Date 10 April 2023
QUOTATION NUMBER 2222
POLICY HOLDER Test
06-03-2023
POLICY EFFECTIVE DATE
ANNUALLY
MODE OF PAYMENT
PERIOD OF COVER 12 months from Effective date
All actively at work, full time & permanent employees of the Policyholder & their dependents as per the list provided. Basis of
BENEFICIARIES classification to be provided.
Coverage is mandatory for all Employees & their dependents, who are UAE residents.
Enrollment for all existing beneficiaries has been accepted up to age 65 years. All members aged 65 years and above will be subject to
AGE LIMIT
individual underwriting & pricing.
QUOTATION VALIDITY 30 days from quotation date
THIRD PARTY ADMINISTRATOR Aafiya
This quotation is based entirely on details, data set, census & background information provided in chain of emails for this group. Since
the terms quoted are very sensitive to this data, any variation in it will require revision of the quotation.
OTHER CONDITIONS Any members with Mission visa are not eligible to be included under this group medical isnsurance.
The quoted rate is subject to change if the total member at inception will vary by more than 10%.
Reimbursement claim submission within 60 days for UAE claims & 90 days for outside UAE.
1. Client confirmation by signing & stamping the quotation accepted
2. Updated membership list in excel format, including Emirates ID Number, Unified ID Number and Passport Number (Format will be
provided upon confirmation)
3. Proof of continuity of Health Insurance cover
4. Photograph of each member scanned separately & saved in JPEG format sorted by members name
REQUIREMENT FOR POLICY ISSUANCE 5. Trade License / Chamber of Commerce certificate
6. Establishment ID card / Entity ID (DHA members only)
7. Ministry of labour list
8. Duly filled, signed and stamped Credit Facility Application Form (Form will be provided upon confirmation)
9. Copies of company owner’s Passport, Visa and Emirates ID
10. VAT Certificate / Tax Registration Number
Additions/ Deletions shall be on pro-rata basis, however the amount of claims paid to the terminated member shall be deducted from
ENDORSEMENTS the pro-rata refund Contribution and in case the claims amount have exceeded the refund Contribution then the refund Contribution
shall be Zero.
Please note that, the Total Contribution quoted is indicative based on the ages of members as of today in the submitted census. The
CONTRIBUTION
Final Contribution may vary upon issuance of the policy and will be mentioned in Invoice.
The Contributions are excluding VAT, and are subject to VAT and any other taxes applicable on final invoice as per the laws and
VAT
regulations enforced in the UAE.
EDGE
CATEGORY Cat A
Network APN Edge
Sum Insured AED 1,50,000
Geographical Cover UAE and ISC
Regulatory Compliance DHA
Inpatient Treatment (Subject to prio approval)
Hospital Accommodation/Room & Board Limit Semi- Private Room
Per Medical Condition and Consequences sublimit AED 1,50,000
Cancer (Pre-existing or newly diagnosed) AED 1,50,000
Consultation, labs, diagnosis, treatments, surgeries and
prescribed medicines and drugs administered whilst in-patient Covered
or daycare
Physiotherapy Treatment (subject to prior approval) Covered up to maximum of 10 sessions / max AED 250 per session
Ground transportation services in the UAE provided by an
Full Covered
authorized party for medical emergencies
Accommodation for a person accompanying an insured child up
AED 200
to 16 years of age, per night
Accommodation for a person accompanying an insured member
in the same room in cases of medical necessity at the AED 200
recommendation of the treating doctor, per night
Organ Transplant Covered up to AED 150,000 excluding any cost related to donor and acquisition of organ
Outpatient Treatment
20% (Max AED 25)
Examination, diagnostic and treatment services by authorized
*No co-payment applicable for follow-up visits made within 7 days
general practitioners, specialists and consultants “Without GP Referral”
Laboratory test services carried out in the authorized facility
Covered 100%
assigned to treat the insured person
Radiology diagnostic services carried out in the authorized
facility assigned to treat the insured person; MRI, CT scans, and
Covered 100%
endoscopies require prior approval in case of medical non-
emergency
