PHYSIOTHERAPY. Up to 6 sessions undertaken within 3 months of the date of a medical referral letter. If your condition becomes a chronic condition and ongoing physiotherapy is aimed at maintaining, rather than curing it, no further payments will be made. Cover subject to 20% co-insurance Cover up to 6 sessions, subject to 20% co-insurance per period of cover Important notes: - • You must obtain pre-authorisation for all benefits in this section. Preventive health services as stipulated by the DHA, for all adults including eligible dependants under your plan. Essential vaccines and inoculations as stipulated in the DHA Immunization Guidelines for newborn babies and children who are insured as dependants under your plan. Preventive health services stipulated by the DHA only Essential vaccines and inoculations stipulated by the DHA only Only the following services are covered under this benefit: - • Full blood count and platelets, mid-stream urine test and analysis, blood group, Rhesus status and antibodies, VDRL, Rubella serology, HIV, Hepatitis C (for high risk patients only), glucose tolerance (for high risk patients only), full blood sugar, 3 prenatal ultrasound scans, 8 visits to a Primary Healthcare Centre in the Restricted Network 3 network. • Pre-natal tests and examinations, as per DHA policies • Post-natal treatments and examinations, as per DHA policies Full cover Cover subject to 10% co-insurance Emergency ▇▇▇▇ treatment Cover up to AED7,000, subject to 10% co-insurance Planned caesarean section Cover up to AED10,000, subject to 10% co-insurance Medically necessary termination of pregnancy Cover up to AED10,000, subject to 10% co-insurance During your child’s first 30 days of life, we will pay for BCG vaccine, hepatitis B and neonatal screening tests (PKU), sickle cell screening, congenital hypothyroidism and congenital adrenal hyperplasia. Full cover Diagnostic and treatment services required for dental and gum treatment in a medical emergency. Cover subject to 20% co-insurance Hearing, vision aids and surgical/laser vision correction required in a medical emergency. Cover subject to 20% co-insurance
Appears in 1 contract
Sources: Business Health Plan Agreement
PHYSIOTHERAPY. Up Medically necessary physiotherapy when you have been referred on the advice of your medical doctor to a physiotherapist who is registered to practice physiotherapy in the country where the treatment is administered. You must send us your medical referral letter in support of your claim. After your first 6 sessions undertaken within 3 months of the date of physiotherapy, if you need more sessions you must contact us for pre-authorisation. We will write to your doctor for a medical referral letterreport in order to assess your claim further. After your first 6 sessions, we will not pay for any physiotherapy that we have not pre-authorised. If your condition becomes is (or becomes) a chronic condition and ongoing physiotherapy treatment is aimed at maintaining, maintaining rather than curing it, no further payments will be made. Cover is subject to 20% the co-insurance chosen by your employer Cover up to 6 sessions, is subject to 20% the co-insurance chosen by your employer Cover is subject to the co-insurance chosen by your employer Cover is subject to the co-insurance chosen by your employer Up to 10 sessions per period of cover for post-hospital treatment received within the 90-day period following the date you are discharged from hospital Cover is subject to the co-insurance chosen by your employer Key Full cover within annual benefit limit Partial or limited cover No cover Optional cover Flex Core Flex Up • Preventive screening for diabetes every three years for insured persons aged 30 and over, or every year for insured persons aged 18 and over who are considered high risk—as stipulated by the DHA. • Hepatitis C screening and treatment (to be followed as per the guidelines set out in the • Cancer screening and treatment (to be followed as per the guidelines set out in the DHA Cancer Support Programme) • Adult pneumococcal conjugate vaccine (as per guidelines set out by DHA for the adult pneumococcal vaccination) • health screens (eg tests for cholesterol, high blood pressure, anaemia, lung/kidney/liver function, cardiac risk) • medically necessary vaccinations Developmental check-ups for children up to six years old. Essential vaccinations and inoculations for children up to six years old, as stipulated by the Full cover Full cover No cover Option A Up to US$250 or AED918 per period of cover (only if selected by your employer) Option B Up to US$500 or AED1,835 per period of cover (only if selected by your employer) Full cover Full cover Full cover Full cover Treatment for chronic conditions and pre-existing medical conditions. Up to US$40,872 or AED150,000 Up to US$40,872 