ASNIC | Al Sagr Insurance
Flexi Diamond Option 4
The short version
NEXTCARE — GN Excluding Mediclinic Group & American HospitalWhat Flexi Diamond Option 4 does and does not do, before you read the insurer's own Table of Benefits.
Annual limit
AED 500,000
Medical network
NEXTCARE — GN Excluding Mediclinic Group & American Hospital
Consultation
Covered with 20% co-pay
Pharmacy
Covered with 20% co-pay
What is good
Good to know
Get your price to download this plan's Table of Benefits and your quote.
Everything in the policy
Medical Network
NEXTCARE — GN Excluding Mediclinic Group & American Hospital
Annual Limit per Person
AED 500,000
Area of Coverage
Worldwide Including USA & Canada
In-patient Services
Covered. Deductible for In-Patient Services: NIL
Out-patient Services
Covered
Hospital Accommodation
Private Room
Consultation Deductible (Co-Pay)
20% coinsurance on all OP consultation or AED 50/- on all OP consultation, whichever is lower.
Diagnostics & Laboratory Services
Covered
Medicine Limit
Covered in full with co- insurance on specified providers as mentioned in the Network table ( Page 1 point3) with 20% Co-Pay
Maternity
In-patient: 10% coinsurance payable by the insured Maximum benefit 10,000 AED per normal delivery, 10,000 AED for medically necessary C-section, complications and for medically necessary termination (All limits include coinsurance. Waiting Period: (Non -working spouses who are confirmed pregnant after time of enrollment will be subject to 9 months waiting period). where any conditions develops which becomes an emergency, the medically necessary expenses will be covered up to Max Limit AED 150,000/-PPPY. Out-patient: 10% Copay , Maximum 8 visits checks and tests in accordance with DHA Antenatal Care Protocols Waiting Period: ( Non -working spouses who are confirmed pregnant after time of enrollment will be subject to 9 months waiting period).
Women and maternity on this plan
Married women pay an extra maternity premium on this plan; single women pay the standard price.
Women's premiums on this plan are higher than men's, whether or not they are married.
Get a quote to see the amount for your family.
Alternative Medicines
Homeopathy & Ayurveda: Covered up to a limit of AED 2,500 per person per year Outpatient: 20% coinsurance payable by the insured per visit ( No coinsurance if a follow up visit made within seven days ) Covered on reimbursement ONLY
Physiotherapy
Covered up to 15 sessions per ailment/condition per person per year
Psychiatric Treatment
Mental Health (Outpatient Counselling): Coverage up to limit of AED 800/- Outpatient: 30% coinsurance payable by the insured per visit No coinsurance if a follow-up visit is made within seven days
Home Nursing
Covered up to a limit of AED 3,000/- per person per year for a period not exceed 30 days in aggregate Immediately following Hospital discharge on the recommendation of a specialist and must be provided by a qualified nurse. All treatments under this benefit must be pre-authorized by us.
Routine Dental Benefits
Covered up to a limit of AED 2,000/- with 20% co-ins (limit including co-ins) Direct billing only. (under Network facilities)
Routine Optical Benefits
Covered up to a limit of AED 1000/- with 20% co-ins (limit including co-ins) Direct billing only. Under Network facilities)
Pre-existing / Chronic Conditions
Maximum limit AED 150,000 PPPY Treatment for chronic Or pre-existing conditions excluded for first 6 months of first membership. Included thereafter (Where any condition develops which becomes an emergency, the medically necessary expenses will be covered up to the annual aggregate limit)
Emergency Road Ambulance Services
Covered
Repatriation of Mortal Remains
Coverage up to limit of AED 5000/- Repatriation costs for the transport of mortal remains to the country of origin
Within the Network (Direct Billing)
Direct Billing Basis
Outside the Network (Reimbursement)
Reimbursement Basis. Elective treatment outside the network: 20% Co-insurance subject to UCR Network Charges
Emergency Treatment
Emergency treatment Outside the Network within UAE or within geographical scope (Life threatening cases): Covered in full on Direct and or reimbursement basis
Air-Ticket for Insured Member
AED 2,000/- per person per year Insured patient only. Return Air Fare to Patient for Surgery in Home Country ( if treatment is not available in the country of residence or the treatment expense is up to 50% of the cost in UAE ). Pre-approval from ASNIC required
Cancer Treatments
Covered
Cash indemnity for in-patient stays
Covered up to AED 300/- per day. When treatment is received as an In-Patient for an eligible Medical Condition in a Government Hospital, where no costs were incurred for accommodation and/or for treatment, then this benefit pays for a daily cash benefit for In-Patient stay more than 3 days. This benefit is not applicable for Accident & Emergency admissions.
