DHA Basic Plan

BENEFITS COVERAGE Basic Plan

Eligibility Criteria Employees plus Dependents (LSB or Non- LSB)

Minimum Employees Required 2 Employees

Annual Limit AED 150,000 PPPY

UAE + Home country*

*Home country coverage is applicable upon 100% of UAE UCR
Geographical Coverage
*Only In Patient will be covered in Home countries (Out Patient treatment NOT
covered)
Inpatient: Nextcare RN3 network
Assigned Network Outpatient: Nextcare PCP Network
Outpatient treatment restricted to clinics only

Third Party Administrator (TPA) Nextcare

Treatment outside network within UAE

No Coverage outside Network within UAE
(other than emergency cases)

Covered with Nil waiting period for existing members who were covered
previously under any insurance scheme.
Pre-existing & Chronic Conditions Any new member/addition will be covered subject to 6 months waiting period.
All pre-existing or chronic conditions which develop into an emergency within
the 6 months waiting period shall be covered up to the annual aggregate limit.

Inpatient Treatment (IP) - subject to pre approval Covered upto Annual Limit - *subject to below co-insurance

Non urgent cases (Elective) - Prior approval is compulsary

Approval Requirements Emergency medical service - Approval required from the insurance company
within 24 hours of admission to the authorized network hospital

20% coinsurance payable by the insured with a cap of AED 500 payable per
encounter
*Co-insurance for all IP Services
An annual aggregate cap of AED 1,000
Above these caps the insurer will cover 100% of the treatment

Semi - Private / Ward

Room and Board
In-patient services will be recieved in rooms of two or more beds

Hospital Accomodation and related services Covered

Intensive care unit and coronary artery disease treatment Covered

Consultant's, Surgeon's and Anesthetist's Fees Covered

Various therapies including physiotherapy, chemotherapy, radiation

Covered
therapy etc.

Ground transportation services in the UAE provided by an authorized

Covered
party for medical emergencies (Ground Ambulance Services)

The cost of accomodating a person accompanying an insured child up to the

Covered maximum up to AED 100 per night
age of 16 years

The cost of accomodation of a person accompanying an in-patient in the

same room in cases of medical necessity at the recommendation of the
Covered maximum up to AED 100 per night
treating doctor and after the prior approval of the insurance company
providing coverage

Return Airfare ticket for In-Patient claims subject to a maximum

reimbursement of 100% of UAE usual and customary rates. Direct billing
Covered
might be arranged to pre-scheduled operations in some countries. Cover
will be subject to policy terms and conditions.
Outpatient Treatment (OP) Covered upto Annual Limit - *subject to below co-insurance

Referral Procedure: General Practitioner referral is required for specialists consultation, otherwise consulting a specialist without GP referral is not allowed

20% co-insurance per consultation

Deductible on OP consultation
(Nil for follow up visit made withing seven days for the same ailment)

Diagnostic Procedures
Covered upto Annual limit, subject to 20% co-insurance
(X-ray, MRI, CT scan, PET, Ultrasound, Lab test etc)

Covered upto AED 1,500 PPPY (including co-insurance), subject to

Out Patient Medicine Limit - Restricted to formulary drugs where available
30% co-insurance

Physiotherapy treatment services

Max upto 6 sessions, subject to 20% co-insurance
(Prior approval is required)

Maternity - In Patient and Out patient

10% co-insurance payable by the insured

8 out patient visits within the network as specified by the table of benefits
Visits to include reviews, checks and tests in accordance with DHA antenatal care
protocols
All care provided by obstetrician for low risk or specialist obstetrician for high
risk referrals by the network provider as specified on the TOB

Investigations to include:
Maternity Treatment - Out Patient
- FBC and Platelets
Any condition that turns into an emergency, the medically necessary
- Blood group, Rhesus status and antibodies
expenses will be covered up to annual limit
- VDRL - MSU & urinalysis
- Rubella serology
- HIV
- Hep C offered to high risk patients
- GTT if high risk
- FBS , random s or A1c for all due to high prevalence of diabetes in UAE
3 ante-natal ultrasound scans

Maternity Treatment - In-patient 10% co-insurance payable by the insured

Any condition that turns into an emergency, the medically necessary AED 7,000 for normal delivery or AED 10,000 for medically necessary C-section,
expenses will be covered up to annual limit complications and for medically necessary termination

Cover for 30 days from birth.

