Orient Insurance P.J.S.C - Family Care - Silver Premium - 20% Max AED 25 consultation ded & 10% on all OP
Yearly Cover
AED 1,000,000.00
Deductible
20% co-pay (max AED 25) on OP consultation & 10% co-pay on all OP services; 20% co-pay on all OP services (30% co-pay on pharmacies) in Saudi German Hospital, Mediclinic, Al Zahra & Dr. Sulaiman Al Habib Hospital Group
Coverage
Worldwide
Chronic Conditions
Covered up to AED 150,000 (with pre-existing conditions)
Pre-Existing Conditions
Not Covered
In-Patient
Ambulance Coverage
Covered for in-patient treatment with pre-authorization
Hospital Accomodation
Private Room with pre-authorization
Hospital Cash Benefit
Not Covered
Parent Accomodation
Covered with pre-authorization
Out-Patient
Vaccination
Covered for children up to 6 years with 10% co-pay & pre-authorization
Physiotherapy
Covered with pre-authorization; up to 15 sessions with 10% co-pay for out-patient treatment
Scans
Covered; pre-authorization required for in-patient treatment; 10% co-pay for out-patient treatment
Health Checks
Diabetes screening covered once every year for members over 18 years with 10% co-pay
Psychiatric Treatment
Not Covered
Alternative Medicine
Up to AED 1,600 on reimbursement basis with 10% co-pay
Prescription Drugs
Not Covered
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Network
Network Coverage
149 Hospitals
1024 Clinics
66 Laboratories
1797 Pharmacies
15 Dentals
0 Optics
Treatment Outside Area of Cover
Not Covered
Treatment Outside Network
For elective treatment 80% of covered cost (100% for South-East Asia) subject to network rates on reimbursement basis
Maternity
Pregnancy Cover
Covered with 10% co-pay on out-patient maternity treatment; up to AED 10,000 for normal delivery and up to AED 10,000 for medically essential C-section & complications; preauthorization required for in-patient treatment
Newborn Baby Cover
Covered up to AED 150,000 for 30 days from birth; preauthorization required for in-patient treatment
Natal Complications
Covered with 10% co-pay; pre-authorization required for inpatient treatment
Dental
Dental Coverage
Up to AED 3,500 with pre-authorization & 20% co-pay on direct billing (additional 20% co-payment on reimbursement)
Accidental Damage to Teeth
Covered if treated within 3 months; 10% co-pay