Plan Name: DHA-EBP-ENHANCED-1

Table of Benefits
Healthcare Insurance

All amounts are in AED

Coverage Details
Total Annual Limit Coverage & Pre-existing
Annual upper limit for healthcare services 150,000 per insured member per year
Pre-existing & chronic conditions Covered*3

Healthcare Services Geographical Scope

In Dubai Covered
In Abu Dhabi Covered
Other Emirates Covered
Arab Countries and South East Asia Home Country only, for Inpatient treatment
International Home Country only, for Inpatient treatment

Medical Network
Inpatient services are restricted to DHA Plus Network Hospitals
DHA plus
Outpatient services are restricted to DHA Plus Network clinics

Inpatient Healthcare Services (at designated network hospitals – prior approval is required)
Shared room
Patient Accommodation
20% co-insurance with maximum ceiling*1
Tests, diagnosis, treatments and surgeries in Covered
hospitals for non- urgent medical cases 20% co-insurance with maximum ceiling*1
Covered
Emergency treatments
20% co-insurance with maximum ceiling*1
Transportation services for medical Covered
emergencies by an authorized party 20% co-insurance with maximum ceiling*1
Accommodation for a person accompanying an Covered up to AED 100 per night
insured child up to 16 years of age. 20% co-insurance with maximum ceiling*1
Accommodation for an accompanying person in Covered up to AED 100 per night
the same room in case of critical conditions and 20% co-insurance with maximum ceiling*1
as per recommendation of attending physician.
Normal Delivery: AED 7,000 per policy year
Medically necessary C-Section, abortion and other maternity
complications: AED 10,000 per policy year
In patient maternity services
10% coinsurance applicable on all services.
Maternity complications, if leading to emergency, will need to be
covered up to the annual indemnity. Waiting period on pre-existing
condition does not apply to maternity.

Page 1 of 7

Oman Insurance Company (P.S.C.), Paid up Capital 461,872,125, C.R. No. 41952, Insurance Authority No. 9 dated 24/12/1984
Head Office: P.O. Box 5209, Dubai, United Arab Emirates. Tel.: +971 4 233 7777, Fax: +971 4 233 7775, www.tameen.ae
Plan Name: DHA-EBP-ENHANCED-1

Coverage Details
Outpatient Healthcare Services (at designated network Clinics – prior approval is required except GP
consultation)
Examination, diagnostic and treatment services GP consultation & Specialist consultation on referral from GP
of clinics and health centers by general 20% co-insurance
practitioners and specialists, provided that the
insured member is referred to a specialist
and/or consultant by a general practitioner.
Follow ups are exempted from fees if made
within a week from the date of first examination.
Covered
Laboratory tests
20% co-insurance
X-ray diagnostic services including MRI, CT Covered
scans and endoscopies 20% co-insurance
Physiotherapy treatment. Subject to referral 6 sessions covered every year
from a specialist and prior approval from OIC 20% coinsurance
Covered with a limit of AED 1,500 per year including co-insurance.
Cost of medicine – pharmacy Co-insurance: 30%
Coverage as per DHA approved formulary.
Examination, diagnostic and treatment for Antenatal Care
pregnancy and gynecology services in 8 visits to primary healthcare facility. All consultations by PHC
authorized health centers and clinics by general Obstetrician for low risk or Specialist Obstetrician for high risk, on
practitioners and specialists, provided that the referral. Initial investigations includes the below.
insured member is referred to a specialist • FBC and Platelets
and/or consultant by a general practitioner. • Blood group, rhesus status and antibodies
Follow ups are exempted from fees if made • VDRL
within a week from the date of first examination. • MSU & urinalysis
• Rubella serology
• HIV
• FBS, random s or A1c for all due to high prevalence of
diabetes in UAE
• Hep C, offered to high risk patients
• GTT if high risk
• 3 antenatal ultrasound scan
Visits to includes reviews, checks and tests in accordance with
DHA Antenatal Care Protocols
10% coinsurance for all services.

Other Benefits
Diagnostic and treatment services for Covered only for life threatening medical emergency cases only*2
dental and gum treatments. 20% coinsurance
Hearing and vision aids, and vision correction Covered only for life threatening medical emergency cases only*2
by surgeries, and laser. 20% coinsurance

Covered for 30 days from birth. Coverage includes BCG, Hepatitis

B and neo- natal screening tests (Phenylketonuria (PKU),
New born cover Congenital Hypothyroidism, sickle cell screening, congenital
adrenal hyperplasia).
The cover is provided under the mother’s policy.

