Schedule of Benefits (Care Bronze DNE with Dental)

Plan Name

Care Bronze DNE with Dental

Annual Benefit Limit

Territorial Limit1

AED 250,000 Per Person Per Policy Year

UAE and Asia 1*.
Emergency cover Worldwide excluding USA & Canada

Network (Allowing direct

billing at designated
provider)

Network Within UAE: Standard 3

Inpatient & Outpatient on direct billing in UAE

Network Outside UAE: Asia 1

Pre-existing conditions
Inpatient Treatment

Inpatient on direct billing within Territorial limit- Daman respective Network

Fully Covered; subject to Individual Underwriting
(No waiting period if pre-requisition of uninterrupted (pre-)coverage is fulfilled)
Network
Non-network

Inpatient & Day Treatment2

(including Pre & Post In Hospital Treatment Covered)
Accommodation Type-Private Room
Hospital Accommodation & Services
Consultants, Surgeons & Anesthetists Fees and other fee
Home Nursing (Medically Necessary cases)
(Maximum AED 200/day up to 40 days Per Person Per year)
Ambulance Services
(Medical Emergency cases, subject to General exclusion)
Parent Accommodation for accompanying an Insured Child under 16 years
of age
(Maximum AED 100 per day)
Companion Accommodation in cases of medical necessity at the
recommendation of the treating doctor
(Maximum AED 100 per day)
Outpatient Treatment
Physician Consultation
(Within Abu Dhabi Emirate - A deductible of AED 50 applicable;
Outside Abu Dhabi Emirate 20% coinsurance applicable with an Out of
pocket limit of AED 50)
(Co-insurance/deductible not applicable for follow up within 7 days)
Diagnostics (X-Ray, MRI, CT-Scan, Ultra Sound, etc.), Laboratory
(Specialized investigation and scan including but not limited to MRI, Scan,
Endoscopies with Pre-authorization only)
Pharmaceuticals
(Long term medications to be dispensed up to 90 days without preauthorization)
Alternative Medicine and Chiropractic3,5
(including sessions/consultations up to AED 1,500 per Policy Year)
Physiotherapy2
(Limited to 15 sessions per Policy Year)
Other Benefits
Repatriation of Mortal Remains to country of origin
Covered on reimbursement up to AED 5,000 Per Person
Emergency Treatment
Diagnostic and treatment services for dental and gum treatment
(Medical emergency cases)
Hearing and vision aids, and vision correction by surgeries and laser
(Medical emergency cases)
Healthcare services for work illnesses and injuries as per Federal Law No.
8 of 1980 concerning the Regulation of Work Relations, as amended, and
applicable laws in this respect
Circumcision Healthcare services
Vaccinations3,6
Preventive services3,7
Maternity8

100% covered

80% covered

100% covered
100% covered
100% covered

80% covered
80% covered
80% covered

100% covered

80% covered

100% covered

100% covered

100% covered

80% covered

100% covered

80% covered

Network

Non-network

Within Abu
Dhabi 100%
Covered
Outside Abu
Dhabi
80% covered

80% covered

90% covered

70% covered

90% covered

70% covered

90% covered

90% covered

90% covered

70% covered

Network

Non-network

100% covered

100% covered

100% covered

100% covered12

100% covered

100% covered

100% covered

100% covered

100% covered

80% covered

100% covered
100% covered
100% covered
Network

80% covered
80% covered
80% covered
Non-network

National Health Insurance Company Daman (PJSC) (P.O. Box 128888, Abu Dhabi, U.A.E. Tel No. +97126149555 Fax No. +97126149550)
Doc Ctrl No.:

STEMP/US-002

Version No.: 1

Revision No.:

Date of Issue:

20.01.2013

Page No(s).:

1 of 2

Schedule of Benefits (Care Bronze DNE with Dental)

Maximum annual limit per person (Inpatient & Outpatient Maternity)11:

Inpatient within and outside UAE; Outpatient outside UAE: AED 10,000
Outpatient within UAE: 100% covered
Inpatient Maternity 2
Including:
New Born care (including BCG, Hepatitis B and neo-natal screening tests9)
Outpatient Maternity
Outpatient Maternity - Physician Consultation
(Within Abu Dhabi Emirate - A deductible of AED 25 applicable;
Outside Abu Dhabi Emirate 10% coinsurance applicable with an Out of
pocket limit of AED 25)
(Co-insurance/deductible not applicable for follow up within 7 days)
Dental Module 1
Dental 2,4
(Maximum Annual limit AED 1,000 Per Person)
Accidental dental treatment
Optical not covered
Other Services covered (Through Service Providers Only)
International Assistance Service (Assist America)
Second Opinion facility for specific conditions (Europ Assistance)
Renewal Incentive
Annual Health Checkup at designated providers for a claim free year on
renewal of your policy2,10
*

100% covered

80% covered

90% covered
Within Abu
Dhabi 100%
Covered
Outside Abu
Dhabi
90% covered
Network

70% covered

Non-network

80% covered

80% covered

100% covered

100% covered

100% covered

Not covered

80% covered

Asia 1 includes: Bangladesh, Bhutan, India, Myanmar, Nepal, Pakistan, and Sri Lanka.

SOB REF NO: SOB-US-008-R0-291014 |

S Package NO: 4564 & 4565 |

Please note: (1) Coverage outside UAE is limited to 90 days per treatment. (2) A single holiday or business trip may not
exceed 90 days. Exception: For Maternity benefit, coverage is extended up to 180 days.
2
Pre-authorization required to avail this benefit. All Emergency cases do not require pre-authorization but should be notified
to Daman within 24 hours.
3
Available on reimbursement only. Non-network Providers covered on re-imbursement only.
4
Following services are covered: a) X-Rays; b) Extractions; c) Amalgam / Composite Fillings; d) Root Canal Treatments; e)
Prescribed Drugs for the above mentioned services (covered as part of Outpatient Pharmaceuticals).
5
Alternative Medicine is limited to Herbal Medicine, Homeopathy medicine, Acupuncture, Osteopathy, Chinese Medicine and
Ayurvedic treatment only.
6
Includes vaccinations and inoculations for new borns and children as per DHA.
7
Preventive services for diabetes, every 3 years from age 30 and for High risk individuals annually from age 18.
8
Maternity: Where any condition develops into an emergency, the medically necessary expenses will be covered up to the
annual aggregate limit.
9
Neo-natal screening tests includes: Phenylketonuria (PKU), Congenital Hypothyroidism, Sickle cell screening, congenital
adrenal hyperplasia.
10
Includes: a) Physical Examination by General Practitioner b) Electrocardiogram c) Complete Blood Count(CBC) d) Blood
Urea Nitrogen e) Total Cholesterol f) Fasting Blood Sugar g) Creatinine h) Urinalysis i) Stool Examination j) Serum Glutamic
Oxaloacetic transaminase (SGOT) k) Serum Glutamic Pyruvate transaminase (SGPT)
11
Following sub-limits are applicable:
- Normal vaginal delivery: AED 7,000;
- Caesarian section, complications and medically necessary termination: AED 10,000
- Total Limit per year: AED 10,000
12
Exception: For In & Outpatient maternity treatment at Non Network Provider, 80% covered outside UAE

National Health Insurance Company Daman (PJSC) (P.O. Box 128888, Abu Dhabi, U.A.E. Tel No. +97126149555 Fax No. +97126149550)
Doc Ctrl No.:

STEMP/US-002

Version No.: 1

Revision No.:

Date of Issue:

20.01.2013

Page No(s).:

2 of 2