Terms BasicPlan

Policy Wording
Abu Dhabi Plan

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National Health
Insurance

Company
Daman

Policy Wording

Daman National Health Plan
Basic Plan

The Emirate of Abu Dhabi

Policy Holder : :

Policy Number : : "#
Policy Effective Date :

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<Client Name> National Health Insurance Company Daman

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<Representative Name> Dr. Michael Bitzer
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<Job Title> Chief Executive Officer
____________
_________________
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Stamp & Signature
Stamp & Signature
Copyright: Daman Doc. No. PW/UW.01 Version No.1 Revision No.3 Date issued: 15.03.2009 -1-
Policy Wording
Abu Dhabi Plan
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This policy ("Policy") is entered into contract by and between – ""

National Health Insurance Company - Daman (“Company”)
.(" # $% & '" " ("
")
and the “Policyholder,” as described in Exhibit 1.
Upon acceptance of the Policyholder's application and &

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payment of the required Premiums, this Policy is deemed
executed. The Company agrees with the Policyholder to & 01 2 / . - "% .$*%
provide Coverage for Health Services as set forth in this $ . 03&4 ' ' 5 - '
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Policy, subject to its terms, conditions, exclusions, and
limitations. The following documents are made part of this :
678 9 :378 ";
Policy:
1. The Policyholder’s application . . – (

2. The most current Member Booklet. * >1 . ?6 – =
3. The Schedule of Benefits (Exhibit 2)
4. Amendments and/or Riders (= ") -# $8 – @
0F* 6/ 0 DC
This Policy replaces and supersedes any previous 01 2 * & 0+% 6 2 $ $

agreements relating to the Coverage of Health Services
G& H& '$ . .
between the Policyholder and the Company. The terms and
conditions of this Policy shall in turn be superseded by those . 01 2 * 9 0+% 6
of any subsequent agreements relating to the Coverage of .
Health Services between the Policyholder and the Company.
This Policy shall become effective at 00:00 midnight U.A.E 0+ $ H II:II & # $*% & 6
time on the date specified in Exhibit 1, and will be continued in
force by the timely payment of the required Premiums when & / H& '( " # G 5 * 04
due, subject to termination of this Policy as provided herein.
3J 5 - ' # & &+, -# $*%
When the Policy is terminated, as provided for in Section 5,
this Policy and all Coverage under this Policy will end at 00:00 > & ' 3J .*
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midnight U.A.E time on the date following the date of # J H& J8 2 $
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termination.
.3J4 G 5 * 04 0+ II:II &
This Coverage may be modified by the attachment of Riders

, 53+ /8 .J 0F* 6 / 0 #M 2
$* 78
and/or Amendments. Please read the provisions described in
these documents to determine the way in which provisions in .
6 2 JF1 ";
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this Policy may have been changed.
This Policy will be governed by the laws of the Emirate of Abu .N6 5 -1
Dhabi.
This Policy is executed in English and Arabic language. Any 2 O6 /
J 8 O6 ' * 784 2

translation of this Policy into a language other than English $ # K6 9 '# ;F PQ, & * 784 Q R16
and Arabic shall exist only for convenience of the parties.
However, in case of a disparity between the English and the * 2 1& 6 J% KM# * 789 2 HF1 8
Arabic version, it is being understood that the Arabic version .5;& &
shall be the controlling document.
This Policy sets forth the rights and obligations of the K .%& >1, -8 . 07 "
Policyholder and of all Covered Persons. It is important that
.
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all insured parties familiarize themselves with its terms and
conditions.
Copyright: Daman Doc. No. PW/UW.01 Version No.1 Revision No.3 Date issued: 15.03.2009 - 2 -
Policy Wording
Abu Dhabi Plan
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Policy Introduction
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This Policy should be read in its entirety. Many of the
provisions of this Policy are interrelated; therefore, reading M# 'K T
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just one or two provisions may not provide an accurate
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understanding of Coverage.
Many words used in this Policy have special meanings. These

words will appear capitalized and are defined in Section 1.
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Reviewing these definitions will provide a clearer H& 0%*
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understanding of the Policy Coverage.
. 2 U6 J# / OS
Network and Non-Network Benefits

4
1 25
This Policy describes both Benefit levels available under the .
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Policy.
Network Benefits - These Benefits apply when a Covered

Person chooses to obtain Health Services from a Network 01 / $ %& >1 1 -#
" – 25
Provider. Network Benefits also include Health Services from
V1 7 01 -# . 7
a Non-Network Provider when such services are (1) Medically
Necessary Emergency Health Services or (2) approved by the 6 : ; 01 (() $ 01 W '
Company.
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Section 6 describes the procedures for obtaining Covered

Health Services as Network Benefits. Network Benefits -# 52 01 / $ * 0384 X &
generally provide Coverage at a higher level than Non-
Network Benefits. The Company is financially responsible for R& W
/6 2 R& # -# M# $ .
payment of Covered Network Benefits. -# $ -# : S& V1 -# # O

.52
Non-Network Benefits - These Benefits apply when a

Covered Person decides to obtain Health Services from non- / $ %& >1 -#
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1 25
Network Providers. Under this Policy no Non-Network
Benefits apply apart from those mentioned under the Network -# 6 " 9 '
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Benefits. . -# 0 5
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The information in Sections 1 through 5 and Sections 9

through 10 applies in general to all levels of Coverage. .2 0& -8 / $ (I / Z L / ( &+, "
Sections 6 and 7 explain the procedures Covered Persons J %& >1, / .8 0384 [ X & U
must follow to obtain Coverage for Network Benefits and Non-
Network Benefits respectively. Section 8 describes which \ & U .: V1 -# -# 2 / $
Health Services are Covered. Unless otherwise specified, the 03&4 (( & U 'W
HF1
.52 01
exclusions and limitations of Section 11 apply to both levels of
Benefits. . -# / "Y
Section 12 and Exhibit 2 describe all special conditions, e.g.

what Deductible or Co-insurance are required, if any, and to 6 $ $ $& / '1 -8 = " (= & U
what extent any limitations apply.
. 6 " O6 / '8 '0%
Policy Wording
Abu Dhabi Plan
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Health Services Covered Under the Policy

