our services

Geographic scope of coverage

Basic healthcare services

Within the Emirate of Dubai (and other emirates or countries at the discretion of the insurer)

Emergency medical treatment

Within all emirates of the UAE

Provider network

Limited network is acceptable

The network must provide reasonable geographic access for the insured in relation to place of work and residence

Pre-existing conditions

Cover cannot be denied due to pre-existing conditions

Treatment for chronic and pre-existing conditions excluded for first 6 months of first scheme membership. Included thereafter

Basic healthcare services: in-patient treatment at authorized hospitals

Referral procedure:

In respect of Essential Benefit Plan members, no costs incurred for advice, consultations or treatments provided by specialists or consultants without the insured first consulting a General Practitioner (or equivalent as designated by DHA) who is licensed by DHA or another competent UAE authority will be payable by the insurer. The GP must make his referral together with reasons via the DHA e-Referrals system for the claim to be considered by the Insurer.

Tests, diagnosis, treatments and surgeries in hospitals for non-urgent medical cases

Prior approval required from the insurance company

20% coinsurance payable by the insured 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.

Emergency treatment

Approval required from the insurance company within 24 hours of admission to the authorized hospital

In-patient services will be received in rooms of two or more beds

Prior approval required from the insurance company

Healthcare services for emergency cases

(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)

Ground transportation services in the UAE provided by an authorized party for medical emergencies

Companion accommodation

The cost of accommodating a person accompanying an insured child up to the age of 16 years

Maximum 100 AED per night

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

Maximum 100 AED per night

Maternity services

Note: Where any condition develops which becomes an emergency, the medically necessary expenses will be covered up to the annual aggregate limit.

Out-patient ante-natal services

Requires prior approval from the insurance company

10% coinsurance payable by the insured

8 visits to PHC;

All care provided by PHC obstetrician for low risk or specialist obstetrician for high risk referrals

Initial investigations to include:

» FBC and Platelets

» Blood group, Rhesus status and antibodies

» VDRL

» MSU & urinalysis

» Rubella serology

» HIV

» Hep C offered to high risk patients

» GTT if high risk

» FBS , random s or A1c for all due to high prevalence of diabetes in UAE

Visits to include reviews, checks and tests in accordance with DHA Antenatal Care Protocols

3 ante-natal ultrasound scans

In-patient maternity services

Requires prior approval from the insurance company or within 24 hours of emergency treatment

10% coinsurance payable by the insured

Maximum benefit 7,000 AED per normal delivery, 10,000 AED for medically necessary C-section, complications and for medically necessary termination (All limits include coinsurance)

New born cover

Cover for 30 days from birth.

BCG, Hepatitis B and neo-natal screening tests (Phenylketonuria (PKU),Congenital Hypothyroidism, sickle cell screening, congenital adrenal hyperplasia)

Basic healthcare services: out-patient in authorized out-patient clinics of hospitals, clinics and health centers

Referral procedure:

In respect of Essential Benefit Plan members, no costs incurred for advice, consultations or treatments provided by specialists or consultants without the insured first consulting a General Practitioner (or equivalent as designated by DHA) who is licensed by DHA or another competent UAE authority will be payable by the insurer. The GP must make his referral together with reasons via the DHA e-Referrals system for the claim to be considered by the Insurer.

Examination, diagnostic and treatment services by authorized general practitioners, specialists and consultants

20% coinsurance payable by the insured per visit No coinsurance if a follow-up visit made within seven days

Laboratory test services carried out in the authorized facility assigned to treat the insured person

20% coinsurance payable by the insured

Radiology diagnostic services carried out in the authorized facility assigned to treat the insured person.

In cases of non-medical emergencies, the insurance company's prior approval is required for MRI, CT scans and endoscopies

20% coinsurance payable by the insured

Physiotherapy treatment services

Prior approval of the insurance company is required

Maximum 6 sessions per year. 20% coinsurance payable per session.

Drugs and other medicines

Cost of drugs and medicines up to an annual limit of 1,500 AED (including coinsurance). Medicines should be restricted to formulary products where available.

30% payable by the insured in respect of each and every prescription

No cover for drugs and medicines in excess of the annual limit

Preventive services, vaccines and immunizations

Essential vaccinations and inoculations for newborns and children as stipulated in the DHA's policies and its updates (currently the same as Federal MOH)

Preventive services as stipulated by DHA to include initially diabetes screening

The DHA has to notify authorized insurance companies of any preventive services that will be added to the basic package at least three months in advance of the implementation date and the newly covered preventive services will be covered from that date

Frequency restricted to:

Diabetes:

Every 3 years from age 30

High risk individuals annually from age 18

Excluded healthcare services except in cases of medical emergencies

Diagnostic and treatment services for dental and gum treatments

Subject to 20% coinsurance

Hearing and vision aids, and vision correction by surgeries and laser

Subject to 20% coinsurance