S.

No.

Benefits

Flexi Dubai 2015

- Platinum

Flexi Dubai 2015

- Diamond

Flexi Dubai 2015

- Gold

Flexi Dubai 2015 Silver

Flexi Dubai 2015 Bronze

Flexi Dubai 2015 Steel

AED 1,500,000/=

AED 750,000/=

AED 250,000/=

AED 150,000/=

AED 150,000/=

AED 150,000/=

UAE, GCC, ME,

SEA including
Indian Subcontinent
All UAE residents
(UAE Nationals &
Expatriates
having a Valid
Residence Visa)
GN

UAE, GCC, ME,

SEA including
Indian Subcontinent
All UAE residents
(UAE Nationals
& Expatriates
having a Valid
Residence Visa)

UAE, GCC, ME,

SEA including
Indian Subcontinent
All UAE residents
(UAE Nationals &
Expatriates
having a Valid
Residence Visa)

UAE, Indian Subcontinent and

Philippines

UAE Only

All UAE residents

(UAE Nationals &
Expatriates
having a Valid
Residence Visa)

All UAE residents

(Expatriates
having a Valid
Residence Visa)

Aggregate Limit

Under the terms and conditions

of the plan, we will pay
necessary, customary and
reasonable expenses up to an
overall maximum, per insured
member per year.
Area of Cover

Worldwide
excluding USA &
Canada

Eligibility

All UAE residents

(UAE Nationals
& Expatriates
having a Valid
Residence Visa)

GN + AH

Network

Age Limit

Treatment in
American
Hospital *10%
Co Insurance in
Op only

0 to unlimited

Treatment in
American
Hospital *20% Co
Insurance in Op
& IP .
Treatmant in
Mediclinic Group
& Al Zahra Group
*15% Co
Insurance in Op
only
0 to unlimited

RN

RN2

Treatment in
Zulekha Hospital
*15% Co
Insurance in Op
only

Treatment in
Zulekha Hospital
*15% Co
Insurance in Op
only

0 to unlimited

0 to unlimited

RN3
(Outpatient
treatment
restricted to
clinics only)

0 to unlimited

*Outpatient:
Nextcare's PCP
network
(specialist visits
from RN3
network is
allowed after
referral from PCP
GPs only)
*Inpatient: RN3
hospitals (referral
from PCP doctors
only)
0 to unlimited

Treatment Outside the

Network

If treatment is taken outside the

network for eligible medical
condition covered under the
policy, reimbursement would
be allowed subject to 20% Coinsurance based on Usual,
Customary and Reasonable (
UCR ) Network Charges.
( UCR charges are as per the
discretion of the insurer )

Claims Settlement Basis

( as per Usual, Customary and

Reasonable Charges of the
Network in UAE ).

20% Coinsurance
subject to UCR
Network Charges

20% Coinsurance subject

to UCR Network
Charges

* Treatment outside the Network

is not allowed
and will not be
reimbursed.
* Emergency
treatment within
UAE covered in
full
(Life threatening
cases)

* Treatment outside the Network

is not allowed
and will not be
reimbursed.
* Emergency
treatment within
UAE covered in
full
(Life threatening
cases)

* Treatment outside the Network

is not allowed
and will not be
reimbursed.
* Emergency
treatment within
UAE covered in
full
(Life threatening
cases)

* Treatment outside the Network

is not allowed
and will not be
reimbursed.
* Emergency
treatment within
UAE covered in
full
(Life threatening
cases)

Within the
Network
on Direct Billing
Basis
Outside the
Network on
Reimbursement
Basis
* For emergency
treatment within
UAE covered in
full
(Life threatening
cases)

Within the
Network
on Direct Billing
Basis
Outside the
Network on
Reimbursement
Basis
* For emergency
treatment within
UAE covered in
full
(Life threatening
cases)

Within the
Network
on Direct Billing
Basis
Outside the
Network on
Reimbursement
Basis
* For emergency
treatment within
UAE covered in
full
(Life threatening
cases)

Within the
Network
on Direct Billing
Basis
Outside the
Network on
Reimbursement
Basis
* For emergency
treatment within
UAE covered in
full
(Life threatening
cases)

