Schedule of Benefits

Details
Maximum Annual
Benefit
Type of Network

Category 1
AED 250,000 per person per year

Category 2
AED 250,000 per person per year

Category 3
AED 150,000 per person per year
UAE: OP at PCP Network & IP at
RN3

GN Network

RN Network
UAE: UAE & Home Country
(Excluding USA & Canada )

Qatar: RN2 (OP restricted to Clinics

Only
UAE: UAE & Home Country
(Excluding USA & Canada )

Qatar: Qatar & Home Country

(Excluding USA & Canada )

Qatar: Qatar & Home Country

(Excluding USA & Canada )

Geographical Area

UAE, Arab Countries, Sub-Asia

Countries & Home Country

Deductible

20% with a Max of AED 50 per

consultation visit

20% with a Max of AED 25 per

consultation visit

20% with a Max of AED 15 per

consultation visit

Out-Patient CoInsurance

20% Co-insurance on al OP
services at Mediclinic Group, Al
Zahra Group & Al Ahli Hospital
Doha

Nil

Nil

In-Patient Co-Insurance

5% Co-Insurance on all IP Services

5% Co-Insurance on all IP Services

Nil

Pre-existing & Chronic

conditions

Covered up to annual benefit limit

Covered up to annual benefit limit

Covered up to annual benefit limit

Hospital room & board

Private Room

Semi Private Room

Ward

Physiotherapy

Covered subject to 15 sessions

PPPA

Covered subject to 15 sessions

PPPA

Covered subject to 15 sessions

PPPA

Diagnostic Test

Covered

Covered

Covered

Prescribed Drugs

Covered

Covered

Covered

Repatriation of Mortal
Remains

Not Covered

Not Covered

Not Covered

Copyright NEXtCARE 2013

Schedule of Benefits
Details

Category 1

Category 2

Category 3

Inpatient Cash Benefit

Covered up to AED 200 per night

for max of 180 days for all
inpatient hospitalizations that are not
submitted to the Insurance
Company

Covered up to AED 200 per night

for max of 180 days for all
inpatient hospitalizations that are
not submitted to the Insurance
Company

Covered up to AED 200 per night

for max of 180 days for all
inpatient hospitalizations that are
not submitted to the Insurance
Company

Covered in case of Emergency

Only

Covered in case of Emergency

Only

Covered in case of Emergency

Only

Covered in case of Emergency

Only

Covered in case of Emergency

Only

Covered in case of Emergency

Only

Vaccines, preventive services and

immunizations covered as per
MOH

Vaccines, preventive services

and immunizations covered as
per MOH

Vaccines, preventive services

and immunizations covered as
per MOH

Frequency restricted to :
Diabetes:
- Every 3 years from age 30

Frequency restricted to :
Diabetes:
- Every 3 years from age 30

Frequency restricted to :
Diabetes:
- Every 3 years from age 30

- High risk individuals annually from

age18

- High risk individuals annually from

age18

- High risk individuals annually from

age18

Congenital Illnesses &

Genetic Disorders

Covered on Reimbursement Basis

Not Covered

Not Covered

Economy Air Fare

Ticket outside Qatar
and UAE treatment
(Limited to Geographical
area specified)

Covered on Reimbursement Basis

Covered on Reimbursement Basis

Covered on Reimbursement Basis

Hearing , Vision aids

and Vision Correction
by surgeries & laser
Diagnostic and
treatment services for
dental and gum
treatments
Essential vaccinations
& inoculations for
newborns and children
Dubai Visa Only
Preventive services as
stipulated by DHA to
include initially
diabetes screening
Dubai Visa Only

Copyright NEXtCARE 2013

Schedule of Benefits
Details

Basis of claim
Settlement

Copyright NEXtCARE 2013

Category 1

Category 2

Category 3

UAE:
Within Network: 100% on direct billing

UAE:
Within Network: 100% on direct billing

UAE:
Within Network: 100% on direct billing

Outside Network / within Area of cover

as per territorial scope: 80% of
Network Tariff Rate

Outside Network / within Area of cover as

per territorial scope: 80% of Network
Tariff Rate

Outside Network / within Area of cover

as per territorial scope: : Not Covered
unless emergency life threatening inPatient cases will be covered at 100%
of Network Tariff Rate
Out-Patient: Not Covered

