Sukoon Prime : Choose Best Health Insurance Plan From Sukoon

Plan Summary

Plan NamePrime

Cover AmountAED 5,000,000

Pharmacy LimitUpto AED 1,000,000

TPASukoon

Sukoon - Prime Details

Maternity Cover

Covered

Co-Payment

NilPost Natal Consultation Deductible/Coinsurance - 10% , Post Natal Investigations Coinsurance - 10%, Post Natal Procedures Coinsurance - 10%

Maternity Cover

Birth Defects, Genetic Disorders & Congenital Conditions - Not Covered

Out-patient Maternity Services

With 10% co-insurance

In-patient Maternity Services

Covered for Ante/Post-Natal Consultation, Ante/Post-Natal InvestigationsMaternity complications (Life threatening maternity complications are covered up to indemnity limit) - Coverage upto 25,000, Normal Delivery - Coverage upto 25,000, Medically necessary C - Coverage upto 25,000, Legal Abortion/Miscarriage - Coverage upto 25,000

Waiting Period

Maternity Waiting Period

any pregnancy, which arises within 6 months from the date of this application, shall not be covered under this policy under any condition.

Chronic Condition Waiting Period

With COC nil waiting period, without COC 6 months waiting period

Pre-existing diseases (PED)

Covered only if declared on additional payment

Hospital Access

Direct access to hospital

Coverage Type

Clinic + Hospital Access

Out-Patient Services

Laboratory Tests

Covered

Pharmacy Limit

Prescribed Pharmaceuticals (Pre-approval is required for long term medication above 30 days) - Covered, ONLY Formulary products(Generic Medication) - Not Covered, Vitamins prescribed as replacement therapy for known vitamin deficiency conditions up to prescribed pharmaceutical limit only. - Covered

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

Covered

In-Patient Services

Co-Payment

Consultation Deductible/Coinsurance - 10%, Outpatient procedures - 10%, Physiotherapy - 10%

Room Type

Private

Laboratory Tests

Covered

Pre-existing conditions

Covered up to 150,000 Outside UAE and Inside UAE (subject to exclusions)

Hospital Accommodation and related Services

Accommodation Costs for one parent staying with a child up to the age of 18 years. - 1,000 Per day, Accommodation Costs for one accompanying family member in case of critical medical conditions.* Subject to treating doctor recommendation - 100 Per Day, Daycare treatment including out-patient minor surgeries > 6 hours stay - Covered

Intensive care unit and coronary artery disease treatment

Internal Prosthetic devices implanted during covered surgeries. - Covered, External Prosthetic devices and medical equipment - Covered up to 500 per person per year

Pre-Existing and Chronic Conditions

Covered up to 150,000 per person per year

Network

Premium

Other Services

Co-Payment

Prescribed Pharmaceuticals - 10% and Maximum out of pocket limit - Not Applicable, Post-Natal Prescribed Pharmaceuticals - 10% and Maximum out of pocket limit - Not Applicable

New Born Cover

A New born delivered in UAE is covered up to 30 days as part of the motherÃ¢â‚¬â„¢s insurance and shall share the same indemnity limit. Continuity of cover is subject to scheme opted for allows dependents, addition notification within 30 days and the newborn added to the policy. "If the scheme allows dependents addition, then 1. HAAD: A New born will be enrolled to the scheme from date of birth subject to the notification within 30 days from that date. 2. DHA: A New born will be enrolled to the scheme from date of birth subject to the notification within 7 days from that date. 3. When a baby is born outside UAE, he/she will be enrolled to the scheme only following their entry to the UAE, with a valid entry permit and entry stamp."

Ambulance Service

Covered

Laboratory Tests

10% co-insurance for Laboratory and 10% for Radiology

Physiotherapy Treatment

Immunotherapy & Immunomodulators - Covered if medically necessaryCovered up to 10 sessions

Emergency Treatment

Hepatitis A - Covered, Hormone replacement therapy. (Excluding growth hormone and excluded medical conditions) - Covered

Psychiatric Treatment

Covered up to 15,000 per person per year with 30% Coinsurance

Home Nursing

Covered up to 15,000 per person per year

Cancer Treatment

As Per DHA for breast, colorectal or cervical cancer

Airfare Ticket

Covered (limited to geographical area specified)

Routine Health Checkup

Covered up to 3,000 per person per year

Repatriation of Mortal Remains to Home Country

Activated at 0 Kilometers

Preventive services

Diabetes screening is covered along with Basmah Initiative and Adult Pneumococcal Conjugate Vaccine

HCV Hepatitis C Virus Infection

Covered

Work Related Injuries

Not Covered

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

Enhanced Optical cover - Covered up to 1,500 per person per year including 20% Coinsurance

Elective Treatment

Covered

Accidental Injuries

Death due to Accident (Subject to terms & Conditions) - Covered Upto 100,000 AED, Permanent Total Disability due to Accident (Subject to terms & Conditions) - 100,000 AEDRecreational non-hazardous sports activities (professional and hazardous sports activities even if recreational are not covered) - Covered

Circumcision

Not Covered

Assist America Package

Emergency Medical Evacuation - Activated at 120 Kms., Medical Repatriation- Activated at 120 Kms., Second Medical Opinion - Covered