Flexi Plus - Diamond. UAE, GCC, ME, SEA including Indian Subcontinent. All UAE residents (UAE Nationals & Expatriates having a Valid Residence Visa)

Transcription

1 S. No. Benefits Flexi Plus - Platinum Flexi Plus - Diamond Flexi Plus - Gold Flexi Plus - Silver 1 Aggregate Limit Under the terms and conditions of the plan, we will pay necessary, customary and reasonable expenses up to an overall maximum, per insured member per year. 2 Area of Cover 3 Eligibility 4 AED 1,500,000/= AED 750,000/= AED 250,000/= AED 150,000/= Worldwide excluding USA & Canada Expatriates having a Valid Residence Visa) UAE, GCC, ME, SEA including Indian Subcontinent Expatriates having a Valid Residence Visa) UAE, GCC, ME, SEA including Indian Subcontinent Expatriates having a Valid Residence Visa) UAE, GCC, ME, SEA including Indian Subcontinent Expatriates having a Valid Residence Visa) GN + AH GN RN RN2 5 Age Limit 0 to 70 0 to 70 0 to 70 0 to 70 6 Deductible for Out-Patient Services AED 50/= AED 50/= AED 50/= AED 50/= Treatment Outside the 7 If treatment is taken outside the network for eligible medical condition covered under the policy, reimbursement would be allowed subject to 20% Co-insurance based on Usual, Customary and Reasonable ( UCR ) Charges. ( UCR charges are as per the discretion of the insurer ) 20% Co-insurance subject to UCR Charges 20% Co-insurance subject to UCR Charges Treatment out-side the is not allowed and will not be reimbursed. Treatment out-side the is not allowed and will not be reimbursed. 8 Claims Settlement Basis ( as per Usual, Customary and Reasonable Charges of the in UAE ). ( if eligible ) ( if eligible ) In-Patient Treatment a Accidents and emergencies, intensive care and theatre costs b Hospital Accommodation ( Room Charges ) Private Room Covered Private Room Covered Private Room AED 750/= per day Semi - Private Room AED 450/= per day c Nursing Fees, medical expenses and ancillary charges d Surgeons', consultants, anaesthetist', specialists', General Practitioners' fees e Prescribed Medicine and drugs f Reconstructive surgery following an accident or following surgery for an eligible medical condition g Prostheses: artificial body parts surgically implated to form permanent parts of an insured member's body h MRI, PET, CT Scans i X-Rays, Pathology, diagnostic tests and procedures

2 j k Oncology tests, drugs and consultants' fees including cover for chemotherapy and radiotheraphy Physiotherapy recommended / referred by a General Practitioner or a Specialist, Parent accommodation l Hospital accomodation cost in respect of a parent or legal guardian staying with an Insured member who is under 18 years of age and is admitted to a Hospital as an In-Patient. Accidental Damage to Teeth m Treatment recevied in an Emergency room in a Hospital within 48 hours of incurring Accidental damage caused to sound, natural teeth as a result of an Accident. Hospital Cash Benefit n When treatment received as an In-Patient for an eligible Medical Condition in a Government Hospital, where the no costs were incurred for accommodation and/or for treatment, then this benefit pays for a daily cash benefit for In-Patient stay more than 3 day. AED 300/= per day AED 300/= per day o This benefit is not applicable for Accident & Emergency admissions. Deductible for ( In-Patient Services ) ( Applicable if treatment is taken in a facility in-side/outside the of providers ) NIL NIL NIL NIL

3 p q r s t Out-Patient & Day-care Treatment Deductible for ( Out-Patient Services ) ( Applicable if treatment is taken in a facility inside/outside the of providers ) Primary Consultation and treatment to include General Practitioners' fees, prescribed medicines, drugs and dressings X-ray, pathology, diagnostic tests and procedures Specialist or Consultant fees for consultation with prescribed medicines, drugs and dressings Physiotherapy recommended / referred by a General Practitioner or a Specialist, AED 50/= Per Visit AED 50/= Per Visit AED 50/= Per Visit AED 50/= Per Visit u Oncology tests, drugs and consultants' fees including cover for chemotherapy and radiotheraphy v MRI, PET, CT Scans w Out-Patient Surgical Operations x Post - Hospitalization Treatment y Chronic Medical Conditions Covered if not Pre-existing and sub -limited Up to AED 25,000 Up to AED 15,000 Up to AED 10,000 Up to AED 5,000 z Pre-existing Conditions Covered after 2 years of continuous cover with ASNIC AED 15,000 AED 10,000 AED 5,000 AED 3,000

