Individual Medical
Takaful Plan - Table of Benefits
SILVER
Insurance SILVER
Territorial Scope of Coverage Worldwide
Aggregate Annual Limit AED 1 Million
NEXTCARE RN3
Medical Network
(Out-patient is restricted to Clinics Only)
Room Type Semi-Private
Parent Accommodation for child
AED 150 / DAY
under 18 years of age
Accommodation of an accompanying
person in the same room as per
AED 150 / DAY
recommendation of attending physician,
subject to prior approval.
Home Nursing following inpatient
Not covered
treatment
Emergency road ambulance services
to and from hospital by registered Covered
ambulance services provider
Deductible per Consultation (will not
Be applicable for follow-up within 7
20% max AED 50/-
days for some treatment and with
same doctor)
Covered up to AED 5,000 subject to 20% Co-
Prescribed Drugs & Medicines
Insurance
Diagnostics (X-ray, MRI, CT-Scan,
Ultrasound & Endoscopy diagnostic Covered subject to 20% Co-pay
services)
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
covered without waiting period subject to
Pre-existing & Chronic Conditions
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
Claims Settlement Basis (after
application of Copayments)
Direct billing available. Reimbursement is also
Within the Network possible but will be settled at 80% of the usual
& customary rates of the selected Network.
Reimbursement at 100% of actual costs (subject
Outside the Network in Countries where
to be reasonable) or 100% of the usual &
NEXTCRAE is not present
customary rates of the network, whichever is less
Reimbursement at 80% of actual costs (subject
Outside the Network in Countries where
to be reasonable) or 80% of the usual &
NEXTCARE is present
customary rates of the network, whichever is less
Covered on Reimbursement up to AED 200 per
Cash Indemnity for In-Patient
night and a maximum of 10 nights. The Cash
hospitalizations that are not submitted
Indemnity claim must be submitted within 15
to the Insurance Company
days after discharge from the hospital with a
proof of hospitalization including a discharge
summary.
Vaccination for Children (as per DHA
policies & its updates) includes the Inside Network: 100% of Actual Cost Outside
vaccinations and inoculations for Network: Covered on Network UCR Rates
newborns
Cancer Treatment Screening, Healthcare
Services, Investigations and Treatments
Covered as per terms, conditions and exclusions
only for members enrolled under
of the program defined by DHA
Patient Support Program only (Only for
Dubai Visa Holders)
HCV Hepatitis B and C Virus Infection
Screening, Healthcare Services,
Investigations and Treatments related to
viral Hepatitis and associated Covered as per terms, conditions and exclusions
complications related to Hepatitis B and of the program defined by DHA
C shall only be for members enrolled
under Patient Support Program (Only
for Dubai Visa Holders)
Covered once per Annum on reimbursement
Influenza Vaccine only Limited to the cost of the vaccine and its
administration only
Covered only for members satisfying the
eligibility criteria set by DHA.
Shingrix Vaccine
Limited to the cost of the vaccine and its
administration only
Adult Pneumococcal Conjugate Vaccine Covered as per DHA Adult Pneumococcal
(Only for Dubai Visa Holders) Conjugate Vaccination guidelines
Symptom Checker Covered - Please refer to Nextcare app
Physiotherapy (Subject to pre-approval) 8 sessions per member per annum
Preventive services As per DHA Regulations
Diagnostic and treatment services for
dental and gum treatments (Emergency Covered subject to 20% coinsurance
cases Only) Dental emergency is any
injury to your teeth or gums that can
put you at a risk of permanent damage,
such as Chipped or broken teeth,
Knocked-out tooth, Soft-tissue injuries
and et
Hearing and vision aids, and vision
correction by surgeries and laser
(Emergency cases only)
Hearing Emergencies include
Object/insect in the ear, ruptured
Covered subject to 20% coinsurance
eardrum, sudden hearing loss and etc
Vision Emergencies include bleeding or
discharge from or around the eye,
double vision and Loss of vision, total or
partial, one eye or both etc.
Out Patient Covered up to Maximum AED
10,000/- per person per annum
IN Patient Covered up to Maximum AED
Psychiatric Treatment
10,000/- per person per annum
20% coinsurance payable by the insured per visit
for Out-Patient services
Organ transplantation shall cover the organ
transplantation as recipient excluding any cost
related to donor, and excluding the acquisition
and organ cost
Organ Transplant
Organs covered are: heart, lung, kidney,
pancreas, liver, Allogeneic & autologous bone
marrow
Covered up to Maximum AED 5,000 per person
Repatriation of Mortal Remains to
per annum settled on Reimbursement basis with
Home Country
no co-pay
Second Medical Opinion Not Covered
Covered subject to 10% coinsurance, up to AED
10,000 for normal delivery and up to AED 10,000
for medically necessary C-Section, termination
and complications. 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
In-patient maternity services (requires
not be covered during the policy period and will
prior approval from the insurance
be underwritten at renewal if needed.
company or within 24 hours of
emergency treatment) Strictly Subject to
New born Cover
Medical Application Form (MAF)
Coverage of a pregnant female is extended by
the insurer to provide the same benefits for a
new born child of that female for a period up to
30 days from its date of birth. This cover is
provided regardless of whether or not the new
born is eventually enrolled as a dependent
member under the insurer’s policy
Cover for 30 days from birth. BCG, Hepatitis B
and neo-natal screening tests (Phenylketonuria
(PKU), Congenital Hypothyroidism, sickle cell
screening, congenital adrenal hyperplasia)
Out-patient maternity services: Initial
Covered subject to 10% coinsurance, and a
investigations to include FBC and
maximum of 10 visits and 4 ante-natal
Platelets, Blood group, Rhesus status
ultrasound scans. Pregnancy at time of
and antibodies, VDRL, MSU & urinalysis,
application should be declared in the medical
Rubella serology, HIV, Hep C (for high
application form and is subject to medical
risk patients), GTT (if high risk), FBS,
underwriting. Undeclared Pregnancy at time of
random s or A1c. Visits to include
application will not be covered during the policy
reviews, checks and tests in accordance
with DHA Antenatal Care Protocols. period and will be underwritten at renewal if
Subject to Medical Application Form needed.
(MAF)
Dental benefit Covers the following:
Consultation & X-Ray, Scaling, Tooth Covered up to AED 500/- subject to 30% Co-pay
Extraction, Amalgam fillings, Temporary In-Network: Direct Billing
and/or permanent composite, fillings Out of Network: Reimbursement
and root canal treatment only
Optical benefit
covers the following: Optical
examinations conducted for the
purpose of obtaining eye glasses or Not Covered
lenses
In-Network: Direct Billing Out of
Network: Reimbursement
Limited to AED 2,500 per person per annum 20%
coinsurance payable by the insured per visit. No
coinsurance is applicable if a follow-up visit is
Alternative Medicines/ therapies Covers
made within seven days The claims will be
the following: Chiropractic/ Osteopathy/
settled on reimbursement basis, and only from
Homeopathy and Ayurvedic
providers which are recognized and approved by
Nextcare as alternative preferred providers -
refer to Nextcare website for details
Covered to a limit of AED 60,000/- Subject to
Dialysis
20% Copay per visit
