Plan6

Medical Network

NAS — VN

Annual Limit per Person

AED 1,500,000

Area of Coverage

Worldwide

In-patient Services

Covered

Out-patient Services

Covered

Hospital Accommodation

Semi-Private

Consultation Deductible (Co-Pay)

10% up to AED 15 for General Practitioners, 20% up to AED 25 for Specialists

Diagnostics & Laboratory Services

Covered with Nil Co-Pay

Medicine Limit

AED 5,000 with Nil Co-Pay

Maternity

In-patient up to AED 10,000 with 10% Co-Pay; if a condition develops into an emergency, the medically necessary expenses are covered up to the annual limit. Out-patient 10% Co-Pay, 10 visits and 4 ante-natal ultrasound scans. Strictly subject to declaration on the Medical Application Form: pregnancy at the time of application should be declared every year and is subject to medical underwriting, and an undeclared pregnancy will not be covered during the policy period and will be underwritten at renewal if needed. An undeclared pregnancy, known or unknown to the insured at the time of buying the policy, is considered pre-existing, and all pregnancy-related out-patient and in-patient claims are subject to a charge of additional annual premium or cancellation of the policy with recovery of all claims already settled.

Alternative Medicines

Limited to AED 1,000 per person per annum

Physiotherapy

6 sessions per member per year

Psychiatric Treatment

Out Patient Covered up to Maximum AED 1,500/- per person per annum subject to 20% copay. IN Patient Covered up to Maximum AED 6,000/- per person per annum

Home Nursing

Routine Dental Benefits

AED 500 with 30% Co-Pay

Routine Optical Benefits

Pre-existing / Chronic Conditions

• All pre-existing medical conditions should be declared in the Medical Application Form and is subject to medical underwriting. • All declared Pre-existing and Chronic conditions are covered with a sub limit of AED 150,000/- • Undeclared pre-existing conditions will not be covered during the policy period and will be underwritten at renewal. All adverse findings on health declarations would be priced on each case basis. In case of misrepresentation insurer reserves the right to cancel the policy

Emergency Road Ambulance Services

Covered

Vaccination for Children (as per MOH, UAE)

Inside Network: 100% of Actual Cost. Outside Network : Covered on Network UCR Rates

Repatriation of Mortal Remains

Covered up to Maximum AED 5,000 per person per annum settled on Reimbursement basis with no co-pay

Specialist access

A GP referral is required before specialist access. Out-patient access is restricted to clinics.

Within the Network (Direct Billing)

Direct Billing

Outside the Network (Reimbursement)

Reimbursement at 80% of usual and customary rates (100% in countries where the TPA is not present)

Assist America

Adult Pneumococcal Conjugate Vaccine

As per DHA Adult Pneumococcal accination guidelines

Air-Ticket for Insured Member

Cancer Treatments

Cash indemnity for in-patient stays

Follow-up consultation co-pay (within 7 days)

Dental, hearing & vision aids, vision correction

Covered subject to 20% coinsurance

Hearing Emergencies

Covered subject to 20% coinsurance

Hepatitis B Virus Screening and treatment

Hepatitis C Infection

Influenza Vaccine

Covered once Per Annum

New Born baby coverage

Preventive services (members over 18)

Organ transplantation (recipient only)

Second Medical Opinion

Accompanying person accommodation

Covered (Max upto AED 300 per night)

Vision Emergencies

Covered subject to 20% coinsurance

Work Related Injuries and Illness