Page 2 of 7

Oman Insurance Company (P.S.C.), Paid up Capital 461,872,125, C.R. No. 41952, Insurance Authority No. 9 dated 24/12/1984
Head Office: P.O. Box 5209, Dubai, United Arab Emirates. Tel.: +971 4 233 7777, Fax: +971 4 233 7775, www.tameen.ae
Plan Name: DHA-EBP-ENHANCED-1

• Essential vaccinations and inoculations for newborns and

children is covered as stipulated in the DHA’s policies and its
updates in the assigned facilities (currently the same as
Federal MOH), through selected providers.
• Preventive services as stipulated by DHA to include initially
diabetes screening
Frequency restricted to:
Preventive services, vaccines and
Diabetes: - Every 3 years from age 30
immunizations
- High risk individuals annually from age 18
• Hepatitis C Virus Screening and treatment: To be followed as
per the guidelines laid out in the Hepatitis C support program
• Cancer Screening and treatment: To be followed as per the
guidelines laid out in the Cancer support program
• Adult Pneumococcal Conjugate Vaccine followed As per DHA
Adult Pneumococcal Vaccination guidelines
Reimbursement of return airfare for the insured member to travel
to home country for elective inpatient treatments, subject to
following conditions:
Return Airfare 1) Economy class, limited to a maximum of AED 2,000/- per
treatment
Maximum overall cost inclusive of the airfare does not exceed 90%
of OIC applicable UAE network tariff
Compensation in respect of :
Personal Accident Benefit*
A) Death due to accident : AED 50,000
Subject to terms and conditions as follows
B) Permanent total disability due to accident : AED 50,000

Inside UAE – Outside Network (Coinsurance applies over and above Network Deductions)
Emergency in UAE
Coinsurance (with or without PAR) 0% Coinsurance
Basis of Claims Settlement Actual
Elective in UAE (If treatment / service is not available within the network then cover is 100% at actual subject to
PAR)*1
Coinsurance (with or without PAR) Not Covered
Basis of Claims Settlement Not Applicable

Abroad (within agreed territory) – Coinsurance applies over and above network deductibles
Emergency Abroad
Coinsurance 10% Coinsurance
Basis of Claims Settlement OIC Network Tariff
Elective Abroad
Coinsurance 10% Coinsurance
Basis of Claims Settlement OIC Network Tariff
*1 Co-insurance of 20% for all inpatient services subject to a ceiling of AED 500 per claim and AED 1,000 in aggregation (maximum per year).
*2 These benefits are covered only in case of life threatening medical emergencies.
*3 Waiting period of 6 months is applicable from the first scheme enrollment. Waiting period does not apply for members who were
previously insured, subject to the proof of previous medical insurance cover.

Page 3 of 7

Oman Insurance Company (P.S.C.), Paid up Capital 461,872,125, C.R. No. 41952, Insurance Authority No. 9 dated 24/12/1984
Head Office: P.O. Box 5209, Dubai, United Arab Emirates. Tel.: +971 4 233 7777, Fax: +971 4 233 7775, www.tameen.ae
 Plan Name: DHA-EBP-ENHANCED-1

PERSONAL ACCIDENT COVER

Table Of Benefits
Compensation Payable In Respect Of Accident: Per Person
1) Death: AED 50,000
2) Total And Irrecoverable Loss Of Sight Of Both Eyes: Not Covered
3) Total And Irrecoverable Loss Of Sight Of One Eye: Not Covered
4) Total And Irrecoverable Loss Of Two Limbs: Not Covered
5) Total And Irrecoverable Loss Of One Limb: Not Covered
6) Total And Irrecoverable Loss Of Sight Of One Eye And Loss Of One Limb: Not Covered
7) Permanent Total Disablement By Accident: AED 50,000
8) Temporary Total Disablement By Accident: Not Covered
9) Temporary Partial Disablement By Accident: Not Covered
Compensation Payable In Respect Of Illness:
10) Total And Irrecoverable Loss Of Sight Of Both Eyes: Not Covered
11) Permanent Total Disablement By Illness: Not Covered
12) Temporary Total Disablement By Illness Of Any Kind: Not Covered

Words in bold print in this Insurance have special meaning, as defined in the DEFINITIONS of this Insurance

IMPORTANT NOTICE

PLEASE NOTE THAT SEPARATE INSURANCE IS PROVIDED UNDER THIS POLICY FOR BODILY INJURY CAUSED BY AN
ACCIDENT AND FOR ILLNESS. THIS INSURANCE ONLY RELATES TO THE BENEFITS OF THE POLICY WHICH ARE SHOWN IN
THE SCHEDULE AS BEING INCLUDED AND FOR WHICH PREMIUM HAS BEEN PAID.

