Benefit(s) / Plan(s) Tier 1 (Regional)

General
Regulator Dubai Health Authority
Plan Currency AED
Annual Medical Limit 1,000,000
Network MedNet Green
In-Patient (IP) and Outpatient (OP) IP + OP
• Treatment for pre-existing conditions:
o All pre-existing conditions must be declared and underwritten by HAYAH.
o Declared pre-existing conditions are covered from day one (no waiting period applies).
o Undeclared pre-existing conditions are not covered.
Pre-existing conditions
• Pre-existing conditions accepted are covered up to a limit of AED 150,000

In the case of medical emergency only, the condition is covered up to the Annual Medical Limit of the Plan.
• Treatment for chronic conditions:
o Newly emerging chronic conditions (i.e. occurred after the start of the cover) are excluded for the first 6 months
of the first scheme membership. Waiting period is waived in case of emegency
Chronic conditions
o Conditions are covered from day one if a Certificate of Continuity is provided.

In the case of medical emergency only , the condition is covered up to the Annual Medical Limit of the Plan.

Cancellation of the Policy is possible subject to a formal request by the policyholder. The Cancellation will be processed
Policy Cancellation on prorata temporis.
However, there will be no refund if the policy has already been claimed.

Geographical Scope of Coverage

Geographical area of cover Gulf Cooperation Council Countries (GCC) and Indian Sub-Continent
Emergency In-Patient treatment
while abroad.

Emergency medical expenses

covered while the Insured
Actuals subject to a cap of 100% UAE Equivalent Cost
Member is on vacation, leisure or
business trips subject to a
maximum of 90 days per trip, or
the annual aggregate
Non-emergency treatment abroad.

If the US & Canada are within Area At R&C rates of UAE Equivalent Network
of Cover, cover in US & Canada
provided at only R&C rates of UAE.

Covered subject to equivalent network rates with direct billing where possible
Out of Network Coverage
20% Coinsurance applicable
In-patient & Day Care Health Services at Authorized Hospitals
Coinsurance Nil
In-patient Room Type Private
In-patient Healthcare
Services (Including Pre & Post Covered up to the AML
In-Hospital Treatment)
Day Care Treatment Covered up to the AML
Hospital Accommodation &
Covered up to the AML
Services
Hospital services, Surgery,
Covered up to the AML
Operation Theatre, Anaesthesia.
Laboratory, Radiology, Pathology
Covered up to the AML
and Diagnostic services.
X-ray, MRI, CT-scan, Ultra-Sound,
Covered up to the AML
Endoscopy.
Intensive care unit, Emergency
Covered up to the AML
Ward Services
Internal Surgical Appliances &
Covered up to the AML
Prosthesis (If surgically required)
Minor surgical procedures
performed by a general
Covered up to the AML
practitioner at a Medical facility or
Private Hospital.
Physiotherapy
Following an IP or Day Care
Maximum of 6 sessions per year
procedure and recommended by
Medical Practionner
Accommodation for a person
accompanying an insured child Covered up to AED 100 per day
below 16 years of age.
Accommodation of an
accompanying person in the same
room in cases of critical conditions Covered up to AED 100 per day
and as per recommendation of
attending physician.
Cash Indemnity for InPatient
Treatment post hospitalization up
to max of 10 days, subject to Not Covered
providing discharge summary or
proof of hospitalization.
Out-patient Health Services
Applicable deductible for
consultation.