4 Emergency Local Ambulance aa Cost of road ambulance transport required due to an emergency or medical necessity to the nearest available and appropriate local hospital. Limited to AED 1,000/= Limited to AED 750/= Limited to AED 500/= Limited to AED 250/= Repatriation of Mortal Remains ab In the event of death, the cost of preparation and air transportation of the body, mortal remains or the ashes of an insured person, from the place of death to the home country or the preparation and local burial or cremation of the mortal remains of the insured person, who dies outside the home country. AED 15,000/= AED 10,000/= AED 7,500/= AED 5,000/= ac Maternity Benefit (with 12 months waiting period ) a limit of AED 25,000/= a limit of AED 15,000/= a limit of AED 10,000/= ad Nursing at Home Immediately following Hospital discharge on the recommendation of a specialist and must be provided by a qualified nurse. All treatments under this benefit must be preauthorized by us. AED 5,000/= for a period not exceed 30 days in aggregate. AED 4,000/= for a period not exceed 30 days in aggregate. AED 2,500/= for a period not exceed 30 days in aggregate. AED 1,000/= for a period not exceed 30 days in aggregate. Reconstructive Surgery ae Reconstructive surgery following an Accident or following surgery for an eligible medical conditions, which is not pre-existing and the incident has not occurred prior to commencing this cover under the policy. af Renal Disorder ( Kidney Transplant Only ) (Cost of organ not Covered) Hospital Expense for person donating an Organ for Transplant ( Kidney ) Dental Cover Hospital Expenses Covered. Dialysis ( pre & post ) operative covered. Covered Up to AED 15,000/= Hospital Expenses Covered. Dialysis ( pre & post ) operative covered. Covered Up to AED 10,000/= Hospital Expenses Covered upto AED 20,000/= only Dialysis not covered Hospital Expenses Covered upto AED 15,000/= Only Dialysis not covered ag ah ai Below dental procedures excluding any surgeries. Root Canal, Fillings, Extractions, Antibiotics for Infection of Gums Consultation and X- ray. Optical Cover Cover for a pair of lenses only. Optical Cover Extension Surgery for Cataract Eligibility : only after a continuous cover with ASNIC for 2 years a limit of AED 2,000/= with AED 100/= as deductible a limit of AED 200/= for a pair of lenses a limit of AED 10,000/= after 2 years of Continuous cover with ASNIC a limit of AED 6,000/= after 2 years of Continuous cover with ASNIC

5 aj ak al Annual Breast Screening Annual Prostate Screening Return Air Fare to Patient for Surgery in Home Country ( if treatment is not available in the country of residence or the treatment expense is up to 50% of the cost in UAE ). insurance cover for female 35 years and within our insurance cover for Male 45 years and within our AED 2,000/= Plus AED 2,000/= for accompanying Family Member insurance cover for female 35 years and within our insurance cover for Male 45 years and within our AED 2,000/= Plus None for Accompanying Family Member

6 Exclusions Standard Individual Policy Exclusions would apply. LIMITED PERIOD EXCLUSIONS Limited Period Exclusions x applicable for first 2 years of being covered with ASNIC ( Health services of the following conditions / illness / ailments ) are not covered for the first 2 years of commencing the policy for all insured members Applicable to all categories Applicable to all categories Applicable to all categories Applicable to all categories a.1 Cataracts a.2 Prostatic Hypertrophy Tumors/Benign a.3 Hysterectomy for Menorrhagia or Fibromyoma a.4 Hernia and Hydrocele a.5 Varicose Viens and Varicocele a.6 Piles, Fistula in anus, Fissure Surgeries for : Sinusitis and related a.7 Disorders Arthritis, Gout, Rheumatism and Spinal Disc a.8 Disorders. Joint Replacement, unless arising out of a.9 accidents a.10 Stone in urinary and biliary systems a.11 Dilatations & Currettage a.12 Skin and all internal tumors / cysts/ nodules / polyps of any kind, including breast lumps, adenoids and hemorrhoids a.13 dialysis required for chronic renal failure a.14 surgery on Tonsils, adenoids and sinuses a.15 Gastric and deodenal ulcers a.16 Circumcision, unless necessary for the treatment of a disease not othersise excluded or required as a result of accidental bodily injury