6 7 8+1
In order to insure that eligible expenses are paid as Network / .8 ' -# J*# + & H 6 $86
Benefits, Covered Persons must always verify the
7 6 /%& 6 . & - :; " %& >1,
participation status of a Physician, Hospital or other Provider
from our website as the participation status of a provider may & - 2 ? >1 , -+ $F1 W
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change with time. Covered Persons can verify the
$F1 & - " %& >1_ .1^ 0+
participation status by calling the Company. If necessary, the
Company can provide assistance in referring Covered >1, M 5& '8 0+
. $4
Persons to Physicians or other Providers who participate with .J* & 1] 7 6 36 / %&
them.
Health Services, which are obtained through and Covered by Q ` .8 52 J $ ' 01
a non-profit, charity health program are not Covered under
this Policy. .
.8 52 Q O1
Only Health Services provided in the Territorial Coverage

stated in Exhibit 2, Schedule of Benefits, are covered under '= " # J > 2 # 01 #
the Policy. .
.8 52 '-# $8
The Company is responsible for interpreting the Benefits

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Covered under the Policy and the other terms, conditions,
limitations and exclusions set out in the Policy and in making 0 # # 5 R1, 03&4 '
factual determinations related to the Policy and its Benefits. .J*# * ;J
Should the Covered Person disagree with the claims decision 78 KM# ' 0 + / %& >1 "#

made by the Company, the decision may be formally
appealed as per the Limitation of action clause mentioned in .
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this policy.
The Company reserves the right to change, interpret, modify,

withdraw or add Benefits or terminate the Policy upon Policy 3J 6 -# # 6 .& '$* '&% '2 # J N%
renewal. Such changes need to be in accordance with the 74 : 02 W $ 6 .8 .8
Mandatory Health Insurance Law for Expatriates and
respective Bylaws, as set forward by the Health Authority, Abu D ; $+ J* & '+F* 0
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Dhabi (HAAD) and/or other relevant authorities and approved R1, 0J8 N6 54 O
% a8 $+ J # 0 N6
by the Executive Council of the Emirate of Abu Dhabi and
other concerned authorities in UAE. No person or entities F O6 ; 6 >1 O, a .5 * 09 # *
other than aforementioned authorities have any authority to . / 0F* 6 02 O6 384
make any changes or Amendments to the Policy.
#
Daman Card
Covered Persons must show their Daman Cards every time 5 $ # J 1 0+ 7 %& >1, / *
they request health care services, also the provider will ask for
their personal identity for verification. If Covered Persons do J + W
1 7 . H& ' 01 J#
not show their Daman Cards, the Providers have no way of 'J 1 0+ %& >1, 7
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knowing that they are Covered under a Policy issued by the
Company, and payment may be required by the Covered 5 .8 %& J6 #* $& O6 1 O7 R KM#
Person for Network Benefits. . -# >1 -# %& >1 . H& '
Throughout this Policy Covered Persons will find statements $4 / J 0 %& >1, 8 H& '

that encourage them to contact the Company for further
information. Whenever there is a question or concern &%& 6 $S& O6 8 .0* 7 / $
regarding Health Services or any required procedure, the HJ + / $4 2 '. 38 O6 6 01
Company should be contacted at the telephone number
stated on the Covered Person’s Daman Card. .%& >1 1 + /
Policy Wording
Abu Dhabi Plan
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TABLE OF CONTENTS
SECTION 1: DEFINITIONS………………………………- 6 - …………………………………………………..8&

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SECTION 2: ENROLLMENT AND EFFECTIVE DATE OF …………………………7( $%&

'
( $6( :: "
COVERAGE……………………………………………..- 13 -
SECTION 3: TERMINATION OF COVERAGE………- 16 - …………………………………………….. 7( <= :; "
SECTION 4: PREMIUM RATES……………………….- 18 - …………….……………………………………. # :> "
SECTION 5: GENERAL PROVISIONS……………….- 19 - …………………………………………………@ " :? "
SECTION 6: PROCEDURES FOR OBTAINING

NETWORK BENEFITS…………….- 23 - …………………………... 25 B@ $ 8<
6 :A "
…………………………………….. 7 8+1 :C "

SECTION 7: COVERED HEALTH SERVICES………- 26 -
SECTION 8: REIMBURSEMENT………………………- 29 - ………………………………………………….. E%( :D "
SECTION 9: COORDINATION OF BENEFITS, …………………………….. E%( $G H I25 J( :F "

SUBROGATION AND
REIMBURSEMENT…………………- 30 -
………………………………………….. @ 8<( :9K "

SECTION 10: GENERAL EXCLUSIONS……………..- 31 -
…………………………………………..... 1
:99 "
SECTION 11: SPECIAL CONDITIONS……………….- 36 -
Policy Wording
Abu Dhabi Plan
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SECTION 1: :9 "
DEFINITIONS
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This Section defines the terms used throughout this Policy
and is not intended to describe Covered or Un-Covered 01 H K 9 '
$F1 1& H* &