Follow-up consultation co-pay (within 7 days)
Free follow up with the same doctor for the same ailment within seven days.
Elective Treatment
Elective Treatment Outside the Network within UAE / outside UAE within Geographical scope: 20% Co-insurance subject to UCR Network Charges (UCR charges are as per the discretion of the insurer) on Reimbursement.
Emergency dental (accidental damage)
Cover : Emergency Treatment required to save or alleviate danger to life with 20% co-insurance.
Hearing Emergencies
Cover : Emergency Treatment required to save or alleviate danger to life with 20% co-insurance.
Influenza Vaccine
Covered once per year
New Born baby coverage
Cover for 30 days from birth. (BCG, Hepatitis and neo-natal screening tests. (Phenylketonuria (PKU), Congenital Hypothyroidism, sickle cell screening, congenital adrenal hyperplasia)
Out Patient Surgery
Covered
Preventive services (members over 18)
Covered up to AED 300
Organ transplantation (recipient only)
Coverage up to limit of AED 100,000/- Coverage for Recipients only - Outpatient: 20% coinsurance payable by the insured per visit
Vision Emergencies
Cover : Emergency Treatment required to save or alleviate danger to life with 20% co-insurance.
Only on this plan
Benefits this plan adds beyond the rows compared above.
Everyday care
Out-patient care you are likely to use in a normal year- Emergency dental (accidental damage)
- Cover : Emergency Treatment required to save or alleviate danger to life with 20% co-insurance.
- Hearing Emergencies
- Cover : Emergency Treatment required to save or alleviate danger to life with 20% co-insurance.
- Out Patient Surgery
- Covered
- Vision Emergencies
- Cover : Emergency Treatment required to save or alleviate danger to life with 20% co-insurance.
Prevention & screening
Checks and vaccinations, before there is anything wrong- Influenza Vaccine
- Covered once per year
- Preventive services (members over 18)
- Covered up to AED 300
Cash back and waived fees
Money paid back to you, and charges this plan does not make- Air-Ticket for Insured Member
- AED 2,000/- per person per year Insured patient only. Return Air Fare to Patient for Surgery in Home Country ( if treatment is not available in the country of…
- Cash indemnity for in-patient stays
- Covered up to AED 300/- per day. When treatment is received as an In-Patient for an eligible Medical Condition in a Government Hospital, where no costs were incurred…
- Follow-up consultation co-pay (within 7 days)
- Free follow up with the same doctor for the same ailment within seven days.
Hospital and recovery
What the plan does around a hospital stay- Emergency Treatment
- Emergency treatment Outside the Network within UAE or within geographical scope (Life threatening cases): Covered in full on Direct and or reimbursement basis
- Cancer Treatments
- Covered
- Elective Treatment
- Elective Treatment Outside the Network within UAE / outside UAE within Geographical scope: 20% Co-insurance subject to UCR Network Charges (UCR charges are as per…
- New Born baby coverage
- Cover for 30 days from birth. (BCG, Hepatitis and neo-natal screening tests. (Phenylketonuria (PKU), Congenital Hypothyroidism, sickle cell screening, congenital…
- Organ transplantation (recipient only)
- Coverage up to limit of AED 100,000/- Coverage for Recipients only - Outpatient: 20% coinsurance payable by the insured per visit
- Congenital Conditions
- Maximum limit AED 150,000 PPPY ( life - threatening birth defects, deformities and congenital diseases for New born children only )
- Dialysis
- Covered to a limit of AED 60,000/- Outpatient: 20% coinsurance payable by the insured per visit
- Parent Accommodation for child under 18 years of age
- Covered up to AED 200/- per day
Other benefits
Named in this plan's document and not easily grouped- Immunomodulators and Immunotherapy Medications
- Covered Max AED 10,000 per person per year. As per policy directive (PD 05/2018) and For medically necessary conditions only
- Out-patient co-insurance at hospitals
- 20% Co-insurance on all OP services at all Hospitals & their in-hospital pharmacies Other pharmacies- 20% Co -insurance for Medicines
- Reconstructive surgery
- Covered in Full. Reconstructive surgery following an Accident or following surgery for an eligible medical conditions, which is not pre-existing and the incident has…