Within the
Network
on Direct Billing
Basis

Within the
Network
on Direct Billing
Basis

Outside the
Network on
Reimbursement
Basis

Outside the
Network on
Reimbursement
Basis

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Semi Private
Room
Coveredup to aed
450 per day

Semi Private
Room
Coveredup to aed
450 per day

Semi Private
Room
Coveredup to aed
450 per day

Covered in Full

Covered in Full

Covered in Full

In-Patient Treatment

Accidents and emergencies,

intensive care and theatre costs

Hospital Accommodation (
Room Charges )

Private Room
Covered

Private Room
Covered

Private Room
Coveredup to
aed 750 per day

Nursing Fees, medical expenses

and ancillary charges

Covered in Full

Covered in Full

Covered in Full

d
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f

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i

Surgeons', consultants,
anaesthetist', specialists' ,
General Practitioners' fees
Prescribed Medicine and drugs
Reconstructive surgery
following an accident or
following surgery for an eligible
medical condition
Prostheses: artificial body parts
surgically implated to form
permanent parts of an insured
member's body
MRI, PET, CT Scans
X-Rays, Pathology, diagnostic
tests and procedures
Oncology tests, drugs and
consultants' fees including
cover for chemotherapy and
radiotheraphy
Parent accommodation
Hospital accomodation cost in
respect of a parent or legal
guardian staying with an
Insured member who is under
18 years of age and is admitted
to a Hospital as an In-Patient.
Ground transportation services
in the UAE provided by an
authorized party for medical
emergencies
Accidental Damage to Teeth
Treatment recevied in an
Emergency room in a Hospital
within 48 hours of incurring
Accidental damage caused to
sound, natural teeth as a result
of an Accident.

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered up to
AED 200/= per
day

Covered up to
AED 200/= per
day

Covered up to
AED 200/= per
day

Covered up to
AED 200/= per
day

Covered up to
AED 200/= per
day

Covered up to
AED 200/= per
day

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Hospital Cash Benefit

When treatment is received as

an In-Patient for an eligible
Medical Condition in a
Government Hospital, where
no costs were incurred for
accommodation and/or for
treatment, then this benefit
pays for a daily cash benefit for
In-Patient stay more than 3
days.
This benefit is not applicable
for Accident & Emergency
admissions.

Covered up to
AED 300/= per
day

Covered up to
AED 300/= per
day

Covered up to
AED 200/= per
day

Covered up to
AED 200/= per
day

Covered up to
AED 200/= per
day

Covered up to
AED 200/= per
day

NIL

20% coinsurance
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

20% coinsurance
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

Deductible for ( In-Patient

Services )
o

( Applicable if treatment is
taken in a facility
in-side/outside the Network of
providers )
Medical emergencies on
Hearing and vision aids, and
vision correction by surgeries
and laser.
Accidental damage to teeth &
Gum Treatment recevied in an
emergency room in a hospital
within 48 hours of incurring
accidental damage caused to
sound , nutural teeth as a result
of an accident.

NIL

NIL

NIL

Cover : Emergency Treatment required to save or alleviate danger to life

Cover : Emergency Treatment required to save or alleviate danger to life

Maternity - In patient services.

Waiting Period: Nil - Non working spouses who are
confirmed pregnant after time
of enrollment will be subject to
9 months waiting period.

10% coinsurance
10% coinsurance
10% coinsurance
payable by the
payable by the
10% coinsurance
10% coinsurance
10% coinsurance
payable by the
insured
insured
payable by the
payable by the
payable by the
insured
Maximum
Maximum
insured Maximum insured Maximum insured Maximum
Maximum
benefit 15 ,000
benefit 7 ,000
benefit 7 ,000
benefit 7 ,000
benefit 7 ,000
benefit 10 ,000
AED per normal
AED per normal
AED per normal
AED per normal
AED per normal
AED per normal
delivery, 20 ,000
delivery, 10 ,000
delivery, 10 ,000
delivery, 10 ,000
delivery, 10 ,000
delivery, 15 ,000
AED for
AED for
AED for medically AED for medically AED for medically
AED for medically
medically
medically
necessary Cnecessary Cnecessary Cnecessary Cnecessary Cnecessary Csection,
section,
section,
section,
section,
section,
complications and complications and complications and
complications
complications
complications
for medically
for medically
for medically
and for medically
and for medically
and for medically
necessary
necessary
necessary
necessary
necessary
necessary
termination (All
termination (All
termination (All
termination (All
termination (All
termination (All
limits include
limits include
limits include
limits include
limits include
limits include
coinsurance)
coinsurance)
coinsurance)
coinsurance)
coinsurance)
coinsurance)
Where any condition develops which becomes an emergency, the medically necessary expenses will be covered up to Maximum limit AED 150,000 PPPY