Physiotherapy treatment, subject to prior approval Covered up to maximum of 10 sessions / max AED 250 per session
Drugs and other medicines Covered 100% up to a maximum of AED 10,000
Other Benefits
Maternity Treatment
(Prior approval required; emergency cases to be notified within
24 hours)
Out-patient ante-natal services
All care provided by PHC obstetrician for Covered with 10% co-payment up to a maximum of 8 visits for low risk primiparas or 8 visits for multiparas
low risk or specialist obstetrician for high Initial investigations to include the following: FBC and Platelets; Blood group, Rhesus status and antibodies; VDRL; MSU & urinalysis;
risk referrals Visits to include reviews, Rubella serology; HIV; HepC offered to high risk patients; GTT if high risk; FBS, random s or A1c for all due to high prevalence of diabetes
checks and tests in accordance with DHA in UAE;
Antenatal Care Protocols
Covered with 10% co-payment up to a maximum of AED 10,000 for Normal Delivery and for medically necessary C-section, complications
In-patient maternity services and medically necessary termination
(all limits include co-payment)
New born cover Covered for 30 days from birth for the following tests: BCG, Hepatitis B and neo-natal screening test
Covered for essential vaccinations and inoculations for newborns and children as stipulated in DHA policies in assigned facilities
Preventive services, vaccines, and immunizations
Preventive services are covered as stipulated by DHA to include initial diabetes screening
Frequency restricted to Diabetes for every 3 yrs from age 30 yrs and annually from age 18 yrs for high risk individuals
Diagnostic and treatment services for dental and gum
Covered for medical emergencies
treatments
Hearing and vision aids, and vision correction by surgeries and
Covered for medical emergencies
laser
Alternative Medicine
(acupuncture/chiropractic/ayurvedic/homeopathic) - Covered with 20% coinsurance per visit upto AED 2,500
Reimbursement only
Coverage up to annual limit of AED 10,000/- (Outpatient: 20% coinsurance payable
Psychiatry Treatment & Mental Health (Inpatient, outpatient by the insured per visit
and emergency coverage) No coinsurance if a follow-up visit
made within seven days)
Additional Benefits (Optional)
Dental treatment is covered which arises from medical necessity COVERED
Sublimit AED 1,000 (incl. coinsurance)
Coinsurance Coinsurance: 20%
Only such treatment is covered which arises from medical necessity:
Treatments Routine examination once a year, Teeth Extraction, Amalgam fillings, Temporary and/or permanent composite fillings, x-ray, root canal
and gum treatment only. No treatment, braces, dentures, crowns covered for cosmetic reasons.
Optical NOT COVERED
Sublimit
Coinsurance
Treatments
Claims Settlement for Emergency / Elective Medical Treatment
80% Direct Billing/Reimbursement (basis as per UAE network tariff)
Basis of Settlement Outside UAE Pre-approval is required.
Covered for IP Elective treatments only.
Basis of Settlement Inside Aafiya Network & within UAE Direct Billing
Basis of Settlement Outside Aafiya Network & within UAE Covered at 80% Reimbursement basis as per our network tariff
i. Emergency Medical Treatments / Non-Network within
Covered at 100% Intimation within 24 Hrs.
UAE
ii. Government Hospitals / Non-Network within UAE Covered for emergency treatments at 100%. Intimation within 24 Hrs.
Exclusions As per DHA
Principal Dependents
Age Number of Member PPPY Total Contribution Number of Member PPPY Total Contribution
0-17 0 1,447.27 0.00
18-40 0 1,568.48 0.00 1 1,568.48 1,568.48
41-59 0 3,021.82 0.00 0 3,021.82 0.00
60 and above 0 12,463.03 0.00 0 12,463.03 0.00
Total without Maternity 0 0.00 0.00 1 1,568.48 1,568.48
Maternity 0 595.15 0.00 0 595.15 0.00
Total 0 0.00 0.00 1 1,568.48 1,568.48
Cat A - Total Number of Members Total Contribution
1 1,568.48
NO. OF MEMBERS AGE 65+ ARE SUBJECTED TO MEDICAL UNDERWRITING 0
TOTAL NUMBER OF LIVES 1
TOTAL Contribution AED 1,568.48
TOTAL Premium (Excluding VAT and BASMAH) AED 1,568
BASMAH (AED 37 per insured member): AED 37
VAT (5%): AED 80.27
TOTAL Premium (Including VAT and BASMAH) AED 1,685.75
For and on Behalf of the Insurance Company For and on Behalf of the Group
Dubai National Insurance Test
Date Date
10-04-2023 10-04-2023
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