services. .52 Q 6 52
"Accident” – a sudden, unexpected, violent external event,
causing a severe physical bodily Injury, which is usually '5 &8 .& H -+ Q 'b8% 81 ? – "L+ "
visually identifiable and is documented by a competent >1 $ 1 & $+ " '* >1 + 5
authority such as a law enforcement officer or Physician.
.. 6
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“Accident related constructive surgery” – the Coverage
under this policy would be restricted only for the cases 5
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resulting from Accidents incurred during the validity of the 6 . $*% & 36 ? 8 09 #
policy and may be extended to the insured whose continuity
of Coverage is proven and accepted by the Company .:& J # K2 & 0 O
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before hand.
“Accident related Dental Treatment” – the Coverage (() /
.8 2 – "L+ J%( 4G@"
under this policy would be restricted (1) to sound natural ? ; 09 W (=) & * &, /
teeth and (2) only for the cases resulting from Accidents
incurred during the validity of the policy treatment taken [= c $F1 , H%1 / VF*.
& 5 $F1 -
within 72 hours of accidental impact and is restricted to pain .? /, &
management only.
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“Active at Work” – an employee who is (1) employed on a
full-time basis by the Policyholder and is currently being # (=) O
6 '$ . 0+ # K -#
paid a full-time salary, or (2) is on formal paid or unpaid . . 8, # Q 6 # & 578
leave from the Policyholder.
"Amendment" - any attached description of additional or 0F* .
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alternative provisions to the Policy. Amendments are *1 0F* . $+ J*+ # $*% &
effective only when signed by the Company. Amendments
are subject to all conditions, limitations and exclusions of . $ * W 3&M ' 03& ' -8
the Policy except for those, which are specifically amended.
“Authorization Request Form for Hospitalization” – a >1 `* . K . -"B&( 5 "( 5 "
form that must be completed by the attending Physician of
.K $+ $+ K # %&
the Covered Person and approved by the Company prior to
hospitalization.
“Benefit” – the extent or degree of service Covered a&6 / J %& >1_ " 1 8 6 R – "%&"
Persons are entitled to receive based on their contract with . -
the Company.
“Benefit Plan” – the combination of all Benefits that J %& >1_ " -# -8 `7 – "25
"
Covered Persons are entitled to receive based on their . - a&6 /
contract with the Company.
“Chronic Disease” – A disease with one ore more of the ,&: 0% 6 6 H P O6- "- E
"
following characteristics: lasting 3 months or more, leave
residual disability, cause by non-revisable pathological . 62 + Q 0% W 6 :; :78 W 6 J6 F
alteration, required special training of the patient for . 5% H9
rehabilitation, or may require a long period of supervision.
“Claim Form” – a form which must be completed by the 6 $86 `* . $+ J;* .8 5& – " 4/ "
attending Physician in order for the Covered Person to
.81 0* *8 -# >1 2 / %& >1 $
obtain Coverage for treatment.
“Co-insurance” – the percentage of Eligible Expenses in . '&+, / #4 & H & – "$ ( "
addition to the Premium, which Covered Persons are .
.8 5 01 3 J*# %& >1,
required to pay for certain Health Services provided under
the Policy. Covered Persons are responsible for the / 5 $ & 0% O6 -# S& %& >1,
payment of any Co-insurance directly to the Provider of the .1 7 $+ K 5# 6 1 0+ 1 7
Health Service at the time of service or when billed by the
Provider.
Policy Wording
Abu Dhabi Plan
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“Company- National Health Insurance Company

(Daman)” - entity assumes the coverage of risks subject to 1 2 $ ; – "()
P"
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this contract. .*
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"Confinement" and "Confined" - an uninterrupted
overnight stay following formal admission to a Hospital. ./%& / & $1 * + D """ "#H"
“Congenital Anomaly” – An anatomical or physiological

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defect disease or malformation … etc which may be either
hereditary/familial/genetic or due to an influence occurring + '59 2 $ $F1 ? .& / R7* + 6 8 /; /
during gestation up to birth, and may or may not be obvious .59 :N 9 6
at birth.
“Country” – United Arab Emirates. .5 * 04 – "+"
"Coverage" or "Covered" - the entitlement by a Covered
01 5%&9 # %& >1 6 D "+&(" 6 "7("
Person to Health Services provided under the Policy,
subject to the terms, conditions, limitations and exclusions . 03& ' ' 5 - '
.8
of the Policy. Health Services must be provided (1) when G $+ (=) '$*% & (() 01 .8
the Policy is in effect; and (2) prior to the date that any of
the individual termination conditions of Section 3.1 occur; # (@) '(D@ & 0 O% 3J4 O6 JN
and (3) only when the recipient is a Covered Person and . # 5
, 0 # % %& >1 %&
meets all eligibility requirements specified in the Policy.
“Coverage Category” – Classifications of employees H1 # " J
'$* . ;# %N H – "7( R5"
within an employer group, who are eligible for different "# = " # 8 '08 '
2 0;# .-# 0&
levels of Benefits. These Coverage Categories, if any, are
listed in Exhibit 2 to the Corporate Policy. .5
"Covered Person" - either the Primary Insured or an '8& K; #6 6 6 &; K S >1 3& – "B7 1"
Enrolled Dependant, but applies only while Coverage of
.$*% & .8 >1 W
2 # "