Out-Patient & Day-care Treatment

Deductible /Co insurance for (

Out-Patient Services )
1

3
4

Free follow up with the

same
doctor for the same ailment
within seven days.
Primary Consultation and
treatment to include General
Practitioners' fees, prescribed
medicines, drugs and dressings
X-ray, pathology, diagnostic
tests and procedures
Prescribed Medicine and drugs

20% coinsurance
on OP
consultation or
AED 50/- on all
OP
consultation
whichever is
lower.

20% coinsurance
on OP
consultation or
AED 50/- on all
OP
consultation
whichever is
lower.

20% coinsurance
on OP
consultation or
AED 50/- on all
OP
consultation
whichever is
lower.

20% coinsurance
on OP
consultation or
AED 50/- on all
OP
consultation
whichever is
lower.

20% coinsurance
on OP
consultation or
AED 50/- on all
OP
consultation
whichever is
lower.

20% coinsurance
on OP
consultation or
AED 50/- on all
OP
consultation
whichever is
lower.

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Covered

Covered

30% Coinsurance
Maximum Limit

30% Coinsurance
Maximum Limit

AED 2,000

6
7
8
9

Physiotherapy recommended /
referred by a General
Practitioner or a Specialist,
Oncology tests, drugs and
consultants' fees including
cover for chemotherapy and
radiotheraphy
MRI, PET, CT Scans
Out-Patient Surgical Operations
Post - Hospitalization
Treatment

Covered up to 7 sessions per ailment/condition per person per year

AED 1,500

Covered up to 6
Covered up to 6
sessions per
sessions per
ailment/condition ailment/condition
per person per
per person per
year
year

Covered

Covered

Covered

Covered

Covered

Covered

Covered
Covered

Covered
Covered

Covered
Covered

Covered
Covered

Covered
Covered

Covered
Covered

Covered

Covered

Covered

Covered

Covered

Covered

Other Benefits

ab

ac

ad

Pre-existing Conditions &

Chronic Medical Conditions (
Where any condition develops
which becomes an emergency,
the medically necessary
expenses will be covered up to
the annual aggregate limit. )
- For declared cases only
Maternity - Out patient
services.
Waiting
Period: Nil - Non -working
spouses who are confirmed
pregnant after time of
enrollment will be subject to 9
months waiting period.
New born cover

-Maximum limit AED 150,000 PPPY

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

10% Copay , Maximum 8 visits checks and tests in accordance with DHA Antenatal Care Protocols

_Cover for 30 days from birth.

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

ae

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ag

Life threatening congenital

conditions ( life - threatening
birth defects, deformities and
congenital diseases for new
born children only )
Nursing at Home
Immediately following Hospital
discharge on the
recommendation of a specialist
and must be provided by a
qualified nurse. All treatments
under this benefit must be preauthorized by us.
Reconstructive Surgery
Reconstructive surgery
following an Accident or
following surgery for an eligible
medical conditions, which is not
pre-existing and the incident
has not occurred prior to
commencing this cover under
the policy.

- Maximum limit AED 150,000 PPPY

Covered upto a
limit of
AED 5,000/=

Covered upto a
limit of
AED 4,000/=

Covered upto a
limit of
AED 2,500/=

Covered upto a
limit of
AED 1,000/=

Covered upto a
limit of
AED 1,000/=

Covered upto a
limit of
AED 1,000/=

for a period not

exceed 30 days
in aggregate.

for a period not

exceed 30 days in
aggregate.

for a period not

exceed 30 days
in aggregate.

for a period not

exceed 30 days in
aggregate.

for a period not

exceed 30 days in
aggregate.

for a period not

exceed 30 days in
aggregate.