Emergency cases:
UAE: 100% of Incurred Cost

Emergency cases:
UAE: 100% of Incurred Cost

Emergency cases:
UAE: 100% of Incurred Cost

Within territorial Scope: 100% of

Network Tariff Rate for

Within territorial Scope: 100% of

Network Tariff Rate for

Within territorial Scope: 100% of

Network Tariff Rate for

Outside territorial Scope: 100% of

Network Tariff Rate for

Outside territorial Scope: 100% of

Network Tariff Rate for

Outside territorial Scope: 100% of

Network Tariff Rate for

Qatar:
Within Network: 100% on direct billing

Qatar:
Within Network: 100% on direct billing

Qatar:
Within Network: 100% on direct billing

Outside Network / within Area of cover

as per territorial scope: 80% of
Network Tariff Rate

Outside Network / within Area of cover as

per territorial scope: 80% of Network
Tariff Rate

Outside Network / within Area of cover

as per territorial scope: : Not Covered
unless emergency life threatening inPatient cases will be covered at 100%
of Network Tariff Rate
Out-Patient: Not Covered

Emergency cases:
UAE: 100% of Incurred Cost

Emergency cases:
UAE: 100% of Incurred Cost

Emergency cases:
UAE: 100% of Incurred Cost

Within territorial Scope: 100% of

Network Tariff Rate for

Within territorial Scope: 100% of

Network Tariff Rate for

Within territorial Scope: 100% of

Network Tariff Rate for

Outside territorial Scope: 100% of

Network Tariff Rate for

Outside territorial Scope: 100% of

Network Tariff Rate for

Outside territorial Scope: Not Covered

Schedule of Benefits
Details

Limit

Co-Insurance

Out- patient antenatal services

(requires prior
approval from the
insurance company )
In- Patient Maternity
services
New born Cover

Category 1

Category 2

Category 3

UAE:
Out-Patient : up to the limit of policy
In-Patient: AED 10,000 for Normal
Delivery & AED 15,000 for CSection, Complication & Legal
abortion

UAE:
Out-Patient : up to the limit of policy
In-Patient: AED 10,000 for Normal
Delivery & AED 15,000 for CSection, Complication & Legal
abortion

UAE:
Out-Patient : up to the limit of policy
In-Patient: AED 7,500 for Normal
Delivery & AED 10,000 for CSection, Complication & Legal
abortion

Qatar:
Out-Patient & In-Patient: AED
10,000 for Normal Delivery & AED
15,000 for C-Section, Complication &
Legal abortion
UAE:
Out-Patient : 10% Co-Insurance
In-Patient: 5% Co-Insurance

Qatar:
Out-Patient & In-Patient: AED
10,000 for Normal Delivery & AED
15,000 for C-Section, Complication &
Legal abortion
UAE:
Out-Patient : 10% Co-Insurance
In-Patient: 5% Co-Insurance

Qatar:
Out-Patient & In-Patient: AED
10,000 for Normal Delivery & AED
15,000 for C-Section, Complication &
Legal abortion
UAE:
Out-Patient : 10% Co-Insurance
In-Patient: Nil

Qatar:
Out-Patient : 10% Co-Insurance
In-Patient: Nil

Qatar:
Out-Patient : 10% Co-Insurance
In-Patient: Nil

Qatar:
Out-Patient : 10% Co-Insurance
In-Patient: Nil

Fully Covered

Covered for medically necessary C-section, complications and for medically necessary termination (all
limits include co-insurance)
Cover for 30 days from birth. This cover is provided under mothers policy. BCG , Hepatitis B and neo-natal
screening test Phenylketonuria (PUK). Congenital Hypothyroidism, sickle cell screening, congenital adrenal
hyperplasia

Copyright NEXtCARE 2013