such person under the Policy is in effect.
“Daman Card” – the identification card the Company issue .8 %& $ H* + D " #"
for every member covered under this Health Insurance .
Policy.
“Day Treatment” – medical treatment which must be V 9 K '/%& # K .8 O
VF* – "+ " 4G@"
provided in the Hospital, but which does not require a ./%& # ? /
Confinement.
"Deductible" - the defined monetary amount, in addition to %& >1, . & / # ' d – "$ ("
the Premium, which Covered Persons are required to pay S& %& >1, . .8 5 01 3
for certain Health Services provided under the Policy.
Covered Persons are responsible for the payment of any 5# 6 1 0+ # 1 7 / 5 $ O6 -#
Deductible directly to the Provider of the Health Service at .1 7 J
the time of service or when billed by the Provider.
"Dependant" (1) the Primary Insured’s legal spouse(s) or / (=) 6 &; K S >1 V7,/V7 (() – "%"
(2) unmarried Dependant children of the Primary Insured or
>1 V7 6 &; K S >1 87 Q * $%6 F
the Primary Insured’s spouse (including a natural child,
stepchild, a legally adopted child, or a child placed for 6 '+ / $% 'V7 '* $% W
# ) &; K S
adoption) below the age of 18 or (3) as may be stipulated in
# > (@).(\ & (+ $ P2 e $%
Mandatory Health Insurance Law for Expatriates and
respective Bylaws of Abu Dhabi. .N6 54 +
The principal place of residence of the legal spouse or V7 Q $* >1 6 V7 &; & 6 .8
unmarried Dependant child must be with the Primary
Insured unless the Company approves other arrangements .R16 0 / "# '&; K S >1 -
or as may be stipulated in Health Insurance Law of Abu
Dhabi.
The Primary Insured will be required to reimburse the 01 P* &; K S >1 . H&
Company for any Health Services provided to their
Dependants at a time when the Dependants did not satisfy .
J >1, W;6 9 * >1, /
these conditions.
"Designated Facility" - a Hospital, named by the Company $1 O
'* "# K6 / $+ /& /%& – "+(% J5
"
as a Designated Facility, which has entered into an
agreement with or on behalf of the Company to render 01 6 52 01 6 - +% #
Policy Wording
Abu Dhabi Plan
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Covered Medically Necessary and Medically Appropriate .* 09 6 P6 VF* : ;F
Health Services for treatment of specified diseases or
conditions.
"Donor" - a person alive or deceased from whose body one K P2 6 6 K&8 V1& O
0 6 >1 "S
("
or more organs have been extracted with the intention to
transplant them (totally or partially) in the body of another .3, e7 " () 1] >1 : 6 :;78
person (the Recipient) via an Organ Transplant.
(() : '&4 &8 81 1& 57J86 – "R+ -=6"
"Durable Medical Equipment" – medical equipment used
externally from the human body which: (1) can withstand 1 1& (@) TWFJ&f + Q (=) T 1&4 6
repeated use; (2) is not designed to be disposable; (3) is 6 P 8 $ # >1 : 5% Q (C) T PQ
used to serve a medical purpose; (4) is generally not useful
to a person in the absence of a Sickness or Injury; and (5) ./%& V1 1& (L) T
is used outside of the Hospital.
“Effective Date” – the date that Coverage becomes O
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G – "$%&
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effective, which may be either the Enrollment Date of a
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G 6 '%& >1 $8& G 6
Covered Person, or the date on which Coverage renews.
"Eligible Expenses" - Reasonable and Customary '52 01 * 0% – " ( T
"
Charges for Covered Health Services, incurred while the
. $*% & 36
Policy is in effect.
"Eligible Person" – (1) an employee of the Policyholder >1 (=) 6 a6 / . R HN (() – "$UV 1"
who is Active at Work or (2) other person who meets the
. # . # 5 , 0 % 1]
eligibility requirements specified in both the application and
the Policy. : "$S >1" H* 6 .8 'W
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Furthermore, the definition of “Eligible Person” must be in
74
accordance with the Mandatory Health Insurance Law for
Expatriates and respective Bylaws, as set forward by the * N6 D ; $+ e & '1 K; #
Health Authority, Abu Dhabi (HAAD) and/or other relevant
.N6 54 O
% a8 $+
authorities and approved by the Executive Council of the
Emirate of Abu Dhabi.
"Emergency" - The acute onset of a medical or surgical
, 5 5 P JN 86 ;8% – "W
"
condition manifested by acute symptoms of sufficient
severity, including pain, that the absence of immediate %N $F1 / OS 6
J VF* 6 ?
treatment at Health Facility could reasonable be expected to .&8 36 # 51 `;6
result in placing the patient’s health or bodily functions in
serious jeopardy or dysfunction pf any body organ or part.
"Emergency Health Services" - the health care services O6 VF* 7F 07J8 01 – "R
8+1"
and supplies necessary for the treatment of an Emergency. .g
“Emirate” – Emirate of Abu Dhabi. .N6 5 – "
"
"Enrolled Dependant" - a Dependant enrolled for .8 2 P2 U $ $8& $* >1 – "$6 $% 1"
Coverage under the Policy.
.
“Enrollment Date” – the original Effective Date of
.%& >1 & , 2 $*% & G – "$6( '
("
Coverage for a Covered Person.
"Experimental, Investigational or Unproven Services" - '8 ' 01 – "Q+(%
X R( I
6( 8+1"
medical, surgical, diagnostic, or other health care services,
6 6 '038 '08F '07J8 '8 'R16 01 6 1
technologies, supplies, treatments, procedures, drug
therapies or devices that, at the time the Company makes a D : 5 '* 2 '57J86
determination regarding Coverage in a particular case, is
determined to be: 0;J $+ # & *8 5 - D6
A. Subject to formal review and approval by local 6 T 1&9 P2
medical authorities for the proposed use; or
B. The subject of an ongoing clinical trial O8 O& 14 e D.
C. Not demonstrated through prevailing pre-reviewed
medical literature to be safe and effective for ] J6 / *; & *8 5N Q DV
treating or diagnosing the condition or illness for .K J1& h P 6 >1 6 VF* K#
which its use is proposed.
Policy Wording
Abu Dhabi Plan
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The Company, in its judgment, may deem an Experimental, 5* Q 6 ;&9 '8 01 ' .& ' "
Investigational or Unproven Service to be a Covered Health
Service for treating a life threatening Sickness or condition if 0+
'5 5J 6 P VF* 52 01 J6 /
it is determined by the Company that the Experimental, : 0+ 5* Q 6 ;&9 '8 1 6
Investigational or Unproven Service at the time of the
determination: T*+ # J ] D6
A. Is safe with promising efficacy; and
.:& K & ? ` D.
B. Is provided in a clinically controlled research
setting
( 0+ $ H ii:ii & #) P"<=(Y '
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“Expiry Date” – The day (at 00:00 midnight local time),
month and year from which the Policy expires. . K# J O
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“Full-time” – an employee who is on a permanent pay roll - K $* . ; -# ;+ / e HN – "$ "+"
of the Employer and having full time employee status. .$ HN
“General Exclusions” – the health Benefits and services # 8 2 5& 01 -# – "@ 8<("
excluded from Coverage that are listed in Section 10 of this .%& >1, -8 / "
ji &
Policy and apply to all Covered Persons.
"Health Services" - the health care services and supplies - ' .8 07J8 01 – " 8+1"
Covered under the Policy, except to the extent that such .5& 6 5 W 07J8 01
health care services and supplies are limited or excluded.
"Hospital" - an institution, operated pursuant to law, which: # &; $ $* (() : ' :# $* &&S – "B&("
(1) is primarily engaged in providing Health Services on an >1, VF /%& $1 VF* a&6 / 01
Inpatient basis for the care and treatment of injured or sick
individuals through medical, diagnostic and surgical 0 6 $+ 8 1 ' "# $F1 /
facilities by or under the supervision of a staff of Physicians; .& =C / 5 P 01 J (=) T3, "# H
(2) has 24 hour skilled nursing services. A Hospital is not
primarily a place for rest, custodial care or care of the aged 0 a & 6 8 6 ' &; $ a /%&
and is not a nursing home, convalescent home or similar .W
J &&S 6 6 'P
institution.
." P" -8 – "B&( $1+ 4G%"
“Hospitalization” – see Inpatient.
“Hospitalization Class” – the class of Hospital room and 01 5 /%& 01 #Q 8 – " B&( $1+ 4G% R5"
services, indicated on the Covered Health Services in .%& >1 & 'k & # 52
Section 7, to which the Covered Person is entitled.
+F* 0
09 W
# P # &8 – ""
“Injury” – bodily damage other than Sickness including all
related conditions and recurrent symptoms. .5 P,
“Inpatient” – Hospital Confinement requiring an overnight : 0 . /%& # + – "" E
"
.F
stay.
“Inpatient Benefit” – Hospitalization or Day Treatment or # VlF /+ 6 VF 6 /%& $1 VF – "" E
%&"
Observation / Treatment in an Emergency Room / Facility 0* *8 a&6 / S8 9 "# / g #Q
which cannot be carried out on out patient basis.
.81
“International” – outside of the Country.
. V1 – "+"
“International Hospitalization” – a Confinement in a
Hospital located outside of the Country. . V1 /%& # ? – " + B&( $1+ 4G% "
“Limit” – the maximum amount paid by the Company under
the terms of this Policy. .
.8 K*# d /+6 – "+ "
“Maternity Benefit-Inpatient” – includes charges for a * '* 59 H $ – "B&( $1+ +Y $ %&"
vaginal delivery, a Medically Necessary cesarean section,
any complications of pregnancy or delivery and legal O6 '59 6 $ 36 ? 0% 6 ':
abortion. .+ PJ8
“Maternity Benefit-Outpatient” – includes charges for all
outpatient pre-natal and post-natal Physician visits, 07 1 H $ – "6
1 8+% 5 +Y $ %&"
including investigations & treatment. .VF* 0% W
# '59 * $+ .
“Medically Appropriate” – based on the prevailing
standards of medical practice relative to a specific .5 * & 5;& * a&6 / – "Z "RG"
condition.
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
"Medically Necessary" - health care services and supplies J6 / 07J8 01 – "Z .

