Policy holder name: Policy start date:

Insured ID: Policy end date:

Mobile No.: Email:

INDIVIDUAL MEDICAL INSURANCE

Type of benefit Plan

Annual limit 1 Million

Geographical scope of coverage Worldwide Excluding US & Canada
Emergency scope of coverage Worldwide
Network Applicable* available options NRI Care- N3
Underwriting terms and coverage criteria for  All pre-existing medical conditions should be
Pre-existing, Chronic conditions: declared in the Medical. Application Form and is
subject to medical underwriting.
 All medical underwritten conditions will have no
waiting period
 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.

Cover in USA and Canada is limited to 90 days per
year and only applies in case of accident /
emergency during business trips or holidays
abroad (Elective treatment is not covered)
INPATIENT SERVICES
Coverage is up to the relevant Annual Benefit Limit per person/per policy year with pre-approval
Hospitalization class Private room
Companion Room and accommodation for Covered (Max up to AED 100 per night)
beneficiary below the age of 16

The cost of accommodation of a person accompanying a

beneficiary below 16 years of age in the same room in cases
of medical necessity at the recommendation of the treating
doctor and with prior approval
Intensive care unit and coronary artery disease Covered
treatment
Use of hospital medical equipments (e.g. heart Covered
and lung support systems etc.)
Recipient Organ transplantation service, Covered up to 25,000 per person per year
excluding any charges related to Donor
Ambulance Services (in Medical Emergency only Covered
and if followed by admission)
Repatriation costs for the transport of mortal Covered upto AED 7500/-
remains to the country of origin

OUTPATIENT SERVICES
Physician Consultation Covered with Co-pay of 20% max 50 per
consultation
Copay on consultation for follow up within 7 days No Co-pay
for same treatment and with same doctor
Diagnostics( X-Ray, MRI, CT-Scan, ultrasound and Covered with 0% co-pay per invoice
Endoscopy)
Prescribed Drugs and Medicines(covered upto ABL) Covered with 0% co-pay per invoice
Physiotherapy( Subject to Prior Approval) Covered with 20% co-pay per invoice
Covered up to 15 sessions per member per year
OTHER SALIENT BENEFITS
Day care Treatment Covered
Out Patient Surgery Covered
Emergency Mental health Treatments Covered
Work Related Injuries Not covered
New Born baby coverage Babies born inside and out-side UAE - New born
expenses are covered from Date of Birth under
the mother’s card for the first 30days from date
of birth upto Annual Benefit Limit of mother.
New born babies will be added to the principle
policy only if requested by the policy holder and
is subject to Medical underwriting.
Coverage for new born are in line with DHA
benefit guidelines.
Emergency Dental treatment for accidental damage Covered
to natural teeth
Preventive services covered for members over 18 Diabetic Screening:
years of age Fasting Blood Sugar and HBA1C tests are covered
once a policy year for eligible members
Cancer Treatments- Screening Healthcare services, Covered as per terms, conditions and exclusions
investigations and treatments only for members of the program defined by DHA
enrolled under Patient Support Program
Hepatitis C Infection- Screening Healthcare services, Covered as per terms, conditions and exclusions
investigations and treatments related to viral of the program defined by DHA
hepatitis and its compliocations only for members
enrolled under Patient Support Program
Policy sum insured increases by 10% for every IP
claim free year. The maximum increase allowed
is 50% of policy sum insured.
In any policy year, the accrued No claims bonus,
No claim bonus
shall not exceed 50% of the sum insured
available in the renewed policy.
The no claim bonus shall be applicable on an
annual basis subject to continuation of the
 policy.
The entire No claims bonus will be forfeited if
the policy is no continued/ renewed on or before
policy period end date or the expiry of the grace
period whichever is later.
If a claim is payable under the policy, the
company agrees to automatically make the
reinstatement of up to the sum insured once in a
policy year which is valid for the policy year only,
subject to the conditions specified below:
The recharge shall be utilized only after sum
insured & no claim bonus has been completely
exhausted in that policy year.
Auto recharge
The recharge shall be available only for all future
claims i.e next incident / admission which are
not in relation to any illness or injury for which a
claim has already been admitted for the insured
person during that policy year.
For any treatment related to a declared PEC &
Maternity - auto recharge would not be
applicable.
Covered. This benefit shall be available only once
Health check up in India during a policy year. This benefit does not
reduce the sum insured
Cashless IPD in India Covered
Port benefits are available subject to continuous
4 year coverage of this policy in UAE.