THE INSURED MUST DISCLOSE TO THE UNDERWRITERS ALL FACTS, MATTERS AND CIRCUMSTANCES MATERIAL TO THIS
INSURANCE, INCLUDING, BUT NOT LIMITED TO WHETHER THE INSURED PERSON ENGAGES IN ANY OCCUPATION,
SPORT OR PASTIME OR OTHER ACTIVITY OF A HAZARDOUS NATURE.

We, the Underwriters, hereby agree with the Insured, to the extent and in the manner herein provided, that if the
Insured Person:

(a) sustains Bodily Injury caused by an Accident or

(b) suffers Illness;

We will pay to the Insured, or to the Insured's Executors or Administrators, according to the Schedule of Benefits after
the total claim shall be substantiated under this Insurance

Provided Always That:

1. No weekly benefit shall become payable until the total amount thereof has been ascertained and agreed.

2. the total sum payable under this Insurance in respect of any one or more claims shall not exceed in all the total of the
larger of benefit 7 or 11 and benefit 8 or 12 multiplied by the maximum benefit period as shown in the Schedule of
Benefits less any excess as shown in the Schedule of Benefits.

3. if Item 1 of the Schedule of Benefits is not covered, then no claim shall be payable, other than for weekly benefits, in
respect of any Accident which would have given rise to a claim for death had that item been covered.

Page 4 of 7

Oman Insurance Company (P.S.C.), Paid up Capital 461,872,125, C.R. No. 41952, Insurance Authority No. 9 dated 24/12/1984
Head Office: P.O. Box 5209, Dubai, United Arab Emirates. Tel.: +971 4 233 7777, Fax: +971 4 233 7775, www.tameen.ae
 Plan Name: DHA-EBP-ENHANCED-1

4. if Item 1 of the Schedule of Benefits is covered and an Accident causes the death of the Insured Person within twelve
months following the date of the Accident and prior to the definite settlement of the benefit for disablement provided
for under Items 2 to 7 of the Schedule of Benefits, there shall be paid only the benefit provided for in the case of
death.

5. no benefit shall be payable under Items 10 or 11 of the Schedule of Benefits should Illness cause the death of the
Insured Person within twelve months of that Illness first manifesting itself.

DEFINITIONS

In this Insurance:

1. 'BODILY INJURY' means identifiable physical injury which

a) is caused by an Accident, and

b) Solely and independently of any other cause, except illness directly resulting from, or medical or surgical treatment
rendered necessary by such injury, occasions the death or disablement of the Insured Person within twelve
months from the date of the Accident.

2. 'ACCIDENT' means a sudden, unexpected, unusual, specific event which occurs at an identifiable time and place during
the Period of Insurance.

Accident shall also include disappearance. If the Insured Person is not found within twelve months of
disappearing, and sufficient evidence is produced satisfactory to the Underwriters that leads them inevitably
to the conclusion that the Insured Person has sustained Bodily Injury and that such injury has caused the
Insured Person’s death, the Underwriters shall forthwith pay any death benefit, where applicable, under this
Insurance, provided that the person or persons to whom such sum is paid shall sign an undertaking to refund
such sum to the Underwriters if the Insured Person is subsequently found to be living.

3. 'ILLNESS' means sickness or disease of the Insured Person which first manifests itself during the Period of
Insurance and occasions the total disablement of the Insured Person within twelve months after manifesting itself.

4. 'TEMPORARY TOTAL DISABLEMENT' means disablement which entirely prevents the Insured Person from attending
to their business or occupation.

5. 'TEMPORARY PARTIAL DISABLEMENT' means disablement which prevents the Insured Person from attending to a
substantial part of their business or occupation.

6. 'PERMANENT TOTAL DISABLEMENT' means disablement which entirely prevents the Insured Person from attending
to any and every occupation and which lasts twelve months or the maximum benefit period for Temporary Total
Disablement as stated in the Schedule of Benefits whichever is the longer and at the end of that period is beyond hope
of improvement.