or AED150,000 Important notes: - • You must obtain pre-authorisation for all benefits in this section. Rehabilitation treatment you receive as an in-patient, carried out under the control and supervision of a specialist in a recognised rehabilitation hospital or unit, and only when it immediately follows in-patient treatment for illness or injury covered by your plan. This benefit is payable only when the admission takes place on the written recommendation of your treating specialist and the admission must take place immediately following your discharge from hospital. Up to 7 days per medical condition Up to 7 days per medical condition Important notes: - • You must obtain pre-authorisation for all benefits in this section. The medical services of a qualified nurse to treat you in your own home when it is medically necessary and relates directly to an illness or injury covered by your Up to 2 weeks per medical condition Up to 2 weeks per medical condition Key Full cover within annual benefit limit Partial or limited cover No cover Optional cover Important notes: - • You must obtain pre-authorisation for all benefits in this section. Preventive health services as stipulated by US$40,872 or US$40,872 or The overall maximum limit to the DHA, amount that you can claim for all adults including eligible dependants under benefits in the lifetime AED150,000 AED150,000 care section that are covered by your plan during your lifetime. Hospice and palliative care Up to the lifetime Up to the lifetime On diagnosis of a terminal medical condition covered by your plan, all costs for treatment limit for all lifetime limit for all lifetime received on the advice of a medical practitioner or specialist for the purpose of offering relief care care of symptoms. Essential vaccines This includes all hospital or hospice accommodation, and inoculations as stipulated nursing care by a Artificial life maintenance Up to the lifetime Up to the lifetime Treatment you require after you have already been on artificial life maintenance for 8 limit for all lifetime limit for all lifetime weeks. care care Persistent vegetative state and neurological damage Up to the lifetime Up to the lifetime Treatment you require after you have been in the DHA Immunization Guidelines hospital for newborn babies and children who 8 weeks for permanent neurological limit for all lifetime limit for all lifetime damage or if you are insured as dependants under your planin a persistent vegetative state. Preventive health services stipulated by the DHA only Essential vaccines and inoculations stipulated by the DHA only Only the following services are covered under this benefitcare care Important notes: - • Full blood count You are eligible for the Flex Up benefits in this section only if they have been selected by your employer and plateletsthey are stated on your Certificate of Insurance. Hearing, mid-stream urine test vision aids, and analysis, blood group, Rhesus status and antibodies, VDRL, Rubella serology, HIV, Hepatitis C (for high risk patients only), glucose tolerance (for high risk patients only), full blood sugar, 3 prenatal ultrasound scans, 8 visits to surgical/laser vision correction required in a Primary Healthcare Centre in the Restricted Network 3 networkmedical emergency. • Pre-natal tests and examinations, as per DHA policies • Post-natal treatments and examinations, as per DHA policies Full cover Cover is subject to 10% the co-insurance Emergency ▇▇▇▇ treatment chosen by your employer Cover up to AED7,000, is subject to 10% the co-insurance Planned caesarean section Cover up to AED10,000, subject to 10% co-insurance Medically necessary termination of pregnancy Cover up to AED10,000, subject to 10% co-insurance During chosen by your child’s first 30 days of lifeemployer We will pay for an annual optical test. Within this benefit, we will pay for BCG vaccinelenses, hepatitis frames, and contact lenses only upon a change of prescription. The optical care benefit is limited to US$100 or AED367 for adults and for children, or to US$200 or AED734 for adults and for children, depending on which option your employer has selected. You are not eligible for cover if neither option is selected. No cover Option A Up to US$100 or AED367 for adults and children per period of cover (only if selected by your employer) Option B Up to US$200 or AED734 for adults and neonatal screening tests children per period of cover (PKU), sickle cell screening, congenital hypothyroidism and congenital adrenal hyperplasia. only if selected by your employer) Key Full cover within annual benefit limit Partial or limited cover No cover Optional cover Important notes: - • You are eligible for the Flex Up benefits in this section only if they have been selected by your employer and they are stated on your Certificate of