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• Pre-existing medical conditions are illnesses or injuries that exist before you take out a travel insurance policy, they include chronic diseases, such as hypertension, respiratory diseases, and diabetes as well as any diseases that you may be receiving treatment for, such as cancer. Mental health conditions such as depression and anxiety may also fall under pre-existing conditions
• Pre-existing diseases need to be declared while buying health insurance because your policy is underwritten based on your health declaration
• As per the requirement of the insurer, certain policies/member addition is included with a medical application form, where the pre-existing existing medical conditions including signs are symptoms must be declared.
• The insurer would require the MAF (medical application form) to understand the risk of the policy and to cover the conditions with additional premium, if required.
• Any undeclared pre-existing condition will not be covered (MAF required policies) as per the medical policies and hence it is necessary to declare the pre-existing condition to avail the coverage of the conditions.
• Depending on the plan (whether Individual or Group), declaration of pre-existing chronic condition is important for the insurance company to provide coverage of the declared conditions for the policy year. A medical application form (MAF) and a latest medical report is required to be submitted for the insurance company to review the current health condition of the member. An additional loading/premium on top of the standard rate will be levied for the declared cases. Final amount will be coming from the insurance company upon reviewing the submission.

Kindly note, the coverage of the medical insurance is subjected to the Table of benefits under the policy, where the coverage is well defined with the limits and sublimit.

Some of the coverage under the medical insurance is as below, which is again depends on the benefits you choose.

• Maternity Cover - Maternity coverage includes the prenatal, postnatal and delivery expenses as per the agreed policy terms.
• Emergency cover - The Emergency Medical benefit covers treatment for an unexpected illness or injury or any life-threatening conditions which offers extensive coverage and acts as a financial pillow in case of medical emergencies.
• Vaccination cover for the kids – cover the cost of immunizations and preventive care services as per health plan.
• Diagnostic test & treatments – The medical policies will cover the medically indicated Tests, diagnosis, treatments, and surgeries in hospitals for non-urgent medical cases
• Outpatient Services – Any services as outpatient, such as consultation, lab/radiology tests, pharmaceutical/medicine, etc. will be covered.
• Inpatient Services – Any treatment which required more than 12 hours of admission is referred as inpatient services and the same will be covered as per the terms agreed.
• Day case – Any day case admission for any small procedures will also be covered under the medical insurance.

All the medical insurance is having a standard exclusion and any services mentioned under the same will not be covered.

Some of the excluded services are as below.

• Any treatment which is not medically indicated will not be covered.
• Treatment related to cosmetic will not be covered.
• Treatment related to obesity.
• Any Hazardous sports activity, suicide etc will not be covered.
• External prosthetic devices and medical equipment.
• Patient treatment supplies (including for example: elastic stockings, ace bandages, gauze, syringes, diabetic test strips, and like products; non-prescription drugs and treatments,) excluding supplies required as a result of Healthcare Services rendered during a Medical Emergency.

• Pre-existing conditions
• Age Factor - Overage members
• Marital Status (E.g., Married Females)
• Gender
• BMI (Individuals)
• Loss Ratio (Groups)
• Type of coverage (Network/ Benefits etc)

• Deductible is applied based on the policy terms and conditions.
• For groups, you have the options to choose from such as 20% with a CAP.
• The amount is being borne by the member/insured and paid from their own pocket when going for the out-patient check-ups and/or diagnostic, whenever applied as per the terms and conditions of the policy.

• Yes, but for Individual Cases, only if declared in the medical form.
• For Groups – Major declarations are generally required so here also it would be covered if declared.
• A waiting period may be applied on the policy (depending on the plan & insurer)
• It may not be covered if the Medical Condition falls under the Exclusion List.

• These days most of the policies are card-less policy is activated on the Emirates id and medical insurance policy is linked through the member’s Emirates ID
• Emirates id is a mandatory requirement for all medical providers.
• Members Can Use Insurer or TPA Mobile Application
• Members Can Use ECARDS

• The coverage is subjected to the updating of the marital status, as ‘Married’ in the insurance system with the valid marriage certificate.
• For Abu Dhabi & Dubai Visa holders, it is mandatory cover (DOH & DHA); So yes, it is covered.
• For Northern Emirates some plans may not have Maternity covered (mostly for individual policies only)
• Any undeclared maternity cases will not be covered, for the policies with declaration.
• For Daman AUH Basic, if the member was added as single and is newly married (after policy inception), Maternity benefit can be requested to Daman during midterm amendment to add/update in the policy of the member. However, if marriage date mentioned in the certificate is prior to the policy inception date, Maternity correction can only be done during the renewal period and must be informed accordingly.
• Policy waiting period will be applied as per the policy terms and conditions.

• Optical & dental is an additional benefit covered if chosen at the time of placement (additional premium applies) will be covered as per the terms.
• Dental and Optical cover is always come with certain services with a specific limit.

• The cheapest plans are the basic plan set by the authority (DOH & DHA).
• The plans could be for families as well as employees alone.

• There is no any restriction of number of claims during the policy period, however the maximum coverage will be up to the annual limit, sub limits.
• At the same time, certain services are having limited sessions like physiotherapy, alternative benefit etc, which will be as per the agreed benefits.

• No, one single policy only.
• As per the law, dual coverage is not being allowed in the UAE. Hence, only 1 medical insurance policy should be active for the member.

• NO, cancellation charges apply and note that cancellation can only be done, if the member has cancelled visa (individual & groups) or has a prove of another insurance active already (groups)
• Due to the medical insurance being mandated by law, Mid-term cancellation can only be done if the member can provide the following documents:
  • Visa cancellation copy; or
  • Application for a new insurance policy.
• Cancellation fee may not be applied; however, deletion clause will be applied such as no refund for the cancellation and/or short-term deletion clause period will be applied

• The coverage outside the network is subjected to the availability of the reimbursement benefit under the policies.
• In case of any life-threatening emergencies, the member can access non network provider with a case notification to the insurer within 24 hours from the time of incidence.
• There will not be any reimbursement for elective treatment for the basic policies, without reimbursement benefit.

Medical Claim Reimbursement Checklist:
- Duly filled out claim form of the concerned insurance company / TPA, signed and stamped by the treating doctor with beneficiary signature
- All official itemized invoices with the service details
- Payment proof such as official receipts, paid stamp, card payment slips, etc.
- Prescription from the treating doctor for all the medications availed and for optical items.
- All the diagnostic reports including but not limited to Laboratory and Radiology reports
- Referral letterfrom specialist consultant and progress reports (after every 5 sessions) for claims related to physiotherapy treatment/ chiropractic treatment
- Discharge summarywith theoperative notes(for surgical treatment) for all the inpatient, daycare, emergency admissions
- Medical Report with injury details (when, where and how) for claims related to any kind of injuries
- Medical Insurance cardcopy
-  Bank Details (if applicable)
- Copy of passport showing exit and entry stamp for the treatments done outside UAE
- A police report in case of accident (if covered under medical policy)

Important Notes:

• The insurance company has the right to request further documents not mentioned above such as detailed medical report, etiology, medical justification, etc. if required to further process the claim
• Pre-approval / intimation is required for In-Patient and Daycare treatments outside network and outside UAE including high cost (invasive) Out-patient procedures
• All Emergency cases must be notified within 24 hours from the admission date per DHA exclusion # 21
• Claim documents must be in English or Arabic language only
• All the documents must be submitted with the cut off period per policy terms and conditions