Classification: Restricted

Individual Medical Policy for NE visa holders

(NAS)
Schedule of Benefits – Plan 2
➢ All visas (or citizenships) must be related to UAE's Northern Emirates (Ajman, Fujairah, Ras al-
Khaimah, Sharjah and Umm al-Quwain).

➢ The attached list of exclusions apply.

➢ Members eligible under this product are employees (including domestic workers) with salary up to
AED15,000 (as per a salary certificate that must be provided).

➢ Spouses (Male, Female) and children are eligible for this plan.

BENEFITS / COVERAGE Plan (2)

Aggregate annual limit
The annual upper limit for Healthcare Services Per
AED 150,000 on aggregate; Sub-limits apply
insured member per year
Scope of Coverage
UAE Excluding Abu Dhabi & Al Ain Emirates
Territorial Scope of Coverage
Emergency Extension to UAE
Direct billing is available within the Network.

Elective Treatment (Non-Emergency) within the Reimbursement is also covered, but up to

Territorial Scope 75% of the usual, customary and reasonable
Network rates, after deducting the original
copayments under the plan.
Elective Treatment (Non-Emergency) outside the
Not covered
Territorial Scope
Covered for emergency treatments on a
Emergency Outside network within UAE (Intimation
reimbursement basis only at 100% maximum
within 24 Hrs) till the patient is stabilized
of applicable network tariff
Emergency outside UAE Not covered
Network
Medical Providers Network (Subject to ongoing changes) NAS -VN (OP restricted to clinics)
Pre-existing/Chronic Conditions/Maternity
Waiting Period on Pre-existing, Chronic Declared
12 months
Conditions and Maternity (not applicable for renewals)
Sub-Limit on Pre-existing and Declared Chronic AED 10,000 on In-Patient and Out-Patient
Conditions (after the end of the Waiting Period) Combined
Inpatient Healthcare Services
Sublimit: AED 100,000/- with nil coinsurance
(Prior Approval is required from the insurance
on all covered services below
company or TPA)
In-patient Healthcare Services - Room Type Semi-Private
Tests, diagnoses, treatments and surgeries in hospitals
Covered
for non-emergency medical cases

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Prescribed medicines and drugs administered whilst in-

patient hospitalization or daycare patient and Covered
healthcare services for emergency cases
Ground transportation services in the UAE are provided
Covered
by an authorized party for medical emergencies
Physiotherapy treatment services Limited to 8 session PPPA – Nil coinsurance
Accommodation for a person accompanying an insured
Covered up to AED 100 per night
child up to 16 years of age.
Accommodation of an accompanying person in the
same room in cases of critical conditions and as per Covered up to AED 100 per night
recommendation of attending physician
Outpatient Healthcare Services Sublimit : AED 50,000/-
Co-payment for services provided by General Covered subject to 20% coinsurance
Practitioners, Specialists and Consultants Examination,
diagnostic and treatment services of clinics and health Consultations with Specialists or Consultants
centers by general practitioners, and specialists. Follow- are covered only if the insured member
ups are exempted from fees if made within a week from consulted first a licensed General Practitioner
the date of the first examination. who referred him/her based on a valid reason
Covered subject to 10% coinsurance and prior
Laboratory tests services
approval
Radiology and diagnostic services, including X-ray, MRI, Covered subject to 10% coinsurance and prior
CT scans and endoscopies approval
Limited to 6 sessions PPPA subject to 20%
Physiotherapy treatment services
coinsurance and prior approval
Coverage upon prescription as per approved
formulary subject to 20% coinsurance and up
Cost of medicine
to AED 1,500 per person per year (incl.
coinsurance)
Maternity Services
Covered up to AED 10,000 for married
females aged between 18 and 45, after the
waiting period, subject to 10% Copayment
In-patient Maternity services and prior approval
Complications and life-threatening cases are
covered up to the In-Patient General Annual
Limit
Covered for married females aged between
18 and 45, after the waiting period, subject to
10% Copayment and prior approval
It includes ante-natal services restricted to 8
visits to Primary Health Care Centre
Out-patient Maternity services Initial investigations to include:
• FBC and Platelets
• Blood group, Rhesus status and antibodies
• VDRL
• MSU & urinalysis
• Rubella serology

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• 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
Other Benefits
Diagnostic and treatment services for dental and gum Covered only if related to a medical
treatments emergency, subject to 20% copayment
Hearing and vision aids, and vision correction by Covered only if related to a medical
surgeries, and laser emergency, subject to 20% copayment
Not covered. Newborn babies must be
Newborn cover
enrolled from day one
Covered as per MOH list subject to 20% co-
Essential vaccines
payment
Preventive services, routine check-ups, and
Immunizations (as related to all benefits including the
Not covered
ones listed in the previous sections of this Table of
Benefits excluding 'Essential Vaccines')

Plan Rate PPPA AED

Plan 2 (0-45) year 640.00
Plan 2 (46-65) year 1125.00
Plan 2 (66 and over) year 4360.00