Portability benefits will give credit for waiting

Portability in India period on named ailments and pre-existing
diseases movement to India on the similar
available Care Health Insurance product subject
to guidelines applicable

Hearing and vision aids, and vision correction by Covered in medical emergencies
surgeries and laser
To be followed as per the guidelines laid out
Adult Pneumococcal Conjugate Vaccine (On
in Adult Pneumococcal Vaccination
Reimbursement Basis)
guidelines
Influenza Vaccine As per DHA guidelines Covered once per
(For Dubai members) (On Reimbursement Basis) annum on at designated clinics only.
MedNet’s Global Emergency Assistance services - No Financial limitations applicable under this
coverage through Assist America benefit
- Worldwide Emergency Medical Evacuation
- Worldwide Hospital Admission Assistance
- Medical Consultation, Evaluation, Referral &
Monitoring
- Care of minor children & Compassionate visit

ADDITIONAL BENEFITS
MATERNITY BENEFIT
Inpatient & Outpatient coverage - Normal Delivery expenses are covered up to a
Includes: sub limit of AED 10,000/-
1. Pre & Post-natal treatments - Medically necessary Caesarean Section and
2. Normal delivery complication expenses are covered up to a sub
3. Medically necessary Caesarean Section limit of AED 10,000/-
4. Maternity related Complications - Any Medical Emergency expenses related to
5. Medically necessary legal terminations Maternity will be covered up to a sub limit of
* In-patient maternity treatment are subject to prior AED 150,000/-
approval - Out Patient eligible Maternity expenses are
covered up to Annual limit
- 10% co-payment applicable on all Maternity
treatments, including outpatient Maternity
consultation (no Deductible applies)
- The following screening tests are covered as
per DHA Antenatal care protocol:
• FBC and Platelets
• Blood group, Rhesus status and antibodies
• VDRL
• MSU & urinalysis
• Rubella serology
• HIV
• Hepatitis C offered to high risk patients
• GTT, if high risk
• FBS, Random blood sugar OR HbA1C
• Ultrasonography: 3 scans
Alternative Medicine Benefit Covered on reimbursement up to AED 1,600/-
Covers: Osteopathy, Chiropractic, Homeopathy,
Acupuncture, Ayurveda and Herbal Treatments
Vaccination for Children as per MOH schedule (On Covered
Reimbursement Basis)
DENTAL BENEFIT
Free Access - Covered with pre-authorization only – Covered with 20% copay up to AED 3500.
Co payment 20% applicable
Reimbursement* - Additional 20% co-payment Services Included:
applicable on top of free access copay 1. Root Canal Treatment (RCT)
2. Fillings- Composite Amalgam Only
3. Tooth Extractions
4. Scaling and Polishing
5. Medications- Only Antibiotics for infection of
gums and following tooth extraction/RCT
6. Dental Consultation and X-ray
All dental services other than mentioned above
are excluded

