Orient Takaful Plan 5 : Choose Best Health Insurance Plan From Orient Takaful

Plan Summary

Plan NamePlan 5

Cover AmountAED 1,000,000

Pharmacy LimitUpto AED 5,000

TPANextcare

Orient Takaful - Plan 5 Details

Maternity Cover

Waiting Period - This is the time span during which you cannot claim specified benefits from the insurer

40 Days ( any pregnancy, which arises within 40 calendar days from policy inception will be at the discretion of the insurer)

Out-patient Maternity Services

Covered subject to 10% coinsurance, and a maximum of 10 visits and 4 ante-natal ultrasound scans Pregnancy at time of application should be declared in the medical application form and is subject to medical undewriting Undeclared Pregnancy at time of application will not be covered during the policy period and will be underwritten at renewal if needed.Undeclared Pregnancy at time of application will not be covered during the policy period and will be underwritten at renewal if needed10% co-payment, and a maximum of 10 visits and 4 ante-natal ultrasound scansPregnancy at time of application should be declared in the medical application form and is subject to medical undewriting

In-patient Maternity Services

10% co-payment, up to AED 7,000 for normal delivery and up to AED 10,000 for medically necessary C-Section, termination and complicationsCovered subject to 10% coinsurance, up to AED 10,000. In case of any condition developping into an emergency, the medically necessary expenses will be covered up to the annual aggregate limit. Pregnancy at time of application should be declared in the medical application form and is subject to medical undewriting Undeclared Pregnancy at time of application will not be covered during the policy period and will be underwritten at renewal if needed.In case of any condition developping into an emergency, the medically necessary expenses will be covered up to the annual aggregate limitPregnancy at time of application should be declared in the medical application form and is subject to medical undewritingUndeclared Pregnancy at time of application will not be covered during the policy period and will be underwritten at renewal if needed

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 conditionany 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.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

Referral procedure to be followed:- Direct access to specialist in the clinincsReferral procedure to be followed:- Direct access to specialist in the clinincs

Dental and Gum Treatment

Co-Payment

20% Co-payment

Hearing and Vision Aids

Co-Payment

20% Co-payment

Coverage Type

Clinic With Specialist

Out-Patient Services

Co-Payment - This is what you'll pay your health provider when claiming with this policy

10% up to AED 15/- for General Practitioners. 20% up to AED 25/- for Specialists

In-Patient Services

Co-Payment - This is what you'll pay your health provider when claiming with this policy for hospitalization

Covered

Room Type

Semi PrivateSemi-Private

Ambulance Service

Covered

Companion Accomodation

Accommodation of an accompanying person in the same room as per recommendation of attending physician : 150 per dayParent Accommodation for child under 18 years of age : 150 per day

Parent Accommodation for child under 18 years

AED 150 / day

Territorial Scope Of Coverage

Coverage

Worldwide

Pre-Existing and Chronic Conditions

Covered up to a limit of AED 150,000 per member per year. No waiting period applies if evidence of continuity of coverage is provided; otherwise a waiting period of 6 months applies to the first scheme membership. All pre-existing medical conditions should be declared in the medical application form and is subject to medical undewriting Undeclared pre-existing conditions will not be covered during the policy period and will be underwritten at renewal.

Waiting Period

6 months(subsequent coverage subject to declaration)

Network

NEXTCARE RN3NEXTCARE RN3 (Out-patient is restricted to Clinics Only)NEXTCARE RN3

Other Services

Laboratory Tests

10% Co-payment

Physiotherapy Treatment

10 sessions per member per annum

Emergency Treatment

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

Psychiatric Treatment

Not Covered

Repatriation of Mortal Remains to Home Country

Not Covered

Medication

Co-Payment

Covered up to AED 5,000 subject to 15% Co-payment

Essential Vaccines & Preventive Services

As per DHA Regulations

Diagnostics (X-RAY, MRI, CT-SCAN)

Covered subject to 20% Co-payCovered subject to Nil Co-payCovered subject to 10% Co-pay

Psychiatry

In-Patient, Out-Patient, and Emergency cover up to a maximum of AED 10,000/- per person per annum. 20% coinsurance payable by the insured per visit for Out Patient services. No coinsurance is applicable for follow up visits made within seven days.