"
which are determined by the Company to be Medically ': ;F
Appropriate, and
1. Necessary to meet the basic health needs of the T%& >1 &&, 084 D(
Covered Person; and
2. Rendered in the most Medically Appropriate manner - ' 1 ;F 57J8, e : ;F , Dm
and type of setting appropriate for the delivery of the T1 58 % $ 4 *
1,
Health Service, taking into account both cost and
quality of care; and * 0% / VF* 5 'e ? # D n
3. Consistent in type, frequency and duration of treatment T R 0;J 6 ?, ' 0&&S
with scientifically based guidelines of medical,
research, or health care Coverage organizations or T >1 - # D C
governmental agencies that are accepted by the
Company; and TJ 6 K 6 %& >1 :#F1 .&, DL
4. Consistent with the diagnosis of the condition; and
5. Required for reasons other than the convenience of the :J6 / 58 :& *8 $F1 D X
Covered Person or his or her Physician; and
6. Demonstrated through prevailing pre-reviewed medical 6 'K J1& h P 6 >1 VF* *# ] (.X
literature to be either:
6.1 Safe and effective for treating or diagnosing the :*+ J# ] =.X
condition or Sickness for which their use is
proposed or, '5 5J 6 P VF* j.m.X
6.2 Safe with promising efficiency: . .+ ? ` m.m.X
6.2.1 for treating a life threatening Sickness or
condition,
6.2.2 in a clinically controlled research setting.
The fact that a Physician has performed or prescribed a
procedure or treatment or the fact that it may be the only VF* W
6 'VF 6 38 H 6 3 . +
treatment for a particular Injury, Sickness or Mental Illness 1 W 6 * 9 &% P 6 P '4
does not mean that it is a Medically Necessary Covered
Health Service as defined in this Policy. The definition of # 1& : O H* .
# & :
Medically Necessary used in this Policy relates only to & . J# W H1 2 # "*
Coverage and differs from the way in which a Physician
engaged in the practice of medicine may define Medically .: O H* .
Necessary.
"Mental Illness" – a mental or bodily condition marked '1 .M &; $ H &8 6 &% – "@ E
"
primarily by sufficient disorganization of personality, mind, O* $* 6 84 '&% 3, 51 8 H* '$*
and emotions to seriously impair the normal psychological,
social, or work performance of the individual. .>1
"Network" - when used to describe a Provider of Health +% 1 7 6 * ' 01 7 H J1& – " "
Services, means that the Provider has a participation
%& >1, / 01 ' - $*% &
agreement in effect with the Company, to provide Health
Services to Covered Persons. The Company may change .1^ 0+ 7 - 2 + .
the participation status of Providers from time to time.
“Network Benefits” – Benefits available for Covered $+ J 52 01 -# – " 25"
Health Services when provided by a Network Provider. 1 7 $+ 01 * . 1 7
Health Services provided by a non-Network Provider are
considered Network Benefits when such Health Services $+ & 5* 01 W -# V1
are approved in advance by the Company or are .; 01 6
Emergency Health Services.
“Non-Emergency Hospitalization” – any Confinement 8 * 9 /%& $1 O6 – "W

X 5 B&( $1+"
which is not as a direct result of Emergency Health .; 01 5
Services.
“Non-Network Benefits” – Coverage available for Health V1 7 01 2 – " 4
1 25"
Services obtained from non-Network Providers. Coverage . (m) " # 01
V1 -# 2# .
for Non-Network Benefits is only provided if the services are
assured in Exhibit (2).
$1 -# * V1 1 7 01
Health services provided by a non-Network Provider are
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
considered Network Benefits when such Health Services .; 01 6o & J # 0
are approved in advance by the Company or are
Emergency Health Benefits.
"Organ Transplant" - an operation of moving an organ
from the Donor to the Recipient. . / e $ "<@ $"
“Out-of-Hospital Benefits” – Benefits offered under this $ 01 2

