Family Care Product

Table of Benefits (Valid for Dubai Based Members)

Below limit options are per person in AED
Annual Aggregate Limit
AED 1,000,000
Overarching total limit for all benefits and sub-limits.
Geographical Scope of Coverage for Elective & Emergency Treatment
Worldwide

Coverage outside UAE is limited to 90 days per treatment

Coverage Criteria for Treatment outside UAE
A single holiday or business trip may not exceed 90 days
GOLD
SILVER PREMIUM
Applicable Network SILVER CLASSIC
GREEN
SILK ROUTE

• All pre-existing medical conditions should be declared in the Medical

Application Form and is subject to medical underwriting.
Underwriting terms and coverage criteria for Pre- • All declared Pre-existing and Chronic conditions are covered with a sub
existing, Chronic conditions: limit of AED 150,000/-
• Undeclared pre-existing conditions will not be covered during the policy
period and will be underwritten at renewal.

In-Patient Benefit
Coverage is up to the relevant Annual Benefit Limit per person/per policy year with
pre-approval
Hospitalization Class Private Room
Hospital Accommodation and related Services Covered
Intensive care unit and coronary artery disease treatment Covered
Consultant’s, Surgeon’s and Anaesthetist's Fees Covered
Various therapies including physiotherapy, chemotherapy, radiation
Covered
therapy etc
Recipient Organ transplantation service, excluding any charges related
Covered
to Donor
Use of hospital medical equipments (e.g. heart and lung support systems
Covered
etc.)
Ambulance Services (in Medical Emergency only and if followed by
Covered
admission)

Companion Room & Board expenses for Beneficiary below 16 years of

age
Covered
The cost of accommodation of a person accompanying a beneficiary
Covered maximum up to 100 AED per night
below 16 years of age in the same room in cases of medical necessity at
the recommendation of the treating doctor and with prior approval

Repatriation costs for the transport of mortal remains to the country of

Covered up to AED 7,500/-
origin
Out-Patient Benefit

Covered with Co-pay of 20% max 50 per consultation

Physician Consultation
Covered with Co-pay of 20% max 75 per consultation
Diagnostics and Laboratory Tests
Pharmaceuticals Covered with 0% co-pay per invoice
Covered with 10% co-pay per invoice
Physiotherapy (Require pre-authorization)
Covered up to 15 sessions/ Per member Per year
*Approval protocol for Free access at network providers will follow DHA guidelines
 OTHER SALIENT BENEFITS
Day care Treatment Covered
Out Patient Surgery Covered
Emergency Mental health Treatments Covered
Work Related Injuries Covered

Under this benefit the treatment required within three months

following accidental damage to sound natural teeth caused by
a violent external means when the treatment is given by a
Physician, dentist or dental surgeon is covered.
Emergency Dental treatment for accidental damage to natural teeth
*No treatment will be covered after 3 months of the accident.

**Treatment required as the result of the consumption of food or

drink or any foreign bodies contained in such food or drink is
not covered.

Babies born inside and out-side UAE - New born expenses are
covered from Date of Birth under the mother’s card for the first
30days from date of birth with a sublimit of AED 150,000/-.

New Born baby coverage New born babies will be added to the principle policy only
upon requested by the policy holder and is subject to Medical
underwriting.

Coverage for new born are in line with DHA benefit guidelines.

Preventive services covered for members over 18 years of age Diabetic Screening:
Fasting Blood Sugar and HBA1C tests are covered once a policy
*Prior Approval is required for Free Access facility
year for eligible members

Cancer Treatment:
Screening, healthcare services, investigations and treatments only for
members who are enrolled under "Patient Support Program" only
Covered as per terms, conditions and exclusions of the
HCV Hepatitis C Virus Infection: program defined by DHA
Screening, healthcare services, investigations and treatments related to
viral Hepatitis and associated complications related to Hepatitis C shall
only be for members enrolled under Patient Support Program.