Insurance. • The benefits in the section are subject to the co-insurance stated on your network card and Certificate of Insurance. Pharmacy costs for all conditions covered by your plan. Up to US$5,000 or AED18,350 per period of cover, subject to the co- insurance stated on your network card and Certificate of Insurance Up to US$10,000 or AED36,700 per period of cover, subject to the co- insurance stated on your network card and Certificate of Insurance (only if selected by your employer) Important notes: - • You are eligible for the Flex Up benefits in this section only if they have been selected by your employer and they are stated on your Certificate of Insurance. • All dental treatment must be carried out by a dentist in a hospital emergency room or dental surgery. • Treatment for damaged crowns, dentures, bridge work or false teeth is only covered under the Dental Plus benefit. • We do not cover orthodontic consultations or treatment of any kind. Diagnostic and treatment services required for dental and gum treatment in a medical emergency. Cover is subject to the co-insurance chosen by your employer Cover is subject to the co-insurance chosen by your employer • screening (eg the checking for and/or the assessment of any diseased, missing and filled teeth including X-rays where necessary) twice per year The Dental Basic benefit is limited to US$250 or AED918, or US$500 or AED1,835, per period of cover. You are not eligible for cover if neither option is selected by your employer. No cover Option A Up to US$250 or AED918 per period of cover, subject to a nil or 20% co-insurance Hearing(as selected by your employer) Option B Up to US$500 or AED1,835 per period of cover, vision aids and surgical/laser vision correction required in a medical emergency. Cover subject to a nil or 20% co-insuranceinsurance (as selected by your employer) No cover Up to US$1,000 or AED3,670 per period of cover, subject to a 20% co-insurance (only if selected by your employer) Key Full cover within annual benefit limit Partial or limited cover No cover Optional cover Important notes: - • You are eligible for the Flex Up benefits in this section only if they have been selected by your employer and they are stated on your Certificate of Insurance. • Dependent children included in your plan are not eligible for these benefits. • You must obtain pre-authorisation for all benefits in this section. • We do not cover the treatment of any newborn child born following assisted reproduction (eg IVF) in the event of the birth occurring within 36 weeks of conception. • Any charges incurred during normal childbirth (including a planned caesarean section) will be paid from the routine in-patient maternity care and newborn care benefits. • We do not cover pregnancy test kits or pre-natal classes and doulas. • We do not cover termination of pregnancy or any treatment or investigations that arise as a result of complications relating to termination of pregnancy. • We do not cover breast pumps. • pre-natal tests and examinations, as per DHA policies • post-natal treatments and examinations, as per DHA policies Full cover Full cover • any hospital accommodation costs for the newborn baby • basic newborn healthcare (physical examination, vitamin K, hepatitis B vaccine, BCG vaccine, one hearing test, blood tests for PKU, congenital hypothyroidism and G6PD, prior to discharge from the hospital) The limits shown for this benefit apply to each pregnancy, regardless of the number of children born. Any hospital or birthing centre accommodation costs will be limited to the cost of a standard hospital room. Emergency in-patient or day-patient treatment necessary as a direct result of a Childbirth by emergency caesarean section, including surgeons', anaesthetists', and the- atre fees, and any additional accommodation charges incurred as the result of the surgical procedure, are also covered under this benefit. We do not provide cover under this benefit for complications arising from a pregnancy established through assisted reproduction (eg IVF) until after the standard 12-week scan, irrespective of how long you have been covered by your plan. We will pay the following costs for treatment that your newborn baby receives during their first 30 days of life: - • DHA-mandated treatment your newborn baby receives as an out-patient (including consultations, tests, procedures, vaccinations, and medication). We will pay the following costs for treatment that your newborn baby receives during their first 90 days of life: - • Emergency treatment your newborn baby receives as an in-patient or day-patient (including treatment of birth defects and congenital or hereditary conditions) for any medical conditions they develop during their first 90 days of life. The limits shown apply to each pregnancy, regardless of the number