Orient E-Med : Choose Best Health Insurance Plan From Orient

Plan Summary

Plan NameE-Med

Cover AmountAED 150,000

Pharmacy LimitUpto AED 2,500

TPANextcare

Orient - E-Med Details

Maternity Cover

6 months ( any pregnancy, which arises within 6 months from policy inception will be at the discretion of the insurer)10% co-payment payable by the insured.10% co-payment payable by the Policy Holder. 8 Check-ups + 3 ante-natal ultrasound scans are covered at the Primary Health Care Centre. (All Care provided by Primary Health care obstetrician for low risk or specialist obstetrician for high risk referrals.)

Waiting Period

Maternity Waiting Period

6 months waiting period applies -for first scheme membership -in case of new entrant to UAE and/ or no continuity of cover (COC ) provided.

Chronic Condition Waiting Period

Waiting period of 6 months

Pre-existing diseases (PED)

Covered only if declared on additional payment

Hospital Access

Referral procedure to be followed:- Customer has to visit GP, after GP refers then customer can visit the specialist in clinics.

Dental and Gum Treatment

Co-Payment

20% co-payment.

Hearing and Vision Aids

Co-Payment

20% co-payment.

Coverage Type

Clinic Only

In-Patient Services

Room Type

In-patient services will be received in rooms of two or more beds

Ambulance Service

Ground transportation services in the UAE provided by an authorized party for medical emergencies.

Companion Accomodation

Maximum AED 100 per night. (The cost of accomodating a person accompanying an insured child up to the age of 16 years.)Maximum AED 100 per night. (The cost of accommodation of a person accompanying an in-patient in the same room in case of medical necessity at the recommendation of the treating doctor and after the prior approval of the insurance company providing coverage.)

Pre-Existing and Chronic Conditions

Any new Chronic condition will have a waiting period of 12 months.All declared Pre-existing and Chronic conditions are covered with a sub limit of AED 150,000/-, Undeclared pre-existing and Chronic conditions will not be covered during the policy period

Network

Network - PCP/RN3

Other Services

Radiology diagnostic

20% coinsurance payable by the insured (In Case of non-medical emergiencies, the insurance company's prior approval is required for MRI, CT scans and endoscopies.)

Physiotherapy Treatment

YES (Prior approval of the insurance company is required.)Maximum 6 sessions per year.

Test, diagnosis, treatments related to surgeries in hospitals

Prior approval required from the insurance compay / TPA.

Emergency Treatment

Approval required from the insurance company within 24 hours of admission to the authorized hospital.

Healthcare services for emergency cases

Prior approval required from the insurance company (Prior approval required from the insurance company Where a pre-existing or chronic condition develops into an emergency within the 6-month exclusion preriod this must be covered up to the annual aggregate limit.)

Medication

Co-Payment

30% co-payment (co-payment by the insured in respect of each and every prescription.)

Limit

AED 2500 Annually

Description

No cover for drugs and medicines in excess of the annual limit. Restricted to a list of formulary products where available at the physician and the pharmacist.