Schedule of Benefits (Enhanced Bronze Plan without Dental)

Enhanced Bronze Plan without Dental

Plan Name
Annual Benefit Limit AED 300,000 Per Person Per Policy Year
Territorial Limit1 UAE
Extended to Southeast Asia, India Subcontinent and Arab Country* for inpatient
treatment only on reimbursement basis.
Emergency cover Worldwide excluding USA, Canada & Europe.
Network (Allowing direct Network Within UAE: Grand
billing at designated In & Out-patient on direct billing in UAE.
provider)

Network Outside UAE: Not Applicable

Exception: Inpatient emergency treatment on direct billing- Respective Daman
Network in India
Pre-existing conditions Fully Covered
Inpatient Treatment Network Non-network
Inpatient & Day Treatment 2
100% covered 50% covered
(including Pre & Post In Hospital Treatment Covered)
Accommodation Type-Shared Room 100% covered 50% covered
Hospital Accommodation & Services 100% covered 50% covered
Consultant’s, Surgeon’s & Anesthetist’s Fees and other fee 100% covered 50% covered
Ambulance Services
100% covered 100% covered
(in Medical emergency cases, subject to General exclusions)
Parent Accommodation for accompanying an Insured Child under 10 years
of age 100% covered 50% covered
(Maximum limit of AED100 per day)
Companion Accommodation for Critical Illness
100% covered 50% covered
(Maximum limit of AED 100 per day)
Out-patient Treatment Network Non-network
Physician Consultation
100% covered
10% coinsurance applicable in Cleveland Clinic Abu Dhabi (CCAD) and
(Within CCAD 50% covered
deductible of AED 50 for other providers;
90%)
(Co-insurance/Deductible not applicable for follow up within 7 days)
Diagnostics (X-Ray, MRI, CT-Scan, Ultra Sound, etc.), Laboratory
(Specialized investigation and scan including but not limited to MRI, Scan,
100% covered
Endoscopies with Pre-authorization only)
(Within CCAD 50% covered
10% coinsurance applicable in Cleveland Clinic Abu Dhabi (CCAD) and Nil
90%)
for other providers
(Co-insurance not applicable for follow up within 7 days)
Pharmaceuticals
(Maximum Annual Limit AED 5,000 Per Person)
(Long term medications to be dispensed up to 90 days without pre- 80% covered 50% covered
authorization)
(Out of pocket limit of AED 100 per prescription)
Physiotherapy2 100% covered 50% covered
Other Benefits Network Non-network
Repatriation of Mortal Remains to country of origin3
100% covered 100% covered
(Maximum limit AED 7,500 Per Person)
Emergency Treatment 100% covered 100% covered7
Diagnostic and treatment services for dental and gum treatment
100% covered 100% covered
(medical emergency cases)
Hearing and vision aids, and vision correction by surgeries and laser
100% covered 100% covered
(medical emergency cases)
Healthcare services for work illnesses and injuries as per Federal Law No.
8 of 1980 concerning the Regulation of Work Relations, as amended, and 100% covered 50% covered
applicable laws in this respect
Annual Breast Cancer Screening
100% covered 50% covered
(applicable for females> 35 years) 2,4
Annual Prostate Cancer Screening
100% covered 50% covered
(applicable for males> 45 years) 2,5
Colorectal Cancer Screening 100% covered 50% covered

National Health Insurance Company – Daman (PJSC) (P.O. Box 128888, Abu Dhabi, U.A.E. Tel No. +97126149555 Fax No. +97126149550)
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Schedule of Benefits (Enhanced Bronze Plan without Dental)

(applicable for males and females> 40 years) 2,6

Maternity Network Non-network

Maximum annual limit per person (Inpatient & Outpatient Maternity):
Within UAE : 100% Covered
Outside UAE : AED 8,000
Inpatient Maternity1,2 100% covered 50% covered
Outpatient Maternity
100% covered
10% coinsurance applicable in Cleveland Clinic Abu Dhabi (CCAD) and
(Within CCAD 50% covered
deductible of AED 50 for other providers;
90%)
(Co-insurance/Deductible not applicable for follow up within 7 days)
Dental not covered Network Non-network

Optical not covered

Other Services covered (Through Service Providers Only)
Teleconsultation healthcare services
(Deductible Nil)
International Assistance Service through service provider only
Second Medical Opinion through service provider only
Teleconsultation Services – Trudoc Concierge

*As defined by Daman

1
Please note: (1) A single holiday or business trip may not exceed 180 days. (2) Coverage outside UAE is limited to 180 days
per treatment.
2
Pre-authorization required to avail this benefit. All Emergency cases do not require pre-authorization but should be notified
to Daman within 24 hours.
3
Available on reimbursement only. Non-network Providers covered on re-imbursement only.
4
Includes: a) Clinical Examination b) Mammogram c) Pelvic Sonogram (if medically indicated) d) CA 15.3 (if medically
indicated)
5
Includes: a) Clinical Examination b) PSA c) Rectal sonogram
6 Includes: a) FIT (Fecal Immunochemical Test) every 2 years; b) Colonoscopy every 10 years
7 Exception: For in and outpatient maternity treatment at Non Network Provider, 50% covered outside UAE

SOB REF NO: SOB US-8196-R1-121023| DOH License : 47996

SC Package no: 30356 & 30357

National Health Insurance Company – Daman (PJSC) (P.O. Box 128888, Abu Dhabi, U.A.E. Tel No. +97126149555 Fax No. +97126149550)
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