical |
Not Covered |
Not Covered |
Not Covered |
| Repatriation of Mortal
Remains from UAE to
Home Country |
Covered up to AED 10,000
per person |
Covered up to AED 10,000
per person |
Covered up to AED 10,000
per person |
| Work Related Injuries
/illnesses – For
Employees Only |
Covered over and above
workmen’s compensation*
|
Covered over and above
workmen’s compensation*
|
Covered over and above
workmen’s compensation*
|
| Home nursing |
Covered up to AED 10,000
and maximum of up to 8
weeks following discharge
from hospital, if medically
necessary and if
recommended by treating
medical practitioner as
mandatory*
|
Covered up to AED 10,000
and maximum of up to 8
weeks following discharge
from hospital, if medically
necessary and if
recommended by treating
medical practitioner as
mandatory*
|
Covered up to AED 10,000
and maximum of up to 8
weeks following discharge
from hospital, if medically
necessary and if
recommended by treating
medical practitioner as
mandatory*
|
| Home nursing |
Covered up to AED 10,000
and maximum of up to 8
weeks following discharge
from hospital, if medically
necessary and if
recommended by treating
medical practitioner as
mandatory*
|
Covered up to AED 10,000
and maximum of up to 8
weeks following discharge
from hospital, if medically
necessary and if
recommended by treating
medical practitioner as
mandatory*
|
Covered up to AED 10,000
and maximum of up to 8
weeks following discharge
from hospital, if medically
necessary and if
recommended by treating
medical practitioner as
mandatory*
|
| Alternative Medicine -
Only chiropractic,
Ayurveda, homeopathy &
osteopathy
|
Covered up to AED 1,600 per
person per annum*
|
Covered up to AED 1,600 per
person per annum*
|
Covered up to AED 1,600 per
person per annum*
|
| Vaccinations (Covered on
reimbursed basis)
|
Essential vaccinations and
inoculations for newborns
and children as stipulated in
the DHA’s policies and its
updates in the assigned
facilities (currently the same
as Federal MOH)
|
Essential vaccinations and
inoculations for newborns
and children as stipulated in
the DHA’s policies and its
updates in the assigned
facilities (currently the same
as Federal MOH)
|
Essential vaccinations and
inoculations for newborns
and children as stipulated in
the DHA’s policies and its
updates in the assigned
facilities (currently the same
as Federal MOH)
|
| Preventive Services |
Covered Initial Diabetic
Screening. Frequency
Restricted to :
-Every 3 yrs from age 30
-High risk individual annually
from age 18
|
Covered Initial Diabetic
Screening. Frequency
Restricted to :
-Every 3 yrs from age 30
-High risk individual annually
from age 18
|
Covered Initial Diabetic
Screening. Frequency
Restricted to :
-Every 3 yrs from age 30
-High risk individual annually
from age 18
|
| Hepatitis C Virus
Screening and treatment |
To be followed as per the
guidelines laid out in the
Hepatitis C support program
|
To be followed as per the
guidelines laid out in the
Hepatitis C support program
|
To be followed as per the
guidelines laid out in the
Hepatitis C support program
|
| Cancer Screening and
treatment
|
To be followed as per the
guidelines laid out in the
Cancer support program
|
To be followed as per the
guidelines laid out in the
Cancer support program
|
To be followed as per the
guidelines laid out in the
Cancer support program
|
| Adult Pneumococcal
Conjugate Vaccine
|
As per DHA Adult
Pneumococcal Vaccination
guidelines
|
As per DHA Adult
Pneumococcal Vaccination
guidelines
|
As per DHA Adult
Pneumococcal Vaccination
guidelines
|
| International Assistance
Cover (Covered while
traveling outside of UAE
and outside of Home
countries)
|
1- Emergency Medical
Evacuation-Covered up to USD
1,000,000, 2- Emergency
medical repatriation - Covered
up to USD 10,000, 3-
Repatriation of Mortal remain -
Covered up to USD 10,000
|
1- Emergency Medical
Evacuation-Covered up to USD
1,000,000, 2- Emergency
medical repatriation - Covered
up to USD 10,000, 3-
Repatriation of Mortal remain -
Covered up to USD 10,000
|
1- Emergency Medical
Evacuation-Covered up to USD
1,000,000, 2- Emergency
medical repatriation - Covered
up to USD 10,000, 3-
Repatriation of Mortal remain -
Covered up to USD 10,000
|
| Trudoc |
24/7, Mobile Doctor |
24/7, Mobile Doctor |
24/7, Mobile Doctor |
| EXCLUSIONS |
Standard DHA Exclusions |
Standard DHA Exclusions |
Standard DHA Exclusions |
| Premium Calculation |
| Age 00-60 |
6889.00 |
5028.00 |
4488.00 |
| Basmah & HCV Charges |
37.00 |
37.00 |
37.00 |
| VAT 5% |
345.10 |
252.05 |
225.05 |
| GRAND TOTAL |
17271.10 |
5317.05 |
4759.05 |