Takaful Emarat Diamond : Choose Best Health Insurance Plan From Takaful Emarat

Plan Summary

Plan NameDiamond

Cover AmountAED 1,000,000

Pharmacy LimitUpto AED 10,000

TPANAS

Takaful Emarat - Diamond Details

Maternity Cover

Covered subject to 10% coinsurance, and a maximum of 15 visits and 8 ante-natal ultrasound scans.

In-patient Maternity Services

Covered subject to 10% coinsurance, up to AED 20,000. In case of any condition developping into an emergency, the medically necessary expenses will be covered up to the annual aggregate limit..10% co-payment payable by the insured.

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

Coverage Type

Clinic + Hospital Access

In-Patient Services

Room Type

Private

Ambulance Service

Covered

Parent Accommodation for child under 18 years

AED 400 / day

Accommodation of an accompanying person in the same room

AED 400 / day

Home Nursing

Covered (on reimbursement) up to Maximum AED 7,500 per person per annum

Pre-Existing and Chronic Conditions

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

Pre-existing & Chronic Conditions Subject to Medical Application Form (MAF)Where a pre-existing or chronic condition develops into an emergency within the 6 month exclusion period this must be covered up to the annual aggregate limit.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 underwriting. Newly diagnosed medical condition during the policy period will not have a waiting period. Undeclared pre-existing conditions will not be covered during the policy period and will be underwritten at renewal.Coverage of Pre-existing & Chronic Conditions is subject to policy terms, conditions, benefits, and exclusions

Network

NAS - GN

Other Services

Vision

AED 350 for contact lenses per yearAED 300 per pair per bifocal or tri-focal vision lenses - once per year.one pair per year. AED 250 per pair per single vision lenses - once per year.Covered subject to 20% Co-pay and up to AED 1,500 in total and up the following sub-limits: AED 350 for Frames

In-patient (IP Services)

Covered on Reimbursement up to AED 300 per night and a maximum of 10 nights. The Cash Indemnity claim must be submitted within 15 days after discharge from the hospital with a proof of hospitalization including a discharge summary.

Deductible per Consultation

20% up to AED 75/- for Specialists10% up to AED 35/- for General Practitioners

Prescribed Drugs & Medicines

Covered up to AED 10,000 subject to 15% Co-Insurance

Cancer Treatment

Covered as per terms, conditions and exclusions of the program defined by DHA

Vaccinations (Adults)

Covered as per DHA Adult Pneumococcal Conjugate Vaccination guidelines

Organ transplant

Organ transplantation shall cover the organ transplantation as recipient excluding any cost related to donor and excluding the acquisition and organ cost Organs covered are: heart, lung, kidney, pancreas, liver, Allogeneic & autologous bone marrow.

Second Medical Opinion

This benefit gives members access through respective TPA mobile application to world renowned providers to re-evaluate their earlier diagnosis, medical history and treatment plan for non-emergency cases.

Repatriation of Mortal Remains to Home Country

Covered up to Maximum AED 15,000 per person per annum settled on Reimbursement basis with no co-pay

Preventive services

As per DHA Regulations

Vaccination for Children

Inside Network: 100% of Actual Cost Outside Network : Covered on Network UCR Rates

HCV Hepatitis C Virus Infection

Covered as per terms, conditions and exclusions of the program defined by DHA

Within the Network

Direct billing available. Reimbursement is also possible but will be settled at 80% of the usual & customary rates of the selected Network.

Outside the Network in Countries where NAS is not present

Reimbursement at 100% of actual costs (subject to be reasonable) or 100% of the usual & customary rates of the network, whichever is less

Outside the Network in Countries where NAS is present

Reimbursement at 80% of actual costs (subject to be reasonable) or 80% of the usual & customary rates of the network, whichever is less

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

Covered subject to 10% Co-pay

Psychiatry

Outpatient Covered up to Maximum AED 3,000/- per person per annum subject to 20% copay. IN Patient Covered up to Maximum AED 10,000/- per person per annum