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What PCP-C does and does not do, before you read the insurer's own Table of Benefits.
Annual limit
AED 500,000
Medical network
NEXTCARE — PCP-C
Consultation
20% up to AED 50
Pharmacy
Covered, no co-pay
Nothing we would flag on this plan — but read the Table of Benefits before you buy.
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Medical Network
NEXTCARE — PCP-C
Annual Limit per Person
AED 500,000
Area of Coverage
Worldwide. Cover outside the UAE is limited to 90 days per treatment; a single holiday or business trip may not exceed 90 days.
In-patient Services
Covered up to the relevant annual benefit limit per person, per policy year, with pre-approval.
Out-patient Services
Covered
Hospital Accommodation
Private
Consultation Deductible (Co-Pay)
20% up to AED 50 per consultation. Not applicable for a follow-up within 7 days for the same treatment with the same doctor. Out-patient access is restricted to clinics. A GP referral is required for specialist and hospital visits.
Diagnostics & Laboratory Services
X-ray, MRI, CT scan, ultrasound and endoscopy diagnostic services. With Nil Co-Pay
Medicine Limit
Prescribed drugs and medicines. With Nil Co-Pay
Maternity
In-patient maternity: covered subject to 10% coinsurance, up to AED 10,000; where a condition develops into an emergency the medically necessary expenses are covered up to the annual aggregate limit. Out-patient maternity: covered subject to 10% coinsurance, to a maximum of 10 visits and 4 ante-natal ultrasound scans. In-patient maternity requires prior approval from the insurance company, or notification within 24 hours of emergency treatment. A pregnancy at the time of application must be declared on the medical application form and is subject to medical underwriting; for an undeclared pregnancy the policy is subject to re-underwriting before the cover can be used.
Women and maternity on this plan
Women's premiums on this plan are higher than men's, whether or not they are married.
Get a quote to see the amount for your family.
Alternative Medicines
AED 1,600
Physiotherapy
15 sessions per member per year, subject to pre-approval. With 10% Co-Pay
Psychiatric Treatment
AED 800 with 30% Co-Pay
Routine Dental Benefits
AED 3,500 with 20% Co-Pay
Routine Optical Benefits
Emergency cases only
Pre-existing / Chronic Conditions
Covered up to a limit of AED 150,000 per member per year. Pre-existing and chronic medical conditions are subject to medical underwriting and must be declared on the medical application form (MAF). For any undeclared pre-existing or chronic condition the policy is subject to re-underwriting before the cover can be used. A waiting period of 6 months applies unless evidence of continuity of coverage is provided.
Emergency Road Ambulance Services
Covered
Vaccination for Children (as per MOH, UAE)
As per DHA policies and their updates, including the vaccinations and inoculations for new-borns. Inside the network: 100% of actual cost. Outside the network: covered at network UCR rates.
Repatriation of Mortal Remains
AED 7,500
Specialist access
A GP referral is required for specialist and hospital visits. Out-patient access is restricted to clinics.
Within the Network (Direct Billing)
Within the network: direct billing available.
Outside the Network (Reimbursement)
Outside the network within the UAE: reimbursement at 80% of the UCR rates of the selected network. Outside the UAE: reimbursement at 100% of actual costs (subject to being reasonable) or 100% of the network's UCR rates, whichever is less.
Cancer Treatments
Screening, healthcare services, investigations and treatments, for members enrolled under the Patient Support Program only. Covered as per the terms, conditions and exclusions of the programme defined by the DHA.
Follow-up consultation co-pay (within 7 days)
No consultation deductible applies to a follow-up within 7 days for the same treatment with the same doctor.
Coverage Criteria for Treatment outside UAE
Cover outside the UAE is limited to 90 days per treatment. A single holiday or business trip may not exceed 90 days. Subject to UAE usual, customary and reasonable (UCR) rates.
Dental, hearing & vision aids, vision correction
Diagnostic and treatment services for dental and gum treatments are covered in emergency cases only. A dental emergency is any injury to the teeth or gums that can put you at risk of permanent damage, such as chipped or broken teeth, a knocked-out tooth or soft-tissue injuries.
Hearing Emergencies
Covered in emergency cases only. Hearing emergencies include an object or insect in the ear, a ruptured eardrum and sudden hearing loss.
Hepatitis C Infection
Screening, healthcare services, investigations and treatments related to viral hepatitis and associated complications related to Hepatitis C, for members enrolled under the Patient Support Program only. Covered as per the terms, conditions and exclusions of the programme defined by the DHA.
Preventive services (members over 18)
As per DHA regulations.
Organ transplantation (recipient only)
Covered up to a maximum of AED 100,000 per person per year, subject to prior approval. Covers transplantation as the recipient, excluding any cost related to the donor and excluding the acquisition and organ cost. Organs covered: heart, lung, kidney, pancreas, liver, and allogeneic and autologous bone marrow.
Accompanying person accommodation
AED 100 per day for an accompanying person in the same room, as recommended by the attending physician and subject to prior approval.
Vision Emergencies
Covered in emergency cases only. Vision emergencies include bleeding or discharge from or around the eye, double vision and total or partial loss of vision in one or both eyes.
Benefits this plan adds beyond the rows compared above.
