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MEDMED

This document contains patient details including name, identification numbers, contact information, insurance plan and coverage details. The document provides an overview of the patient's insurance benefits, copayments, deductibles, and coverage for various medical services like outpatient, inpatient, dental, optical and more.

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alredhamuhamad
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© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
Download as pdf or txt
27 views2 pages

MEDMED

This document contains patient details including name, identification numbers, contact information, insurance plan and coverage details. The document provides an overview of the patient's insurance benefits, copayments, deductibles, and coverage for various medical services like outpatient, inpatient, dental, optical and more.

Uploaded by

alredhamuhamad
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
Download as pdf or txt
Download as pdf or txt
You are on page 1/ 2

4/24/24, 1:28 PM connect-mednet.

com/reception/registration/registration_screen_tmpl/pdfframe//P/1111795

Patient Details
Card Number 097115010263569001

DHA Member ID I013-036-118352286-02

Mobile Number 558854888

Email

Identification Emirates ID :

L
First Name MOHAMMAD

Last Name MOHAMMADI

TIA
Date of Birth 12 Apr 1961

Gender Male

Start Date 03 Aug 2023

31 Jul 2024
EN
Expiry Date

Member Network ML - Green

Policy Holder SWEET GARDEN GENERAL TRADING CO LLC

Policy Issued From Dubai-DHA


ID

Member Benefits
NF

Payer's Name AMERICAN LIFE INSURANCE CO_TPA_501

Assist America Coverage NO

Package Default Network ML - Green


CO

Approvals Classification Standard

HAAD/DHA Approval Number DHA-6276300000

Territory of Coverage Worldwide Excluding USA & Canada

Pre-Existing Conditions Waiting


0 Month(s)
Period

Chronic Condition Waiting Period 0 Month(s)

Outpatient Plan Covered

Physicial Consultation Deductible 0 AED

Physicial Consultation Copayment Copay 20% Max 50 AED applicable

Laboratory Services Copayment 0%

Radiology Services Copayment 0%

https://connect-mednet.com/reception/registration/registration_screen_tmpl/pdfframe//P/1111795 1/2
4/24/24, 1:28 PM connect-mednet.com/reception/registration/registration_screen_tmpl/pdfframe//P/1111795

Outpatient Procedure Copayment 0%

Pharmaceutical Copayment 0%

Dental Coverage Not Covered

Dental Access 03 Not Covered

Dental Copayment 0%

Alternative Medicine Covered

Alternative Medicine Access 02 Reimbursement & Free Access

Alternative Medicine Copayment 20%

Optical Plan Not Covered

Optical Copayment 0%

L
Optical Access 03 Not Covered

Vaccination Plan Covered

TIA
Vaccination Access 02 Reimbursement & Free Access

Vaccination Copayment 0%

Out Mat Physician Consultation


Copay 0% Max 0 AED applicable
Copayment
EN
Out Mat Laboratory Copayment 0%

Out Mat Radiology Copayment 0%

Out Mat Pharmaceuticals Copayment 0%


ID

Maternity IP Plan Not Covered

Physiotherapy Services Copayment 0%

Inpatient Copay 0%
NF

Inpatient Copay Maximum Amount


250000 AED
per Claim

Psychiatric Access 02 Reimbursement & Free Access


CO

Inpatient Psychiatric Copayment 20%

Outpatient Psychiatric Copayment 20%

DHA Member Registration ID I013-036-118352286-02

PRINT
DISCLAIMER:
24/Apr/2024 13:28 PM
ALL SERVICES OUTSIDE PRE-APPROVAL PROTOCOL ARE SUBJECT TO RESTROSPECTIVE MEDICAL EVALUATION
UPON CLAIM SUBMISSION.
CLAIMS PROCESSING IS SUBJECT TO CONTRACTUAL TARIFF.

https://connect-mednet.com/reception/registration/registration_screen_tmpl/pdfframe//P/1111795 2/2

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