‫ﺟﺪﻭﻝ ﺍﻟﻤﻨﺎﻓﻊ ﻭﺍﻟﻤﻤﻴﺰﺍﺕ – ﺍﻟﺸﺒﻜﺔ ﺍﻟﻄﺒﻴﺔ‬

‫‪Insured Name‬‬ ‫ﺍﻭﺑﺎﻝ ﺍﻟﻮﻁﻨﻴﺔ ﻟﻠﺘﻤﻮﻳﻦ ﺍﻟﻐﺬﺍﺋﻲ ﻭﺍﻟﺨﺪﻣﺎﺕ ﺍﻟﻤﺤﺪﻭﺩﺓ ‪Opal National Catering Company‬‬ ‫ﺍﺳﻢ ﺍﻟﺠﻬﺔ ﺍﻟﻤﺆﻣﻨﺔ‬
‫‪Policy No.‬‬ ‫‪TGM222 – Class A‬‬ ‫ﺭﻗﻢ ﺍﻟﻮﺛﻴﻘﺔ‬
‫‪Policy Period‬‬ ‫ﻣﻦ ‪ 2023/06/01‬ﺇﻟﻰ ‪2024/05/31‬‬ ‫ﻓﺘﺮﺓ ﺍﻟﻮﺛﻴﻘﺔ‬
‫‪Benefits :‬‬ ‫ﺍﻟﻤﻨﺎﻓﻊ ﻭﺍﻟﺘﻐﻄﻴﺎﺕ‪:‬‬
‫ﺍﻟﻤﻮﺍﻓﻘﺔ ﺍﻟﻤﺴﺒﻘﺔ ﻣﻄﻠﻮﺑﺔ‬
‫ﻣﺸﻤﻮﻝ‪:‬ﻳﺠﺐ ﻋﻠﻰ ﻣﻘﺪﻡ ﺍﻟﺨﺪﻣﺔ ﺍﻟﻄﺒﻴﺔ ﺃﺧﺬ ﻣﻮﺍﻓﻘﺔ ﻣﺴﺒﻘﺔ ﻟﺠﻤﻴﻊ ﺍﻟﺤﺎﻻﺕ ﻣﻦ‬ ‫ﺍﻟﻌﻼﺝ ﺩﺍﺧﻞ‬
‫‪In-Patient & Daycare Treatment‬‬ ‫ﺍﻟﻤﺴﺘﺸﻔﻰ ﻭﻋﻼﺝ‬
‫ﺍﻟﺸﺮﻛﺔ ﺍﻟﻤﺘﺤﺪﺓ ﻟﻠﺘﺄﻣﻴﻦ ﻣﺎﻋﺪﺍ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻄﺎﺭﺋﺔ ﻳﺠﺐ ﺇﺷﻌﺎﺭ ﺍﻟﺸﺮﻛﺔ ﺑﻬﺎ ﺧﻼﻝ‬
‫ﺍﻟﺤﺎﻻﺕ ﺍﻟﻴﻮﻣﻴﺔ‬
‫‪ 48‬ﺳﺎﻋﺔ‬
‫‪Hospital accommodation‬‬ ‫ﻏﺮﻓﺔ ﺧﺎﺻﺔ‬ ‫ﻧﻮﻋﻴﺔ ﺍﻹﻗﺎﻣﺔ‬
‫ﻣﺸﻤﻮﻝ‪ :‬ﻭﺍﻟﻤﻨﻔﻌﺔ ﺗﺸﻤﻞ‪ :‬ﺍﻻﺳﺘﺸﺎﺭﺍﺕ‪ ،‬ﺍﻹﺟﺮﺍءﺍﺕ ﺍﻟﺘﺸﺨﻴﺼﻴﺔ‪ ،‬ﺍﻷﺩﻭﻳﺔ‪ ،‬ﺍﻟﻤﻌﺎﻟﺠﺔ‬
‫‪Out-Patient treatment‬‬
‫‪..‬‬ ‫ﺍﻟﻌﻼﺝ ﻓﻲ ﺍﻟﻌﻴﺎﺩﺍﺕ‬
‫ﺗﻜﺎﻟﻴﻒ ﺍﻟﻌﻼﺝ ﺍﻟﻄﺒﻴﻌﻲ ﺍﻟﻤﻮﺻﻰ ﺑﻪ ﻣﻦ ﺍﻟﻄﺒﻴﺐ ﺍﻟﻤﻌﺎﻟﺞ‪ ،‬ﺗﻜﺎﻟﻴﻒ ﺇﺟﺮﺍءﺍﺕ‬ ‫ﺍﻟﺨﺎﺭﺟﻴﺔ‬
‫ﺍﻟﺘﺸﺨﻴﺺ ﻟﻠﺮﻧﻴﻦ ﺍﻟﻤﻐﻨﺎﻁﻴﺴﻲ‬
‫ﺍﻟﻌﻼﺟﺎﺕ ﻁﻮﻳﻠﺔ‬
‫‪Long Term Medications (more‬‬
‫)‪than one month‬‬
‫ﺍﻟﻤﻮﺍﻓﻘﺔ ﺍﻟﻤﺴﺒﻘﺔ ﻣﻄﻠﻮﺑﺔ‬ ‫ﺍﻷﻣﺪ ‪-‬ﺃﻛﺜﺮ ﻣﻦ ﺷﻬﺮ‬
‫ﻭﺍﺣﺪ‬
‫ﺟﻠﺴﺎﺕ ﺍﻟﻌﻼﺝ‬
‫‪Physiotherapy Sessions‬‬ ‫ﺍﻟﻤﻮﺍﻓﻘﺔ ﺍﻟﻤﺴﺒﻘﺔ ﻣﻄﻠﻮﺑﺔ‬
‫ﺍﻟﻄﺒﻴﻌﻲ‬