-# – 6
1 8+% 25
cover are services as Physician consultation, incl. Accident
5 # , ? "* &, VF W
# 5&4
related Dental Treatment, Prescribed medicines,
Physiotherapy & Diagnostic testing including pre-operative S8 * $+ 0# W
# 1 >% $
investigations which are conducted on an Out-of-Hospital 9 6 K S >1 4 /%& V1 a&6 /
basis without jeopardizing the insured’s health or which do
not require Hospitalization/Day treatment or necessitate # 1 6 VF //%& $1 .
specialized medical attention and care in a Hospital before, .1 * 6 $F1 6 $+ /%&
during or after the delivery of the service.
"Physician" - any practitioner of medicine who is duly + .8 $S $, .& >1 a . O6 – " "
licensed and qualified under the laws of the country in which .VF* J#
treatment is received.
"Policy" - the Corporate policy, the application of the '&; K S # 0 6 ' $ . '5 – ""
Policyholder, any individual Primary Insured applications, 03&4 '-# * +%9 $ "F 0F*
Amendments and Riders which constitute the agreement
regarding the Benefits, exclusions and other conditions . . R1,
between the Company and the Policyholder.
J 0 + $ * 6 5 8 6 HN – " "
"Policyholder" - the employer or other defined or otherwise
legally constituted group to whom the Policy is issued. .
“Policy Charge” – any charges in addition to the Policy . $+ -# "& &+ / # & 6 – " "
"
Premium that are payable by the Policyholder.
.
“Policy Period” – the period of time (typically one year)
from the Effective Date of Coverage, to the termination of '2 $*% & G ( :8
) 7 5% – " +"
coverage prior to renewal. .8 $+ 2 3J /
“Pre-Existing Condition” – Any known/unknown injury,
illness, sickness, disease or other physical, medical, mental $F16 3 6 P 6 $F6 O6 – "
<+ "
or nervous condition, disorder or ailment that with ? H* Q 6 H* 6 6 6 &8 7 P 6
reasonable medical certainty existed at the time of
application, whether or not previously manifested or 6 P6
6 9 6 NF 6 3& . 5 S

symptomatic, diagnosed, treated or disclosed prior to the O6 $*% & G $+ K# 6 `* 6 >1
effective date, including any subsequent, chronic or
recurring complications or consequences related there to or .K& ? 6 K "* 5 6 7 6 9 `; 6 0%
arising there from.
"Premium" - the periodic fee required for each Primary $* >1 $ &; K S $ . O & – ""
Insured and each Enrolled Dependant in accordance with . : $8&
the terms of the Policy.
“Prescription Drugs” – pharmaceuticals which can only $+ % $F1 # J $ 6 – "& +"
be obtained through a prescription written by a licensed .>1 .
physician.
"Primary Insured" - an Eligible Person who is properly . .8 2 U $ $8& $S >1 – "R
N@ V"
enrolled for Coverage under the Policy. The Primary . / K K ($* Q) >1 &; K S
Insured is the person (who is not a Dependant) on whose
behalf the Policy is issued to the Policyholder. .
“Prosthetic Device” – an artificial device, either external or 6 $ $ '&8 $1 0 6 81 3& ' 7J8 – "@ -=6"
implanted, that substitutes for or supplements a missing or
defective part of the body, e.g. artificial limbs and .. 0N H, $ '&8 .* 6 % 378 $
pacemakers.
“Provider” – a Physician, Hospital, group practice, 6 # '"# O6 6 '0 -8 '/%& '. – "+1 +-"
pharmacy or any facility, individual or group of individuals
. 01 #, 8
that provides a health care service.
"Recipient" - a Covered Person who received or is
0 3N, $ /& 6 / O
/2 >1 – "("
receiving an Organ Transplant Covered under this Policy.
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
"Reconstructive Surgery" - surgery, which is incidental to P2 1 . 6 P ' - 8 – "
(
6"
an Injury, Sickness or Congenital Anomaly when the
primary purpose is to improve physiological functioning of .&8 * 378 ;, %N & J &;
the involved part of the body.
5% &+ $ & 5# * 58 .8 58 2 – "++6("
“Renewal” – new coverage under a new Policy following a
previous term and the acceptance of a Premium for a new .58
Policy Period.
K / K8 5 H&# 'K S >1 0
– " +@H"
"Repatriation" – in case an Insured member has passed
away the Mortal Remains will be repatriated to country of .,
origin.
01 . .8 52 01 "# H O6 – "J "
"Rider" - any attached description of Health Services
Covered under the Policy. Health Services provided by a "F .# &+6 -# *1 + " .8 57
Rider may be subject to payment of additional Premiums. ' # *1 $+ J*+ # $*% &
Riders are effective only when signed by the Company and
. $ * W ' 03&
are subject to all conditions, limitations and exclusions of
the Policy except for those that are specifically amended. $ 9
# 1& "P" U .&8 P – "E
"
"Sickness" - physical illness or disease. The term ji & #
3&M ' 1& 53& 6 &% P /
"Sickness" as used in this Policy does not include Mental
Illness or substance abuse, except those mentioned in
Section 10. %& >1 1 52 Q -# 6 01 – "++ 8<("
“Specific Exclusions” – Non-Covered services or Benefits
.K S
which are specific to the Covered Person being insured.
“Territory of Occurrence” – the country where the claimed .J . H J# – "+ S# "
expenses are incurred.
3, $ 0 384 1 5 K /%& P"$ -
"
"Transplant Center" - a Hospital with a specialized unit
that performs Organ Transplants.
%& >1 R & 58 O6 – "%
X +6 "
“Undeclared Pre-Existing Condition” – any Pre-Existing $ # . 6 &4 # J * ' . 6
Condition known to the Covered Person or Policyholder,
which is not declared on the medical questionnaire or Policy . "
application in case a medical underwriting has been
applied.
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
SECTION 2: :: "
ENROLLMENT AND EFFECTIVE DATE OF
7( $%&
'
( $6(
COVERAGE
2.1 Enrollment. Eligible Persons will be enrolled after . $& 6 * S >1, $8& – $6( ١-٢
their Policyholder sends notification of their
eligibility for Coverage to the Company. . 2 J * J >1
In addition, new Primary Insured and new * 8 &; J S $8& 'W
/ #4
Dependants may be enrolled as described below
in Section 2.4, 2.5, and 2.6. Except as set forth in 3&M .XD= 'LD= 'CD= & # 6 & 8
this section, Primary Insured and/or Dependants K S $8& H& '&
# K > &
shall be enrolled after a written authorization of the
Company. Dependants of a Primary Insured may $8& 9 + . 1 P% * * 6 / &;
not enroll unless the Primary Insured is also K S $8& &; K S $+ *
enrolled for Coverage under the Policy.
. .8 2 &;
Addition: The Policyholder has the right to require
from the insurer, by completing and signing a O6 # pS . # " $ – 5H
subsequent application form, accompanied with "; "# -+ . * *6/- S >16
supporting documents, the addition of new Eligible
Persons and/or Dependants. The Premium relating / & & K& & H& # "* & ,
to these additions shall be calculated on a pro-rata .() 5% 5+
basis.
Deletion: The Policyholder has the right to require . $ * pS . # " $ P T/
from the insurer, by completing and signing a
subsequent request form, supported with the H
1 0+ "; "# -+
respective Daman Cards, the deletion of Covered .8.J* - 1 3J 6 5# .& 2 >16 O6
Persons such as deceased or terminated
employees etc. and their dependants. Daman .H
0 - 0+ 5
cards have to be returned to the Company with the
deletion requests.
2.2 Eligibility Conditions. The eligibility conditions W H " # 5 , .U
٢-٢
stated in Exhibit 2 are in addition to those specified
in Section 2 of the Policy. . m & # 5
The eligibility requirements stated in the Mandatory + # J > , 0
Health Insurance Law for Expatriates and
respective Bylaws, as set forward by the Health J* & '1 K; # 74
Authority of Abu Dhabi (HAAD) and approved by a8 $+ N6 D ; $+
the Executive Council of the Emirate of Abu Dhabi
are in addition to those specified in Section 2 of # 5 W / #4 N6 54 O
%
the Policy = &
2.3 Omission of Eligibility. In case of a
# J > , 0 H+ $ # PU <7 ٣-٢
discontinuation of the eligibility requirements
stated in the Mandatory Health Insurance Law for J* 1 K; # 74 +
Expatriates and respective Bylaws, as set forward O
% a8 $+ N6 – ; $+
by the Health Authority of Abu Dhabi (HAAD)
and/or other relevant authorities and approved by . / .8 .:; J , M# 'N6 54
the Executive Council of the Emirate of Abu Dhabi .J6 0%+
%& >1, :1 *
the Eligibility expires automatically. The
Policyholder is obligated to announce the Covered
Persons for which the discontinuation is given in
written to the Company.
2.4 Effective Date of Coverage. Coverage for
& %& >1, 2 .7( $%&
'
( ٤-٢
Covered Persons is effective as specified in the
Policy after Premium has been paid. In no event O .& -# 6 * #
& $*%
Health Services rendered or delivered before the .2
% G $+ 01 2 $, $
Effective Date of Coverage is covered. Any request
by the Policyholder for the enrollment of an Eligible : $S >1 $8& . . O6 6 .8
Person must be in accordance with the Mandatory & '1 K; # 74
Health Insurance Law for Expatriates and
respective Bylaws, as set forward by the Health a8 $+ N6 D ; $+ K*
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
Authority (HAAD) and/or other relevant authorities .N6 54 O