Dialysis Covered up to AED 60,000/-

Outpatient - 20% coinsurance payable by the
insured per visit

Mental Health (Outpatient counselling) Covered up to the limit of AED 800/-

Outpatient - 30% coinsurance payable by the
insured per visit
Organ Transplantation (Covered for recipients Covered up to AED 100,000/- Outpatient -
only) 20% coinsurance payable by the insured per
visit
Policy sum insured increases by 10% for every IP
claim free year. The maximum increase allowed
is 50% of policy sum insured.
In any policy year, the accrued No claims bonus,
shall not exceed 50% of the sum insured
No claim bonus available in the renewed policy.
The no claim bonus shall be applicable on an
annual basis subject to continuation of the policy.
The entire No claims bonus will be forfeited if the
policy is no continued/ renewed on or before
policy period end date or the expiry of the grace
period whichever is later.
If a claim is payable under the policy, the
company agrees to automatically make the
reinstatement of up to the sum insured once in a
policy year which is valid for the policy year only,
subject to the conditions specified below:
The recharge shall be utilized only after sum
insured & no claim bonus has been completely
exhausted in that policy year.
Auto recharge
The recharge shall be available only for all future
claims i.e next incident / admission which are not
in relation to any illness or injury for which a claim
has already been admitted for the insured person
during that policy year.
For any treatment related to a declared PEC &
Maternity - auto recharge would not be
applicable.
Virtual consultation Examination, diagnostic and treatment
Basic healthcare services: out-patient in services by authorized general practitioners,
authorized clinics of hospitals, clinics and health
specialists and consultants
centres 20% coinsurance payable by the insured per
visit
No coinsurance if a follow-up visit within
seven days
CLAIMS SETTLEMENT TERMS (what is Paid by the Insurer)
Elective treatment Free access Covered (Out-side UAE: covered maximum up to
(Network) 100% of UAE applicable network rates)

Reimbursement Reimbursement in SEA:

(Non network) - 100% of actual covered cost subject to maximum
of 100% of UAE applicable network rates

Reimbursement elsewhere within territorial scope

of cover*:
- 80% of Actual Covered Cost subject to maximum
of 80% of UAE Applicable Network rates
Emergency treatment Free access
(Network)
100% of actual covered cost subject to maximum of
Reimbursement 100% of UAE applicable network rates
(Non network)

Premium Calculation

No. of Actual Basmah Premium Vat Final

Category lives Premium Amount Premium

Principal age
 VAT Clause

The quote provided above is inclusive of Value Added Tax ('VAT') which may be applicable on the policy.

**The company reserves the right to vary the premium rates, if there is a change in the total number of insured
members above or below 15% during the policy year.

DHA EXCLUSIONS

This Insurance Policy is intended to provide cover for expenses incurred for Medical Treatment of Medical
Conditions or Bodily Injuries which, in the opinion of both the treating physician are Medically Necessary and
which are covered under the Terms and Conditions of the Insurance Policy. This Insurance Policy does not cover,
amongst other things, expenses arising directly or indirectly from the following:

Excluded healthcare services except in cases of medical emergencies

1. Diagnostic and treatment services for dental and gum treatments
2. Hearing and vision aids, and vision correction by surgeries and laser