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List of Exclusions
A. Excluded healthcare services

1. Healthcare Services which are not medically necessary

2. All expenses relating to dental treatment, dental prostheses, and orthodontic treatments.

3. Home nursing; private nursing care; care for the sake of traveling.

4. Custodial care including

a) Non-medical treatment services;

b) Health-related services which do not seek to improve or which do not result in a change in the
medicalcondition of the patient.
5. Services that do not require continuous administration by specialized medical personnel.
6. Personal comfort and convenience items (television, barber or beauty service, guest service, and
similarincidental services and supplies).
7. All cosmetic healthcare services and services associated with the replacement of an existing breast
implant. Cosmetic operations which are related to an Injury, sickness or congenital anomaly when the
primary purpose is to improve the physiological functioning of the involved part of the body and breast
reconstruction
following a mastectomy for cancer are covered.
8. Surgical and non-surgical treatment for obesity (including morbid obesity), and any other weight control
programs, services, or supplies.
9. Medical services utilized for the sake of research, medically non-approved experiments and
investigationsand pharmacological weight reduction regimens.
10. Healthcare Services that are not performed by Authorized Healthcare Service Providers.

11. Healthcare services and associated expenses for the treatment of alopecia, baldness, hair fall, dandruff or
wigs.
12. Health services and supplies for smoking cessation programs and the treatment of nicotine addiction.

13. Any investigations, tests or procedures carried out with the intention of ruling out any fetal anomaly.

14. Treatment and services for contraception

15. Treatment and services for sex transformation, sterilization or intended to correct a state of sterility or
infertility or sexual dysfunction. Sterilization is allowed only if medically indicated and if allowed under
the Law.
16. External prosthetic devices and medical equipment.

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17. Treatments and services arising as a result of hazardous activities, including but not limited to, any form of
aerial flight, any kind of power-vehicle race, water sports, horse riding activities, mountaineering activities,
violent sports such as judo, boxing, and wrestling, bungee jumping and any professional sports activities.
18. Growth hormone therapy.

19. Costs associated with hearing tests, vision corrections, prosthetic devices or hearing and vision aids.

20. Mental Health diseases, both outpatient and in-patient treatments, unless it is an emergency condition.
21. Patient treatment supplies (including for example elastic stockings, ace bandages, gauze, syringes, diabetic
test
strips, and like products; non-prescription drugs and treatments,) excluding supplies required as a result of
Healthcare Services rendered during a Medical Emergency.
22. Allergy testing and desensitization (except testing for allergy towards medications and supplies used in
treatment); any physical, psychiatric or psychological examinations or investigations during these
examinations.
23. Services rendered by any medical provider who is a relative of the patient for example the Insured person
himself or first-degree relatives.
24. Enteral feedings (via a tube) and other nutritional and electrolyte supplements, unless medically
necessary during in-patient treatment.
25. Healthcare services for adjustment of spinal subluxation.
26. Healthcare services and treatments by acupuncture; acupressure, hypnotism, massage therapy,
aromatherapy, ozone therapy, homeopathic treatments, and all forms of treatment by alternative
medicine.
27. All healthcare services & treatments for in-vitro fertilization (IVF), embryo transfer; ovum and sperms
transfer.
28. Elective diagnostic services and medical treatment for correction of vision

29. Nasal septum deviation and nasal concharesection.

30. All chronic conditions requiring hemodialysis or peritoneal dialysis, and related investigations, treatments
or procedures.
31. Healthcare services, investigations and treatments related to viral hepatitis and associated complications,
except for the treatment and services related to Hepatitis A.
32. Birth defects, congenital diseases and deformities.

33. Healthcare services for senile dementia and Alzheimer’s disease.

34. Air or terrestrial medical evacuation and unauthorized transportation services.

35. Inpatient treatment received without prior approval from the insurance company including cases of
amedical emergency which were not notified within 24 hours from the date of admission.
36. Any inpatient treatment, investigations or other procedures, which can be carried out on an outpatient
basis
without jeopardizing the Insured Person’s health.
37. Any investigations or health services conducted for non-medical purposes such as investigations related to
employment, travel, licensing or insurance purposes.

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38. All supplies which are not considered as medical treatments including but not limited to: mouthwash,
toothpaste, lozenges, antiseptics, milk formulas, food supplements, skin care products, shampoos and
multivitamins (unless prescribed as replacement therapy for known vitamin deficiency conditions); and all
equipment not primarily intended to improve a medical condition or injury, including but not limited to:
air conditioners or air purifying systems, arch supports exercise equipment and sanitary supplies.
39. More than one consultation or follow-up with a medical specialist in a single day unless referred by
the treating physician.
40. Health services and associated expenses for organ and tissue transplants, irrespective of whether the
Insured Person is a donor or a recipient. This exclusion also applies to follow-up treatments and
complications.
41. Any expenses related to immunomodulators and immunotherapy.

42. Any expenses related to the treatment of sleep-related disorders.

43. Services and educational programs for handicapped.

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