%
of the Emirate of Abu Dhabi and approved by the
Executive Council of the Emirate of Abu Dhabi.
2.5 Coverage for a Newly Eligible Primary Insured. O& H& .+ $UV R
N@ V 1 7( ٥-٢
Coverage for newly eligible Primary Insured shall & $S &; K S 1 2 $*%
take effect as with the payment of the respective
premium and as with the date of issuance of the . + G # K 1 &+,
Daman Card.
$*% O& .(+Y + $& <([) ++6 % 7( ٦-٢
2.6 Coverage for New Dependants (Except
Newborn Children). Coverage for a new - ' K $ O
8 $* 2
Dependent acquired by legal adoption, placement 9
: * V7 6 'O 6 6 ' P2
for adoption, court or administrative order, or
marriage shall take effect if he is to be considered 0
1 # 74 :#
as Dependent in accordance with the Mandatory . + G #
Health Insurance Law for Expats and respective
Bylaws, and as with the date of issuance of the
Daman Card.
2.7 Effective Date of Coverage for Newborn
Children. Newborn children will become $%, U .+Y + $&\ 7( /& '
( ٧-٢
eligible for Coverage on the date of their & 2 U H& .J9 G # 2 S 59
birth. Coverage will become effective on
the date of eligibility under the following : .8 , G $*%
conditions. If the Insurance Company is K S 6 G @I Q # *

notified within 30 days of the newborn
$ # ' * &4 . &+ O6 0 &;
child’s birth within UAE and receives any
required Premium and completed health $+
. $+ 2 8 $+ ':
questionnaire if required and the newborn 1 * $& H& ' $+ 2 8
child is accepted for Coverage by the
Company. If the newborn child is accepted . . /
for Coverage by the Company, written
notification of acceptance will be sent to the
Policyholder.
Coverage for the new born children born out 5 * 09 V1
59 2
of UAE, will become effective on the date of
arrival to UAE If the Insurance Company is 5 * 09 K G # $*% & U&
notified within 30 days of the newborn K G : ni $F1 W
:* 0&

child’s arrival within UAE and receives any
required Premium and completed health . & - . & 0& 5 * 09
questionnaire if required and the newborn # $+ 59 2 $ . $
child is accepted for Coverage by the
: :* $&& M# 59 ? 2 $+ $
Company. If the newborn child is accepted
for Coverage by the Company, written . $ / $
notification of acceptance will be sent to the
Policyholder.
2.8 Effective Date of Coverage for Confinement. If /%& %& >1, +6
.#] 7(
'
( ٨-٢
Covered Persons are already Confined on their +4 W 2 J 2 $*% & G # :*#
Effective Date of Coverage and do not have
Coverage for that Confinement under a prior 52 /%& # +4 01 M# '&
Company, Health Services related to the # +4 *M %& >1, + (6) 6
Confinement are Covered as long as: (a) Covered
Persons notify the Company of Confinement within & '$*% & G & C\ Q # /%&
48 hours of the Effective Date, or as soon as is (.) T:9* 0+ e& 6 '* . #
reasonably possible; and (b) Health Services are
0 (V) 03& ' ' : 01
received in accordance with the terms, conditions,
exclusions and limitations of the Policy (c) they .* 6 2 $*% & G #
occur on the Effective Date of Coverage or later.
If Covered Persons are confined on their Effective J*%
% G # /%& # %& >1, +6

