Pre-existing conditions must be covered

Cover cannot be denied due to pre-existing conditions

Treatment for chronic and pre-existing conditions may be excluded during the first 6 months of membership of an individual’s first scheme within the UAE. (Here “scheme” includes any and all schemes providing cover for medical expenses whether or not it is self-funded or on an insured basis). In all other cases, pre-existing conditions must be covered from date of enrolment.

Not Applicable

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 authorised 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

Not Applicable

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 can be applied

The cost of accommodation of a person accompanying an in-patient in the same room in case of medical necessity at the recommendation of the treating doctor and after the prior approval of the insurance company providing coverage

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 10,000 AED per normal delivery.
• 10,000 AED for medically necessary C-section.
• Complications and for medically necessary termination (All limits include coinsurance).

Newborn cover

Coverage of a pregnant woman is extended by the insurer to provide the same benefits for a newborn child of the insured woman, for a period up to 30 days from the date of birth of the newborn. This cover is provided regardless of whether or not the newborn is eventually enrolled as a dependent member under the insurer’s policy

Cover for 30 days from birth. BCG, Hepatitis B and neo-natal screening tests (Phenylketonuria (PKU), Congenital Hypothyroidism, sickle cell screening, congenital adrenal hyperplasia)

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 is 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). 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

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

NA

NA

Preventive services as stipulated by DHA to include initial 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.

Influenza Vaccine

Mandatory

As per DHA Adult Pneumococcal Vaccination guidelines

Adult Pneumococcal Conjugate Vaccine

NA

As per DHA Adult Pneumococcal Vaccination guidelines

Hepatitis C Virus Screening and treatment

To be followed as per the guidelines laid out in the Hepatitis C support program

NA

Hepatitis B Virus Screening and treatment

To be followed as per the guidelines

NA

Cancer Screening and treatment

To be followed as per the guidelines laid out in the Cancer support program

NA

Diagnostic and treatment services for dental and gum treatments

NA

Subject to 20% coinsurance

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

NA

Subject to 20% coinsurance