In-patient and Day care Treatment |
In-patient and Day care treatment |
20% coinsurance payable by the insured with a cap of AED 500 payable per encounter; and an annual aggregate cap of AED 1,000.
Above these caps the insurer will cover 100% of the treatment.
- Tests, diagnosis, treatments and surgeries in hospitals for non-urgent medical cases (Prior approval required from the insurance company).
- Emergency treatment – Approval required from the insurance company within 24 hours of admission to the authorized hospital.
- Ground transportation services in the UAE provided by an authorized party for medical emergencies.
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Daily Room and Board |
In-patient services will be received in rooms of two or more beds. Prior approval required from the insurance company. |
Parent accommodation |
The cost of accommodating a person accompanying an insured child up to the age of 16 years is covered under Covered under the below
Companion Accommodation’ benefit. |
Companion accommodation of a person accompanying an insured member in cases of medical necessity. |
The cost of accommodation of a person accompanying an in-patient in the same room in cases of medical necessity at the recommendation of the treating doctor and after the prior approval of the insurance company providing coverage.
Maximum AED 100 per night. |
Out-patient Treatment |
Deductible/coinsurance on Consultations |
Examination, diagnostic and treatment services by authorized general practitioners, specialists and consultants – 20% coinsurance from the insured member per visit.
No coinsurance if a follow-up visit made within seven days. |
Diagnostics (x-ray, MRI, CT, PET, Ultrasound,etc), Laboratory |
- Laboratory test services carried out in the authorized facility assigned to treat the insured person – 20% coinsurance from the insured member.
- Radiology diagnostic services carried out in the authorized facility assigned to treat the insured person – 20% coinsurance from the insured member. In cases of non- medical emergencies, the insurance company’s prior approval is required for MRI, CT scans and endoscopies.
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Prescribed Drugs |
Cost of drugs and medicines up to an annual limit of AED 1,500 (including coinsurance) –
30% from the insured member in respect of each and every prescription.
No cover for drugs and medicines in excess of the annual limit. |
Physiotherapy (Prior approval of the insurance company is required). |
Covered up to maximum 6 sessions per year – 20% coinsurance from the insured member per session. |
Other Benefits: |
Pre-existing and Chronic conditions |
Treatment for chronic and pre-existing conditions excluded for first 6 months of first scheme membership. Waiting period not applicable where there is proof of continuous uninterrupted insurance coverage for more than 6 months. |
Ambulance |
Ground transportation services in the UAE provided by an authorized party for medical emergencies |
Vaccinations & Immunizations |
Covered – Essential vaccinations and inoculations for newborns and children up to age 6 years as stipulated in the DHA’s policies and its updates (currently the same as Federal MOH). |
Diabetes Screening – Every 3 years from age of 30. High risk individual annually from age of 18. |
Covered |
Adult Pneumococcal Conjugate Vaccine (For Dubai Visa Holders Only) |
As per DHA Adult Pneumococcal Vaccination guidelines |
Hepatitis C Virus Screening and treatment (For Dubai Visa Holders Only) |
Covered as per the guidelines laid out in the DHA’s Hepatitis C support program |
DHA’s BASMAH Cancer Screening and treatment for Breast, Cervical and Colorectal Cancer (For LSB Dubai Visa Holders Only) |
Covered as per the guidelines laid out in the DHA’s BASMAH Cancer support program |
Hearing, vision aids, vision correction by surgeries and laser in case of medical emergencies only |
Covered – 20% coinsurance from the insured member |
Diagnostic and treatment services for dental and gum treatments in case of medical emergencies only |
Covered – 20% coinsurance from the insured member |
Additional Benefit Extensions |
Pregnancy and Childbirth |
Out-patient ante-natal services
10% coinsurance from the Insured member8 visits to PHC;All care provided by PHC obstetrician for low risk or specialist obstetrician for high risk referrals. Initial investigations to include:
- FBC and Platelets
- Blood group, Rhesus status and antibodies
- VDRL
- MSU & urinalysis
- Rubella serology
- HIV
- Hep C offered to high risk patients
- GTT if high risk
- FBS, random s or Alc for all due to high prevalence of diabetes in UAE.
Visits to include reviews, checks and tests in accordance with DHA, Antenatal Care Protocols, 3 ante-natal ultrasound Scans.
*Above requires prior approval from the Insurance company. In-patient maternity services:
10% coinsurance from the insured member Maximum benefit:
AED 7,000 per normal delivery, AED 10,000 AED for medically necessary C-section, complications and for medically necessary termination (All limits include coinsurance)
*All above treatments require prior approval from the insurance company or Within 24 hours of emergency treatment. |
Pre- and post-natal complications |
Covered within the above ‘Pregnancy and Childbirth’ benefit |
New Born Cover |
Cover for 30 days from birth under the mother’s card
- BCG,
- Hepatitis B and neo-natal screening tests Phenylketonuria (PKU), Congenital
- Hypothyroidism,
- Sickle cell screening, congenital adrenal hyperplasia).
*All above treatments require prior approval from the insurance company or within 24 hours of emergency treatment. |
Cover Extension:
On sole discretion of ADNIC, the coverage shall be extended outside the UAE for treatment, along with Airfare. |
The Coverage shall be extended provided the cost of treatment outside UAE for the required medical procedures is less than 70% of applicable Network rates with a minimum difference of AED 3,000/-,
Air ticket will be covered for insured members in respect of elective treatment subject to the following:
- On eligibility, Covered up to a maximum of AED 2,000/- on reimbursement basis
- Benefit if covered only for In-Patient treatments for Economy class round trip ticket only for patients (i.e. accompanying persons are not covered)
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Teleconsultation Benefit through TruDoc 24X7 |
- 24X7 access to highly trained and licensed Doctor’s & wellness experts.
- Medication delivery, wherever applicable and within the regulatory framework.
- Support for Healthy Life style and support for Acute and Chronic Conditions Appointment booking, on your behalf, within your network.
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