Excluded (non-basic) healthcare services

1. Healthcare Services which are not medically necessary
2. Care for the sake of travelling.
3. Custodial care including
(1) Non‐medical treatment services;
(2) Health‐related services which do not seek to improve or which do not result in a change in the medical
condition of the patient.
4. Services that do not require continuous administration by specialized medical personnel.
5. Personal comfort and convenience items (television, barber or beauty service, guest service and similar
incidental services and supplies).
6. All cosmetic healthcare services and services associated with replacement of an existing breast implant.
Cosmetic operations which are related to an Injury, sickness or congenital anomaly when the primary purpose is
to improve physiological functioning of the involved part of the body and breast reconstruction following a
mastectomy for cancer are covered.
7. Surgical and non‐surgical treatment for obesity (including morbid obesity), and any other weight control
programs, services, or supplies.
8. Medical services utilized for the sake of research, medically non‐approved experiments, investigations, and
pharmacological weight reduction regimens.
9. Healthcare Services that are not performed by Authorized Healthcare Service Providers.
10. Healthcare services and associated expenses for the treatment of alopecia, baldness, hair falling, dandruff or
wigs.
11. Health services and supplies for smoking cessation programs and the treatment of nicotine addiction.
12. Treatment and services for contraception
13. Treatment and services for sex transformation, sterilization or intended to correct a state of sterility or
infertility or sexual dysfunction. Sterilization is allowed only if medically indicated and if allowed under the Law.
14. External prosthetic devices and medical equipment.
15. Treatments and services arising as a result of professional sports activities, including but not limited to, any
form of aerial flight, any kind of power‐vehicle race, water sports, horse riding activities, mountaineering
activities, violent sports such as judo, boxing, and wrestling, bungee jumping and any other professional sports
activities.
16. Growth hormone therapy unless medically necessary.
17. Costs associated with hearing tests, prosthetic devices or hearing and vision aids.
18. Mental Health diseases (in‐patient treatments), unless it is an emergency condition.
19. Patient treatment supplies (including for example: elastic stockings, ace bandages, gauze, syringes, diabetic
test strips, and like products; non‐prescription drugs and treatments,) excluding supplies required as a result of
Healthcare Services rendered during a Medical Emergency.
20. Allergy testing and desensitization (except testing for allergy towards medications and supplies used in
treatment)
21. Services rendered by any medical provider who is a relative of the patient for example the Insured person
himself or first‐degree relatives.
22. Enteral feedings (via a tube) and other nutritional and electrolyte supplements, unless medically necessary
during in‐patient treatment.
23. Healthcare services for adjustment of spinal subluxation.
24. Healthcare services and treatments by acupuncture; acupressure, hypnotism, massage therapy,
aromatherapy, ozone therapy, homeopathic treatments, and all forms of treatment by alternative medicine.
25. All healthcare services & treatments for in‐vitro fertilization (IVF), embryo transfer; ovum and sperms transfer.
26. Elective diagnostic services and medical treatment for correction of vision
27. Nasal septum deviation and nasal concha resection.
28. Healthcare services, investigations and treatments related to viral hepatitis and associated complications,
except for the treatment and services related to Hepatitis A, B and C.
29. Any services related to birth defects, congenital diseases and deformities unless if left untreated will develop
into an emergency.
30. Healthcare services for senile dementia and Alzheimer’s disease.
31. Air or terrestrial medical evacuation and unauthorized transportation services.
32. Inpatient treatment received without prior approval from the insurance company including cases of medical
emergency that were not notified within 24 hours from the date of admission where possible.
33. Any inpatient treatment, investigations or other procedures, which can be carried out on outpatient basis
without jeopardizing the Insured Person’s health.
34. Any investigations or health services conducted for non‐medical purposes such as investigations related to
employment, travel, licensing or insurance purposes.
35. All supplies which are not considered as medical treatments including but not limited to: mouthwash,
toothpaste, lozenges, antiseptics, , food supplements, skin care products, shampoos and multivitamins (unless
prescribed as replacement therapy for known vitamin deficiency conditions); and all equipment not primarily
intended to improve a medical condition or injury, including but not limited to: air conditioners or air purifying
systems, arch supports, exercise equipment and sanitary supplies.
36. More than one consultation or follow up with a medical specialist in a single day unless referred by the
treating physician.
37. Health services and associated expenses for organ and tissue transplants, where the Insured Person is a
donor. This exclusion also applies to follow‐up treatments and complications unless if left untreated will develop
into an emergency.
38. Any expenses related to immunomodulators and immunotherapy unless medically necessary.
39. Any expenses related to the treatment of sleep related disorders.
40. Services and educational programs for people of determination, this also includes disability types such as but
not limited to mental, intellectual, developmental, physical and/or psychological disabilities.
41. All expenses relating dental treatment, dental prostheses, and orthodontic treatments except Emergency
cases (Elective treatments will be covered only if the "Dental Benefit" is chosen and fully as specified in the table
of benefit)
42. Any expenses related to declared pandemic would not be covered.

Healthcare services outside scope of insurance

1. Injuries or illnesses suffered by the Insured Person as a result of military operations of whatever type.
2. Injuries or illnesses suffered by the Insured Person as a result of wars or acts of terror of whatever type.
3. Healthcare services for injuries and accidents arising from nuclear or chemical contamination.
4. Injuries resulting from natural disasters, including but not limited to: earthquakes, tornados and any other type
of natural disaster.
5. Injuries resulting from criminal acts or resisting authority by the Insured Person. 6. Injuries resulting from a road
traffic accident.
7. Healthcare services for work related illnesses and injuries as per Federal Law No. 8 of 1980 concerning the
Regulation of Work Relations, its amendments, and applicable laws in this respect.
8. All cases resulting from the use of alcoholic drinks, controlled substances and drugs and hallucinating
substances.
9. Any investigation or treatment not prescribed by a doctor.
10. Injuries resulting from attempted suicide or self-inflicted injuries. 11. Diagnosis and treatment services for
complications of exempted illnesses.
12. All healthcare services for internationally and/or locally recognized epidemics.
13. Healthcare services for patients suffering from (and related to the diagnosis and treatment
of) HIV - AIDS and its Complications and all types of hepatitis except virus A and C hepatitis.