7. 'LOSS OF A LIMB' means permanent loss by physical separation of a hand at or above the wrist or of a foot at or
above the ankle and includes permanent total and irrecoverable loss of use of hand, arm or leg.

8. ‘LOSS OF SPEECH’ shall mean total loss of speech which lasts twelve months and at the end of that period is beyond
hope of improvement.

Page 5 of 7

Oman Insurance Company (P.S.C.), Paid up Capital 461,872,125, C.R. No. 41952, Insurance Authority No. 9 dated 24/12/1984
Head Office: P.O. Box 5209, Dubai, United Arab Emirates. Tel.: +971 4 233 7777, Fax: +971 4 233 7775, www.tameen.ae
 Plan Name: DHA-EBP-ENHANCED-1

9. ‘LOSS OF HEARING’ shall mean total loss of hearing in one or both ears which lasts twelve months and at the end of
that period is beyond hope of improvement

EXCLUSIONS

This Insurance does not cover claims in any way caused or contributed to by:

1. war, whether war be declared or not, hostilities or any act of war or civil war;

2. the actual or threatened malicious use of pathogenic or poisonous biological or chemical materials;

3. nuclear reaction, nuclear radiation or radioactive contamination;

4. the Insured Person engaging in or taking part in armed forces service or operations;

5. the Insured Person engaging in flying of any kind other than as a passenger;

6. the Insured Person’s suicide or attempted suicide or intentional self-injury or the Insured Person being in a
state of insanity;

7. venereal disease or Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or Human
Immuno-deficiency Virus (HIV) howsoever these have been acquired or may be named;

8. the Insured Person’s deliberate exposure to exceptional danger (except in an attempt to save human life);

9. the Insured Person 's own criminal act;

10. the Insured Person being under the influence of alcohol or drugs;

11. pregnancy or childbirth;

12. Neuroses, psychoneuroses, psychopathies or psychoses, anxiety, stress, fatigue or mental or emotional
diseases or disorders of any type.

CONDITIONS

1. If the Insured Person shall regularly engage in any occupation, sport, pastime or other activity in which materially
greater risk may be incurred than previously disclosed in connection with this Insurance without first notifying the
Underwriters and obtaining their written agreement to the inclusion under this Insurance, (subject to the payment of
any additional premium as the Underwriters may reasonably require as the consideration for such agreement), then no
claim shall be payable in respect of any Accident or Illness arising from such activity.

2. Unless otherwise declared and agreed by the Underwriters no benefit will be payable for any condition for which the
Insured Person has sought advice, diagnosis, treatment or counselling or of which the Insured Person was or should
reasonably have been aware at inception of this Insurance or for which the Insured Person has been treated at any
time prior to inception.

3. Notice must be given to the Underwriters as soon as reasonably practicable of any Accident or Illness which causes
or may cause a claim within the meaning of this Insurance, and the Insured Person must as early as possible seek
the attention of a duly qualified medical practitioner. Notice must be given to the Underwriters as soon as reasonably
practicable in the event of the death of the Insured Person resulting or alleged to result from an Accident.

Page 6 of 7

Oman Insurance Company (P.S.C.), Paid up Capital 461,872,125, C.R. No. 41952, Insurance Authority No. 9 dated 24/12/1984
Head Office: P.O. Box 5209, Dubai, United Arab Emirates. Tel.: +971 4 233 7777, Fax: +971 4 233 7775, www.tameen.ae
 Plan Name: DHA-EBP-ENHANCED-1

All medical records, notes and correspondence referring to the subject of a claim or a related pre-existing
condition shall be made available on request to any medical adviser appointed by or on behalf of the Underwriters and
such medical adviser shall, for the purpose of reviewing the claim, be allowed so often as may be deemed necessary
to make an examination of the Insured Person.

4. Any fraud, concealment, or deliberate mis-statement either in the proposal on which this Insurance is based or in
relation to any other matter affecting this Insurance or in connection with the making of any claim hereunder shall
render this Insurance null and void and all claims hereunder shall be forfeited.

5. The law and jurisdiction applicable to this insurance contract are as stated in the Schedule.

Page 7 of 7

Oman Insurance Company (P.S.C.), Paid up Capital 461,872,125, C.R. No. 41952, Insurance Authority No. 9 dated 24/12/1984
Head Office: P.O. Box 5209, Dubai, United Arab Emirates. Tel.: +971 4 233 7777, Fax: +971 4 233 7775, www.tameen.ae