** Deductible for follow up visits

20% co-pay with a maximum of AED 50
witth the same doctor for the
same medical condition within
network within 7 days from the
date of first visit is not applicable.
Specialist or Consultants for OP
Accessible
practices
Coinsurance on Non
Consultation OP services
10%
(Laboratory, Radiology and
other services, etc)
Prescribed Medicines - Limit Covered up to 10,000
Prescribed Medicines -
10%
Coinsurance
Prescribed Medicine Type Generic Medicine (if available)
Physiotherapy Covered up to 10 Sessions PMPA & subject to 20% coinsurance
Covered up to the AML
Outpatient Surgical procedure
(Subject to applicable coinsurance)
Laboratory, Radiology, Pathology Covered up to the AML
and Diagnostic services (Subject to applicable coinsurance)
X-ray, MRI, CT-scan, Ultra-Sound Covered up to the AML
and Endoscopy diagnostic services (Subject to applicable coinsurance)
Other Benefits
Diagnostic and treatment services
for dental and gum treatments, in Covered up to the AML
case of emergency only
Hearing and vision aids and vision
correction by surgeries and laser, Covered up to the AML
in case of emergency only
Nursing at home by a registered
nurse (Following an immediate Not Covered
Inpatient treatment)
Organ Transplantation • Coverage up to limit of AED 100,000
(Recipient only excluding cost • Coverage for recipients only
organ) • 20% Co-payment
• Cover for 30 days from the date of birth or until addition as a member, whichever is earlier
New-Born Cover
• New-born covered under the mother’s annual limit
Birth Defects & Congenital
Disorders for new-born &/or Not Covered
Deformities
Not Covered
Circumcision
(Subject to 10% coinsurance)
Preventive services, vaccines and • Essential vaccinations and inoculations for new-born and children up to 6 as stipulated in regulator’s policies and
immunizations For New--Born and its updates (Currently the same as federal MOH)
Children • Benefit is covered on reimbursement basis
• Diabetes Screening:
• Normal Risk individuals: Every 3 years from age 30
Preventive services, vaccines and
• High Risk individuals: Annually from age 18
immunizations For Adults.
• Preventive services as mandated by DHA periodically
• Benefit is covered on reimbursement basis
Influenza vaccine Covered up to 55 AED
Herpes zoster vaccine • Offered to people above the age of 50 and immunocompromised patients above the age of 18.
Repatriation of Mortal Remains to • Covered up to maximum AED 10,000 per person per annum
the Country of Domicile • Covered on reimbursement basis
Alternative Medicine
(Ayurvedic, Chiropractic,
Not Covered
Osteopathy, Herbal, Acupuncture,
Acupressure & Homeopathy)
Psychiatric Benefits Capped to AED 1,000 Subject to 20% Coinsurance
Healthcare services for work
related injuries & illness are
covered as per Federal Law No. (8)
Not Covered
of 1980 regarding work relations,
its amendments & the applicable
laws & resolutions in this regard.
Maternity benefit
Up to 10,000 AED for normal delivery
Inpatient services cover normal
Up to 10,000 AED for medically necessary C-section, complications and for medically necessary termination
delivery, medically necessary C-
Emergency up to AED 150,000
section & and medically necessary
Screening tests as per DHA Antenatal Care Protocol
termination
OP maternity is covered up to AML as per DHA
NIL
Waiting Period Any pregnancy arising within 40 days of the policy start date will not be covered
(assuming also the applicant was not pregnant when the policy incepted)
Coinsurance 10%
Optical benefit
Optical (including Checks, Lenses) Not Covered
Dental benefit
Covered services include:

1. Dental consultation
2. Tooth extraction
3. Amalgam/composite fillings
Covered up to 1,000 AED
4. Root canal treatment (R.C.T)
5. Prescribed drugs
6. Surgical interventions
7. X-rays
8. Anesthesia
Coinsurance 20%
Additional benefits
Cancer Treatment [Chemotherapy,
Radiotherapy,
Cancer is covered as per terms, conditions and exclusion of the DHA program
Diagnostics, Advanced Imaging,
Reconstructive Treatment]
Covered up to 60,000 AED
Renal Dialysis
20% Co-Payment
Speech Therapy Not Covered
Emergency Evacuation Not Covered
Medical Repatriation Not Covered
Local Ambulance Covered, as per DHA minimum regulation
Annual Check Up One check-up
every two years available after Not Covered
12 months of continuous cover
Hospice / Palliative Care Not Covered
Stress Management Program Not Covered
Chronic Management Program Not Covered
Global Emergency Assistance Cover Covered
(Provided by Assist America) (Includes Medical Transportation and Repatriation after Treatment, etc.)
Covered up to 800 AED
Mental Health Treatments
20% Co-Payment