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

Plan Summary

Plan NameRhodium

Cover AmountAED 1,000,000

Pharmacy LimitUpto AED 15,000

TPANextcare

Takaful Emarat - Rhodium Details

Maternity Cover

• Covered up to AED 20,000. In case of any emergency condition, the expenses will be covered up to the annual aggregate limit. • New born cover - up to 30 days from date of birth

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 (All Care provided by Primary Health care obstetrician for low risk or specialist obstetrician for high risk referrals.)Covered subject to 10% coinsurance, and a maximum of 15 visits and 8 ante-natal ultrasound scans.Pregnancy at time of application should be declared in the medical application form and is subject to medical underwriting. Undeclared Pregnancy at time of application will not be covered during the policy period and will be underwritten at renewal if needed.Requires prior approval from the insurance company.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.Covered subject to 10% coinsurance, up to AED 20,000.In case of any condition developing 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 underwriting. Undeclared Pregnancy at time of application will not be covered during the policy period and will be underwritten at renewal if needed.

New Born Cover

Vaccination for Children (as per DHA policies & its updates) includes the vaccinations and inoculations for newborns

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

Co-Payment

Covered up to AED 3,000 subject to 20% Co-pay

Covered

Hearing and Vision Aids

Co-Payment

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

Covered

Coverage Type

Clinic + Hospital Access

Out-Patient Services

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

10% up to AED 35/- for General Practitioners 20% up toAED 75/- for Specialists (Services are provided in authorized out-patient clinics of hospitals, clinics and health centers)

Repatriation of Mortal Remains to Home Country

Covered up to Maximum AED 20,000 per person per annum settled on Reimbursement basis with no co-pay

Prescribed drugs and dressings

Covered up to AED 15,000 subject to 15% Co-InsuranceCovered up to AED 15,000 subject to 20% Co-InsuranceCovered up to AED 15,000 subject to 0% Co-Insurance

In-Patient Services

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

Nil co-payment (In-patient treatment at authorized hospitals)

Room Type

Private RoomPrivate

Ambulance Service

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

Companion Accomodation

AED 450 / day (The cost of accomodating a person accompanying an insured child up to the age of 16 years.)AED 450 / day (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 conditions

Pre-existing & Chronic Conditions Subject to Medical Application Form (MAF) Covered up to a limit of AED 150,000 per member per year. All pre-existing medical conditions should be declared in the medical application form and is subject to medical underwriting, policy terms, conditions, benefits, and exclusions. Newly diagnosed medical condition during the policy period will not have a waiting period and is subject to policy terms, conditions, benefits, and exclusions. Undeclared pre-existing conditions will not be covered during the policy period and will be underwritten at renewal subject to policy terms, conditions, benefits, and exclusions.

Hospital Accommodation and related Services

AED 450 / day Hospital Accommodation Subject to prior approval

Cash indemnity benefit

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.

Territorial Scope Of Coverage

Coverage

WorldwideDUBAI & NORTHERN EMIRATES VISA HOLDERSDERS

Pre-Existing and Chronic Conditions

All declared Pre-existing and Chronic conditions are covered up to a limit of AED 150,000/-

Waiting Period

6 Months (Treatment for chronic and pre-existing conditions excluded for first 6 months of first scheme membership. After 6 months covered to the annual policy limit subject to declaration)

Network

NEXTCARE GN+

Other Services

Radiology diagnostic

Covered subject to 10% Co-pay

Test, diagnosis, treatments related to surgeries in hospitals

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.)

Home Nursing

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

Cancer Treatment

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

Vaccinations (Adults)

Covered once per Annum

Local road and air ambulance services

Covered

Medication

Co-Payment

15% Co-Insurance (co-payment by the insured in respect of each and every prescription.)

Limit

Covered up to AED 15,000

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.

Essential Vaccines & Preventive Services

Co-Payment

Covered

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

Covered subject to 20% Co-payCovered subject to 10% Co-payCovered subject to 0% Co-pay

Psychiatry

Covered up to max AED 10,000

Alternative medicine

Limited to AED 2,500 per person per annum subject to 20% Copay No coinsurance is applicable if a follow-up visit is made within seven days The claims will be settled on reimbursement basis, and only from providers which are recognized and approved by Nextcare as alternative preferred providers - refer to Nextcare website for details

Dental and gum treatment

Covered up to AED 3,000/- subject to 20% Co-pay

Hearing and Vision Aid

Covered subject to 20% coinsurance Only In Emergency cases