Adamjee Emerald : Choose Best Health Insurance Plan From Adamjee

Plan Summary

Plan NameEmerald

Cover AmountAED 1,000,000

Pharmacy LimitUpto AED 1,000,000

TPAMEDNET

Adamjee - Emerald Details

Maternity Cover

Out-patient Maternity Services

Out Patient eligible Maternity expenses are covered up to Annual limit: 10% co-payment applicable on all Maternity treatments, including out-patient 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

In-patient Maternity Services

1. Pre & Post natal treatments 2. Normal delivery 3. Medically necessary Caesarean Section 4. Maternity related Complications 5. Medically necessary legal terminations * In-patient maternity treatment are subject to prior approvalNormal Delivery expenses are covered up to a sub limit of AED 10,000/-Medically necessary Caesarean Section and complication expenses are covered up to a sub limit of AED 10,000/-Any Medical Emergency expenses related to Maternity will be covered up to a sublimit of AED 150,000/-

Waiting Period

Maternity Waiting Period

any pregnancy, which arises within forty calendar days from the date of policy issuance, shall not be covered under this policy under any condition

Chronic Condition Waiting Period

All medical underwritten conditions will have no waiting period. Undeclared pre-existing conditions will not be covered during the policy period and will be underwritten at renewal.

Pre-existing diseases (PED)

Covered only if declared on additional payment

Hospital Access

Direct access to hospital

Dental and Gum Treatment

Dental

Reimbursement* - Additional 20% co-payment applicable over free access *No reimbursement for Silk Road NW inside UAE.Covered with Annual sub-limit of AED 3,500CoveredFree Access - Covered with pre-authorization only - Co-payment 20% applicable

Emergency Dental treatment for accidental damage to natural teeth

Under this benefit the treatment required within three months following accidental damage to sound natural teeth caused by a violent external means when the treatment is given by a Physician, dentist or dental surgeon is covered. *No treatment will be covered after 3 months of the accident. **Treatment required as the result of the consumption of food or drink or any foreign bodies contained in such food or drink is not covered.

Dental Consultation

Covered

Hearing and Vision Aids

Hearing and vision aids, and vision correction by surgeries and laser

Covered only in cases of medical emergencies

Coverage Type

Clinic + Hospital Access

Out-Patient Services

Co-Payment

20% co-payment upto AED 50

Laboratory Tests

Covered with 0% co-pay per invoiceCovered with 10% co-pay per invoiceCovered with 20% co-pay per invoice

Physician Consultation

Covered with Co-pay of 20% max 50 per consultation

Pharmaceuticals

Covered with 0% co-pay per invoiceCovered with 10% co-pay per invoiceCovered with 20% co-pay per invoice

In-Patient Services

Room Type

Private

Ambulance Service

Covered (in Medical Emergency only and if followed by admission)

Companion Accomodation

Covered (maximum up to 100 AED per night)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 approvalThe 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

Organ transplant

Covered (Recipient Organ transplantation service, excluding any charges related to Donor)

Repatriation of Mortal Remains to Home Country

Covered up to AED 7,500/-

Hospital Accommodation and related Services

Covered

Intensive care unit and coronary artery disease treatment

Covered

Consultant’s, Surgeon’s and Anaesthetist's Fees

Covered

Various therapies including physiotherapy, chemotherapy, radiation therapy etc

Covered

Use of hospital medical equipments (e.g. heart and lung support systems etc.)

Covered

Pre-Existing and Chronic Conditions

Pre-existing conditions

Undeclared pre-existing conditions will not be covered during the policy period and will be underwritten at renewal.All declared Pre-existing and Chronic conditions are covered with a sub limit of AED 150,000/-All pre-existing medical conditions should be declared in the Medical Application Form and is subject to medical underwriting.

Network

OP- Mednet - Emerald IP - Mednet - Emerald

Other Services

New Born Cover

Babies born inside and out-side UAE - New born expenses are covered from Date of Birth under the motherÃ¢â‚¬â„¢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 upon requested by the policy holder and is subject to Medical underwriting. Coverage for new born are in line with DHA benefit guidelines.Babies born inside and out-side UAE - New born expenses are covered from Date of Birth under the motherÃ¢â‚¬â„¢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 upon requested by the policy holder and is subject to Medical underwriting. Coverage for new born are in line with DHA benefit guidelines.

Laboratory Tests

Nil co-payment.10% co-payment20% co-payment

Physiotherapy Treatment

Covered with 0% co-pay per invoiceCovered up to 15 sessions/ Per member Per year*Approval protocol for Free access at network providers will follow DHA guidelinesCovered with 10% co-pay per invoiceCovered with 20% co-pay per invoiceCovered with 20% co-pay per invoice

Cancer Treatment

Cancer Screening, healthcare services, investigations and treatments only for members who are enrolled under "Patient Support Program" only. Covered as per terms, conditions and exclusions of the program defined by DHACancer Screening, healthcare services, investigations and treatments only for members who are enrolled under "Patient Support Program" only. Covered as per terms, conditions and exclusions of the program defined by DHA

Preventive services

Diabetic Screening: Fasting Blood Sugar and HBA1C tests are covered once a policy year for eligible membersPreventive services covered for members over 18 years of age *Prior Approval is required for Free Access facility(Non AUH)Diabetic Screening: Fasting Blood Sugar and HBA1C tests are covered once a policy year for eligible members

HCV Hepatitis C Virus Infection

Screening, healthcare services, investigations and treatments related to viral Hepatitis and associated complications related to Hepatitis C shall only be for members enrolled under Patient Support Program. Covered as per terms, conditions and exclusions of the program defined by DHA

Day care Treatment

Covered

Out Patient Surgery

Covered

Emergency Mental health Treatments

Covered

Work Related Injuries

Covered

MedNet’s Global Emergency Assistance services

No Financial limitations applicable under this benefit - Worldwide Emergency Medical Evacuation - Worldwide Hospital Admission Assistance - Repatriation of mortal remains to home country from anywhere in the world, including country of residence. - Medical Consultation, Evaluation, Referral & Monitoring - Care of minor children & Compassionate visit *For detailed information please refer Assist America Table of Benefit

Medication

Alternative Medicine

Covered up to AED 1,600/- PMPY **Only on reimbursement basis

Essential Vaccines & Preventive Services

Co-Payment

Covered

Policybazaar Exclusive Offer

For Pakistani Nationality

If family Size = 1 then the spouse only gets per person benefit limit of 350000 AED and room limit is 12000 AEDFor family size = More than 1 the coverage of 250000 AED is present for Parents only with room limit as 6500 AEDFamily size = More than 1 the coverage of 250000 AED is present for Parents only with room limit as 6500 AED