BCG, Hepatitis B and neo-natal screening tests (Phenylketonuria (PKU),

New born Cover
Congenital Hypothyroidism, sickle cell screening, congenital adrenal hyperplasia)

New born is covered up to the mothers annual limit

Other benefits:

Day Care Treatment Covered

Out Patient Surgery Covered

Essential vaccinations and inoculations for new born and children as stipulated in
Vaccination
the DHA’s policies
Normal risk: Every 3 years from age 30
Diabetes Screening test High risk individuals annually from age 18
Preventive services as mandated by DHA periodically

Covered only for emergency cases,

Hearing and vision aids, and vision correction by surgeries and laser
subject to 20% co-insurance

Covered only for emergency cases,

Diagnostic and treatment services for dental and gum treatments
subject to 20% co-insurance

Cancer Treatment
Screening, Healthcare Services, Investigations and Treatments only for Covered as per terms, conditions and exclusions of the program defined by DHA
members enrolled under Patient Support Program only ( To high risk patients for Breast /Cervical /Colorectal Cancer )

Alternative medicine
(Homeopathy, Herbal treatment, Ayurvedic treatment, Acupuncture & Covered as per Pharmacy terms and limits
Chiropractic treatment)
Covered up to AED 10,000 for members above 65 years old and for the natural
Repatriation
death only
HCV Hepatitis C Virus Infection
Screening, Healthcare Services, Investigations and Treatments related to
Covered as per terms, conditions and exclusions of the program defined by DHA
viral Hepatitis and associated complications related to Hepatitis C shall
only be for members enrolled under Patient Support Program
Gross Premium Rate (pppy) for LSB
AED 575.00
Age 0-65 years

VAT 5% AED 28.75

Additional amount Patient Support Program (Basmah & HCV)

AED 38.85
including VAT for Dubai Visa Holders
Gross Premium Rate (pppy) including Patient Support Program
AED 642.60
& VAT
Gross Premium Rate (pppy) for NLSB
AED 781.00
Age 0-65 years
VAT 5% AED 39.05

Additional amount Patient Support Program (Basmah & HCV)

AED 38.85
including VAT for Dubai Visa Holders
Gross Premium Rate (pppy) including Patient Support Program
AED 858.90
& VAT

Disclaimer
This product is designed for groups*1 with maximum 150 members only.
Renewals(existing) under Orient currently having Basic plan are eligible for this product.
Renewals(existing) under Orient currently having any other plan* 2 than Basic should be refered to Orient to be priced
Orient is not responsible for any groups booked under this product if they violate the above conditions

*1 - Groups are defined on quote level not on category/sub-group level.

*2 - Enhanced DHA, SME and Conventional

Underwriting Guidelines
Basic product applicable for all the LSB members below 80 years old. For any member above 80 please refer to Orient
with completed Medical Application Form (MAF)
Basic product applicable for all the NLSB members below 65 years old. For any member above 65 please refer to Orient
with completed Medical Application Form (MAF)
The above plans are applicable for DXB visa and NE visa holders only
Orient has the right to change the plans and Rates if any scheme does not comply with the mentioned guidelines
Groups belonging to the following categories should be referred to Orient for pricing:
(i) Taxi Companies, (ii) Transport Companies, (iii) Educational Institutes, (iv) Medical Service Providers, (v) Banking Services, (vi) Military
Services, and (vii) Associations of any kind