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered in Full

Covered up to a
limit of
AED 2,000/=
with AED 100/=
as deductible

Not Covered

Not Covered

Not Covered

Not Covered

Not Covered

Covered up to a
limit of
AED 200/= for a
pair of lenses

Not Covered

Not Covered

Not Covered

Not Covered

Not Covered

Dental Cover

ah

Below dental procedures

excluding any surgeries.
Root Canal, Fillings, Extractions,
Antibiotics for Infection of Gums
Consultation and X-ray.
Optical Cover

ai
Cover for a pair of lenses only.

aj

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am

Preventive services

Vaccines and immunizations

Essential vaccinations and
inoculations for newborns and
children as stipulated in the
DHAs policies and its updates
in the assigned facilities from
age 0-6 years .
Return Air Fare to Patient for
Surgery in Home Country
( if treatment is not available in
the country of residence or the
treatment expense is up to 50%
of the cost in UAE ). Preapproval from ASNIC required
Global Emergency services Assist America Key services:
Medical Consultation,
Evaluation & Referral, Hospital
Admission Assistance,
Emergency Medical Evacuation,
Medical Monitoring, Medical
Repatriation, Prescription
Assistance, Compassionate
Visit, Care of Minor Children,
Return of Mortal Remains, Lost
Luggage or Document
Assistance, Interpreter & Legal
Referrals, Pre-trip Information.

*Preventive services as stipulated by DHA to include initially diabetes and Papanicolaou test.
*Frequency restricted to:
Diabetes: Every 3 years from age 30
High risk individuals annually from age 18 Papanicolaou: Every 3 years for married female

Covered - according to DHA price list

with 10% Copay on Reimbursement basis only

AED 2,000/=
Plus
AED 2,000/= for
accompanying
Family Member

Covered
(Refer to Global
Emergency
Services
brochure for
complete
information on
coverage,
conditions and
exclusions)

AED 2,000/=
Insured patient
only

AED 2,000/=
Insured patient
only

AED 2,000/=
Insured patient
only

AED 2,000/=
Insured patient
only

AED 2,000/=
Insured patient
only

Covered
(Refer to Global
Emergency
Services brochure
for complete
information on
coverage,
conditions and
exclusions)

Covered
(Refer to Global
Emergency
Services
brochure for
complete
information on
coverage,
conditions and
exclusions)

Covered
(Refer to Global
Emergency
Services brochure
for complete
information on
coverage,
conditions and
exclusions)

Not Covered

Not Covered

an

ao

Second Medical Opinion

(International Medical
Consultation)
- Confirmation of Diagnosis
- Evaluation of cases where
diagnosis has not been possible
- Determination of the most
appropriate course of
treatment
- Follow up on a previously
reported case.

Covered
(Refer to Global
Emergency
Services
brochure for
complete
information on
coverage,
conditions and
exclusions)
- Confirmation of
Diagnosis
- Evaluation of
cases where
diagnosis has not
been possible
- Determination
of the most
appropriate
course of
treatment
- Follow up on a
previously
reported case.

Covered
(Refer to Global
Emergency
Services brochure
for complete
information on
coverage,
conditions and
exclusions)
- Confirmation of
Diagnosis
- Evaluation of
cases where
diagnosis has not
been possible
- Determination
of the most
appropriate
course of
treatment
- Follow up on a
previously
reported case.

Covered
(Refer to Global
Emergency
Services
brochure for
complete
information on
coverage,
conditions and
exclusions)
- Confirmation of
Diagnosis
- Evaluation of
cases where
diagnosis has not
been possible
- Determination
of the most
appropriate
course of
treatment
- Follow up on a
previously
reported case.

Covered
(Refer to Global
Emergency
Services brochure
for complete
information on
coverage,
conditions and
exclusions)
- Confirmation of
Diagnosis
- Evaluation of
cases where
diagnosis has not
been possible
- Determination
of the most
appropriate
course of
treatment
- Follow up on a
previously
reported case.

Not Covered

Not Covered

Death due to accident ( for

Principal only )
(Refer
to addendum for complete
information on coverage,
conditions and exclusions)

Covered Max
AED 25,000.

Covered Max
AED 20,000.

Covered Max
AED 15,000.

Covered Max
AED10,000.

Not Covered

Not Covered