‫ﺍﻟﻤﻮﺍﻓﻘﺔ ﺍﻟﻤﺴﺒﻘﺔ ﻣﻄﻠﻮﺑﺔ‬

‫‪Ambulance‬‬
‫ﻣﺸﻤﻮﻝ‪:‬ﻓﻲ ﺣﺎﻟﺔ ﺍﻟﻀﺮﻭﺭﺓ ﺍﻟﻄﺒﻴﺔ ﻣﻦ ‪ /‬ﺇﻟﻰ ﺍﻟﻤﺴﺘﺸﻔﻰ ﺿﻤﻦ ﺍﻟﻌﻼﺝ ﺍﻟﺪﺍﺧﻠﻲ ﻭﺍﻟﺮﻋﺎﻳﺔ ﺍﻟﻴﻮﻣﻴﺔ‪.‬‬ ‫ﺳﻴﺎﺭﺓ ﺍﻹﺳﻌﺎﻑ‬

‫ﻏﻳﺭ ﻣﺷﻣﻭﻝ ﺑﺎﻟﺗﻐﻁﻳﺔ‬

‫‪Maternity‬‬ ‫ﺍﻟﺤﻤﻞ ﻭﺍﻟﻮﻻﺩﺓ‬

‫‪Dental‬‬ ‫ﻏﻳﺭ ﻣﺷﻣﻭﻝ ﺑﺎﻟﺗﻐﻁﻳﺔ‬ ‫ﺍﻷﺳﻨﺎﻥ‬

‫‪Optical‬‬ ‫ﻏﻳﺭ ﻣﺷﻣﻭﻝ ﺑﺎﻟﺗﻐﻁﻳﺔ‬ ‫ﺍﻟﻨﻈﺮ‬

‫‪Pre-existing & Chronic‬‬ ‫ﺍﻷﻣﺮﺍﺽ ﺍﻟﻤﺰﻣﻨﺔ‬

‫ﻏﻳﺭ ﻣﺷﻣﻭﻝ ﺑﺎﻟﺗﻐﻁﻳﺔ‬
‫‪Conditions‬‬ ‫ﻭﺍﻟﺴﺎﺑﻘﺔ ﻟﻠﺘﺄﻣﻴﻦ‬
‫‪Inpatient & Daycare‬‬ ‫‪10%‬‬ ‫ﺍﻟﻌﻼﺝ ﺍﻟﺪﺍﺧﻠﻲ ﻭﺍﻟﺮﻋﺎﻳﺔ ﺍﻟﻴﻮﻣﻴﺔ‬
‫‪Outpatient‬‬ ‫‪20%‬‬ ‫ﺍﻟﻌﻴﺎﺩﺍﺕ ﺍﻟﺨﺎﺭﺟﻴﺔ‬
‫‪Maternity‬‬ ‫ﻏﻳﺭ ﻣﺷﻣﻭﻝ‬ ‫ﺍﻟﺤﻤﻞ ﻭﺍﻟﻮﻻﺩﺓ‬
‫‪Dental Benefit‬‬ ‫ﻏﻳﺭ ﻣﺷﻣﻭﻝ‬ ‫ﺍﻷﺳﻨﺎﻥ‬ ‫ﺍﻟﻤﺸﺎﺭﻛﺔ ﺍﻟﺘﺄﻣﻴﻨﻴﺔ ‪/‬‬
‫‪Co-insurance/‬‬ ‫ﻏﻳﺭ ﻣﺷﻣﻭﻝ‬
‫‪deductible‬‬
‫‪Optical Benefit‬‬ ‫ﺍﻟﻨﻈﺮ‬ ‫ﺍﻟﻤﺒﻠﻎ ﺍﻟﺬﻱ ﻳﺘﺤﻤﻠﻪ‬
‫ﻏﻳﺭ ﻣﺷﻣﻭﻝ‬ ‫ﺍﻟﺤﺎﻻﺕ ﺍﻟﺴﺎﺑﻘﺔ ﻟﻠﺘﺄﻣﻴﻦ ﻭﺍﻷﻣﺮﺍﺽ‬ ‫ﺍﻟﻤﺮﻳﺾ‬
‫‪Pre Existing/Chronic Conditions‬‬
‫ﺍﻟﻤﺰﻣﻨﺔ‬
‫‪10% IP‬‬ ‫ﻣﻧﻔﻌﺔ ﺍﻟﺣﺎﻻﺕ ﺍﻟﻧﺎﺗﺟﺔ ﻋﻥ ﺣﻭﺍﺩﺙ‬
‫‪Medical expenses due to Accedint Related to Work‬‬ ‫‪20% OP‬‬ ‫ﺍﻟﻌﻣﻝ‬

‫‪Note : For Exclusions please refer to Provider Manual Guide‬‬