of children born. Up to US$2,725 or AED10,000 per pregnancy Up to US$40,882 or AED150,000 per pregnancy Up to US$40,882 or AED150,000 per pregnancy Option A Up to US$5,000 or AED18,350 per pregnancy (only if selected by your employer) Option B Up to US$7,000 or AED25,690 per pregnancy (only if selected by your employer) Up to US$40,882 or AED150,000 per pregnancy Up to US$40,882 or AED150,000 per pregnancy The following are not covered by your plan, as well as any exclusions stated within the table of benefits. Other benefits, as stated within the table of benefits, may also be restricted or excluded depending on your plan. All conditions, tests, treatments or increased treatment costs you incur because of complications that occur directly or indirectly as a consequence of treatment of any excluded condition will also not be covered. We will also not pay for the fees and charges listed below. You will be responsible for them. • fees for the completion or providing of claim forms or any other medical reports or forms such as medical referral letters, even if we have requested them • bank charges incurred as a result of us transferring money • losses you may incur due to fluctuations in exchange rates • charges incurred as the result of payment errors that arise as the result of you having provided us with incorrect information hospitals, doctors, or other providers of medical services • any charges made by your bank or credit card company You are not covered for treatment related to: - You are not covered for treatment related to: - We will only pay for patch testing if you have been referred by a medical doctor. Patch testing is limited to one patch testing investigation over the lifetime of your plan. Your medical referral letter will be required. You are not covered for alternative treatments and therapies, including, but not limited to, aqua physiotherapy, bone-setting, colonic irrigation, hydrotherapy, Intervertebral Differential Dynamics (IDD), kinesiology, naturotherapy, Ayurveda and massage therapy. You are not covered for artificial life maintenance, other than any benefit you are eligible for in the lifetime care section of the table of benefits. You are not covered for treatment directly or indirectly arising from or connected with: - You are not covered for investigations or treatment related to any medical conditions arising directly or indirectly from chemical contamination, radioactivity or any nuclear material whatsoever, including the combustion of nuclear fuel.
Appears in 1 contract
Sources: Health Plan Agreement
PHYSIOTHERAPY. Up to 6 sessions undertaken within 3 months of the date of a medical referral letter. If your condition becomes a chronic condition and ongoing physiotherapy is aimed at maintaining, rather than curing it, no further payments will be made. Cover subject to 20% co-insurance Cover up to 6 sessions, subject to 20% co-insurance per period of cover Important notes: - • You must obtain pre-authorisation for all benefits in this section. Preventive health services as stipulated by the DHA, for all adults including eligible dependants under your plan. Essential vaccines and inoculations as stipulated in the DHA Immunization Guidelines for newborn babies and children who are insured as dependants under your plan. Preventive health services stipulated by the DHA only Essential vaccines and inoculations stipulated by the DHA only Only the following services are covered under this benefit: - • Full blood count and platelets, mid-stream urine test and analysis, blood group, Rhesus status and antibodies, VDRL, Rubella serology, HIV, Hepatitis C (for high risk patients only), glucose tolerance (for high risk patients only), full blood sugar, 3 prenatal ultrasound scans, 8 visits to a Primary Healthcare Centre in the Restricted Network 3 network. • Pre-natal tests and examinations, as per DHA policies • Post-natal treatments and examinations, as per DHA policies Full cover Cover subject to 10% co-insurance Key Full cover within annual benefit limit Partial or limited cover Emergency ▇▇▇▇ treatment Cover up to AED7,000, subject to 10% co-insurance Planned caesarean section Cover up to AED10,000, subject to 10% co-insurance Medically necessary termination of pregnancy Cover up to AED10,000, subject to 10% co-insurance During your child’s first 30 days of life, we will pay for BCG vaccine, hepatitis B and neonatal screening tests (PKU), sickle cell screening, congenital hypothyroidism and congenital adrenal hyperplasia. Full cover Diagnostic and treatment services required for dental and gum treatment in a medical emergency. Cover subject to 20% co-insurance Hearing, vision aids and surgical/laser vision correction required in a medical emergency. Cover subject to 20% co-insurance
Appears in 1 contract
Sources: Health Plan Agreement