Terms & Conditions:

> The proposal assumes compulsory coverage for all members residing in UAE on valid residence and there is no
voluntary option exercised by any member.
> This policy assumes that all UAE national members, if any, enrolled under this scheme do not hold Thiqa medical
Cards.
> The benefits offered in this quotation do not comply with the Health Authority Abu Dhabi regulation for
compulsory insurance and hence Abu Dhabi residence visa holders and/or members working/residing in Abu
Dhabi/Al Ain and/or any person likely to be working in Abu Dhabi/Al Ain temporarily or permanently are not
eligible for this cover.
> The quote is valid for 30 days from the date of issue.
> Quotation is available only to United Arab Emirates Nationals and persons holding a valid residence status visa
for the United Arab Emirates and who are ordinarily resident in the United Arab Emirates.
> All known major pre-existing / Chronic cases including but not limited to Chemotherapy, radiotherapy, Heart
surgery, any major surgery, renal dialysis & osteoarthritis treatment to be mentioned to Dubai Insurance
Company before submitting the final documents to issue the policy if the policy is subject to major medical
declaration and Members having any major medical conditions (as detailed above) shall be subject to individual
medical evaluation & acceptance shall be at the discretion of the insurer with an additional premium &/or
application of sub limits or declined
> Children are covered from Date of Birth
> Change of benefits class may only take place at renewal of the Individual Scheme or upon satisfactory proof of
promotion.
> Deductibles and any co-insurance amounts are to be paid by the insured person.
> Premiums are per person per annum and are payable annually in advance.
> If routine dental treatment is covered all persons must be enrolled.
> Where pre-existing conditions are not covered, Medical Health Declaration form needs to be completed by all
the applicants. DIN reserves the right to ask for any medical check-up if necessary and the cost of which should be
borne by the applicant.
> This proposal is based on the information given. Any change in the number, age or sex of the persons to be
insured or the scope of coverage will result in recalculation of the premium rates.
> Treatment within the DubaiCare Network in UAE will be settled on a direct billing basis.
> No Insurer shall be deemed to provide cover and no insurer shall be liable to pay any claim or provide any
benefit hereunder to the extent that the provision of such cover, payment of such claim or provision of such
benefit would be in violation of any trade or economic sanctions, laws or regulations applicable in the insurer
jurisdiction of domicile, or which the insurer is legally obligated to comply.
> ALL NETWORKS: Please note that the network list is subject to change without any prior notice due to various
factors.

Cancellation of the policy:

The Policy can be cancelled by either party giving 30 days notice in writing to Dubai Insurance co. (P.S.C). In the
event of cancellation by the Policyholder, Dubai Insurance co. (P.S.C) will retain premium as per the following
short term premium rates.
 25% of the annual premium for the first month or part thereof.
 12.5% of the annual premium for each subsequent month or part thereof.
Dubai insurance co. (P.S.C) have the right to cancel the policy with immediate effect if
 Premium is not paid as per the premium payment agreed terms or issued CDC/PDC Cheques are not
honoured.
 Misrepresentation of info
 Non disclosure of material facts.

Errors & Omissions excepted (E & OE):

We make every effort to make sure that the information in this document is accurate and up to date, based on
the information given to us.
We will promptly correct any errors brought to our attention. If you find an error please contact us. We cannot
accept responsibility for the supply of incorrect information, copied within this document.
We reserve the right to withdraw this quotation and its acceptance at any point and for any reason. You will be
informed immediately if such a situation arises