Hearing and vision aids, and vision correction by surgeries and laser Covered only in cases of medical emergencies

- No Financial limitations applicable under this benefit

- Worldwide Emergency Medical Evacuation
- Worldwide Hospital Admission Assistance
- Repatriation of mortal remains to home country from
MedNet’s Global Emergency Assistance services coverage through Assist anywhere in the
world, including country of residence.
America
- Medical Consultation, Evaluation, Referral & Monitoring
- Care of minor children & Compassionate visit

*For detailed information please refer Assist America Table of

Benefit
 Additional Benefits
Maternity Benefit

- Normal Delivery expenses are covered up to a sub limit of

AED 10,000/-
- Medically necessary Caesarean Section and complication
expenses are covered up to a sub limit of AED 10,000/-
- Any Medical Emergency expenses related to Maternity will be
covered up to a sublimit of AED 150,000/-
- Out Patient eligible Maternity expenses are covered up to
Inpatient & Outpatient coverage includes: Annual limit
1. Pre & Post natal treatments - 10% co-payment applicable on all Maternity treatments,
2. Normal delivery including out-patient Maternity consultation (no Deductible
3. Medically necessary Caesarean Section applies)
- The following screening tests are covered as per DHA
4. Maternity related Complications
Antenatal care
5. Medically necessary legal terminations
protocol:
o FBC and Platelets
* In-patient maternity treatment are subject to prior o Blood group, Rhesus status and antibodies
approval o VDRL
o MSU & urinalysis
o Rubella serology
o HIV
o Hepatitis C offered to high risk patients
o GTT, if high risk
o FBS, Random blood sugar OR HbA1C
o Ultrasonography: 3 scans

Alternative Medication Benefit

Alternative Medicine Benefit covers: Osteopathy, Chiropractic, Covered up to AED 1,600/- PMPY
Homeopathy, Acupuncture, Ayurveda and Herbal Treatments
**Only on reimbursement basis
Vaccination Benefit
Covered both on *Free Access & reimbursement basis

Vaccination Covered as per MOH schedule Reimbursements claims are settled at 100% of actual covered
cost subject to maximum of 100% of Applicable Network rates
(Require pre-authorization)
*Free Access facility is available only within specific MedNet
Vaccination Network
Dental Benefit
Emergency Dental & Gum treatments Covered with sub-limit of AED 3,500

Free Access
- Covered with pre-authorization only
Annual Limit based on the plan selection - Covered - Worldwide - Co-payment 20% applicable
'Reimbursement*
- Additional 20% co-payment applicable over free access
*No reimbursement for Silk Road NW inside UAE.

SCHEDULE OF DENTAL BENEFIT

Dental Consultation Covered
Tooth Extraction
- Simple Extraction Covered
- Surgical Extraction
Scaling & Polishing Covered
 Tooth filling
- Amalgam filling
Covered
- Composite filling
- Glass Ionomer filling
Root Canal Treatment (R.C.T) Covered
Crown Covered if followed by an Root Canal Treatment
X- Ray
- Intra Oral { Bite wing/ Periapical / Occlusal} Covered
- Extra Oral { Panoramic X-ray & Tomograms}
Medications
- Antibiotics
- Analgesics
Covered
- Antacids
- Enzyme preparations ( Edema reductions)
- Vitamins ( only with antibiotics)

Medications exclusion
- Mouth wash
- Tooth pastes
Not Covered
- Dentures cleaning agents
- Desensitizing agents
- Anti septic
Anaesthesia
- L. Anaesthesia - Covered
- G. Anaesthesia - Not Covered

Orthodontics Not Covered

- For further details, on the services included in the above table / or about any other services not included
Kindly contact our Medical Call Centre (MCC) at 8004882/ 800MedNet.
- Except For Scaling and Polishing, all other services are covered if medical necessity is established.
CLAIMS SETTLEMENT TERMS (what is Paid by the Insurer)
Free Access
Covered if the chosen provider is available in the selected Network
(Network)

Reimbursement in SEA:
- 100% of actual covered cost subject to maximum of 100% of UAE
applicable network rates
Elective Treatment
Reimbursement Reimbursement elsewhere within territorial scope of cover*:
(Non Network) - 80% of Actual Covered Cost subject to maximum of 80% of UAE
Applicable Network rates

*No Elective treatment reimbursement for Silk Road Network inside

UAE.

Free Access
(Network)
Emergency Treatment 100% of Actual Covered Cost
Reimbursement
(Non Network)