Medgulf
What Plan 6 PCP AUH does and does not do, before you read the insurer's own Table of Benefits.
Annual limit
AED 250,000
Medical network
NEXTCARE — PCP AUH
Consultation
AED 50/- with AED 50 co-pay
Pharmacy
AED 1,500 with no co-pay
Get your price to download this plan's Table of Benefits and your quote.
Medical Network
NEXTCARE — PCP AUH
Annual Limit per Person
AED 250,000
Area of Coverage
Worldwide
In-patient Services
Covered
Out-patient Services
Covered
Hospital Accommodation
Semi-Private
Consultation Deductible (Co-Pay)
AED 50/- with AED 50 Co-Pay
Diagnostics & Laboratory Services
Covered without Co-pay and up to aggregate annual limit
Medicine Limit
AED 1,500 with Nil Co-Pay
Maternity
In-patient Maternity services: Inside Emirate of Abu Dhabi : Covered up to the Annual Limit of the policy ( In-Patient & Out-Patient) Delivery inside Emirate of Abu Dhabi is subject to a deductible of AED 500/- as per DoH law Outside Emirate of Abu Dhabi (within UAE): -Normal Delivery is covered up to AED 10,000/-, C-Section and maternity complications are covered up to AED 12,000/-, Medical Emergency related to Maternity is covered up to Annual Limit of the policy Out-patient Maternity services: covered up to the Annual Limit of the policy subject to the same deductible in the selected plan on consultation. 6-month waiting period for delivery on first membership, unless you show continuous cover
Abu Dhabi law excludes pregnancy and delivery cover for women enrolled as unmarried (Law 23/2005, Art. 13(5)).
Women and maternity on this plan
Married women pay an extra maternity premium on this plan; single women pay the standard price.
Get a quote to see the amount for your family.
Alternative Medicines
Not coveredPhysiotherapy
Covered
Psychiatric Treatment
Not coveredHome Nursing
Not coveredRoutine Dental Benefits
Not coveredRoutine Optical Benefits
Not coveredPre-existing / Chronic Conditions
Covered up to annual Limit. All pre-exisiting conditions should be declared in the Medical Application Form and is subject to medical underwriting. Undeclared pre-existing conditions will not be covered during the policy period and will be underwritten at renewal No waiting period applies if evidence of continuity of coverage is provided; otherwise a waiting period of 6 months applies to the first scheme membership on Inpatient treatment for the following medical conditions: Diabetes mellitus, Arterial diseases, COPD , All cancers cases, Neurosurgery, Cerebro Vascular diseases, All delivery cases (Maternity).
Emergency Road Ambulance Services
Covered
Vaccination for Children (as per MOH, UAE)
Inside Network: 100% Actual Cost Outside Network : UCR Basis
Repatriation of Mortal Remains
Not coveredWithin the Network (Direct Billing)
Direct billing available. Reimbursement is also possible but will be settled at 80% of the usual & customary rates of the selected Network.
Outside the Network (Reimbursement)
Outside the Network in Countries where NEXtCARE is present: Reimbusement at 80% of actual costs (subject to be reasonable) or 80% of the usual & customary rates of the network, whichever is less Outside the Network in Countries where NEXtCARE is not present: Reimbursement at 100% of actual costs (subject to be reasonable) or 100% of the usual & customary rates of the network, whichever is less-80%
Cash indemnity for in-patient stays
Covered on Reimbursement up to AED 200 per night and a maximum of 10 nights. The Cash Indemnity claim must be submitted within 15 days after discharge from the hospital with a proof of hospitalization including a discharge summary.
Follow-up consultation co-pay (within 7 days)
will not be applicable for follow-up within 7 days for same treatment and with same doctor
Dental, hearing & vision aids, vision correction
Covered
Hearing Emergencies
Covered
Organ transplantation (recipient only)
Organ transplantation shall cover the organ transplantation as recipient excluding any cost related to donor, and excluding the acquisition and organ cost Organs covered are: heart, lung, kidney, pancreas, liver, Allogeneic & autologous bone marrow.
Second Medical Opinion
This benefit gives members access through the Lumi mobile application to world renowned providers to re-evaluate their earlier diagnosis, medical history and treatment plan for non-emergency cases.
Symptom Checker
This benefit gives members access through the Lumi mobile application to a tool that uses artificial intelligence algorithms to anonymously analyze the member’s symptoms and medical history to suggest the most probable diagnosis and route of care.
Accompanying person accommodation
AED 150 / day
Vision Emergencies
Covered
Work Related Injuries and Illness
Covered
Benefits this plan adds beyond the rows compared above.