Date of Coverage and the Confinement is covered W
01 M# '& 2 :*1 $1
under a prior Company, Health Services for that
01 -8 . .8 2 9 $1
Confinement are not covered under the Policy. All
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
other Health Services are covered as of the .$*% & G : 52 R1,
Effective Date.
If Covered Persons are confined on the Effective & G # /%& 1 %& >1, R

Date have prior Coverage, Health Services for the +4 6 1 01 M# '& 2 $*%
condition or disability will not be covered under the
Policy until Covered Person’s prior Coverage is .%& >1_ & 2 J / .8 /2
exhausted.
2.9 Benefit Category. Changes of the Benefit $ K h 6 .8 -# H O6 # 2 "25 T(" ٩-٢
Category have to be declared in writing by $ & - "# " . -+ $ -
completing and signing a subsequent application
form, accompanied with a completed medical . $*6 $S >1
questionnaire for each Eligible Person and
Dependant to the Company. O6 6 /, & 3 G # K8& & $S >1 $
Each Eligible Person will be enrolled at the initial 8&9 >1 -# H J*/K* - "9 $8& G
Effective Date or any subsequent Enrolment Date
with his/her Dependants and a specific Benefit . -# ` -
Category under accordance with the Benefit Plan
and the current health status. . 5 $F1(+ 0 ) -# H2 9
A Benefit Category cannot be changed (even if & G # /%& 1 %& >1, R

promoted) during the Policy Period.
6 1 01 M# & 2 $*%
If Covered Persons are confined on the Effective
Date have prior Coverage, Health Services for the >1, & 2 J / .8 /2 +9
condition or disability will not be covered under the . %&
Policy until Covered Person’s prior Coverage is
exhausted.
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
SECTION 3:
:; "
TERMINATION OF COVERAGE
7( <=
3.1 Conditions for Termination of this Entire Policy.
This Policy and all Coverage under this Policy shall 2 $
J H& .=(
Q/U <=
١-٣
automatically terminate on the earliest of the dates .96 J6 ' 6 5
G # :; J8
specified below:
A. On the date specified by the Policyholder, after at 1 * K8 . ' . $+ G # –
least 31 days prior written notice to the Company,
that this Policy shall be terminated. .
3J & K ' / $+, / @( $+
B. On the date specified by the Company, in written . / K8 1 * # ' $+ G # D
notice to the Policyholder that this Policy shall be
terminated, due to the Policyholder’s violation of + . "1 :N '
3J & K
participation and contribution rules. . &
C. On the date specified by the Company in written
. / K8 1 * # $+ G # D4
notice to the Policyholder that this Policy shall be
terminated because the Policyholder provided the / + . ,
3J & K
Company with false information material to the 2 6

% # &8 6 J ;1 0*
execution of this Policy or to the provision of
Coverage under this Policy. The Company has the :
2 6 " .
.8
right to rescind this Policy back to the Effective .J*% & G
Date.
D. On the date specified by the Company, in written . / K8 1 *M $+ G # D
notice to the Policyholder if the Company decides */ 56
H 0+

to discontinue this policy or one of the /several
Coverage Categories, Policy Benefits, Riders and .0F* 6 0 6 -# 6 2 0;#
Amendments.
. / K8 1 * # $+ G # c
E. On the date specified by the Company in written
notice to the Policyholder that Coverage will 6 6
1 + .& 2
3J & K
terminate due to a resolution has been passed or . $
an order made for winding up the Company.
F. On the date specified by the Company in written . / K8 1 * # $+ G # D
notice to the Policyholder that Coverage will + # 02 ? .& 2
3J & K
terminate due to changes occur regarding the
National Health Insurance Law or other legal $ /S * U; 6
general regulations which affect the Policy .
0&&6 7 ? &&6
fundamentally so that subsequently no further
basics for the policy is given.
3.2 Payment and Reimbursement upon H& '
J 3J O6 .<=H +@ E%( 25+ ٢-٣
Termination. Upon any termination of this Policy,
the Policyholder shall be and shall remain liable to # O6 -# 8 $S& . /
the Company for the payment of any and all .3J4 0+ # Q '&+,
Premiums, which are unpaid at the time of
termination.
& H P* . O6 / 2 3J S
Termination of Coverage shall not affect any
request for reimbursement of Eligible Expenses for . .8 .3J4 G $+ 01 1
Health Services rendered prior to the date of & .8 . / P* P2 %& >1
termination. A Covered Person’s request for
reimbursement must be furnished as required in M# '2 3J G # /%& %& >1 $1
.r
Section 9. If the Covered Person is Hospitalized on & /%& # K+ 5% 1 /%& 0%
the termination date of the Coverage, Hospital
@( /+6 ' -# ' $+ J*#
charges for that continuous period of
hospitalization will be paid by the Company, . 3J G
according to the Benefits and limitations of the
Policy, for up to 31 days following Policy
termination.
3.3 Conditions for Termination of a Covered J H& . 6 +&( 1 7( <=
٣-٣
Person's Coverage under the Policy. Covered
Person’s Coverage shall automatically terminate J6 ' 6 G # :; %& >1 2
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
on the earliest of the dates specified below: :96

A. The date the entire Policy is terminated, as . #
& ' 3J K# O
G P
specified in the Policy. The Policyholder is
responsible for notifying Covered Persons of the . 3JM %& >1, sF 9S& .
termination of the Policy.
>1, K# * 9 O
G (@() F * D.
B. Thirty-one (31) days following the date Covered
Persons cease to be eligible as a Primary Insured F& $8& $* 6 &; K S S %&
or Enrolled Dependant provided we receive . + - *
notification with Daman card.
The Company has the right to terminate the Policy " . 6 .&, O, 3J " W
for any of the following reasons. When any of the :1 :* 6 . / .8 ' 6 .&, O6
following apply, the Policyholder must provide
written notice of termination to the Primary Insured: D :&; K S >1 / 3J4
A. The date specified by the Company that all .& J H& 2 $ $+ G P
Coverage will terminate due to fraud or
misrepresentation or because the Primary Insured $ + &; K S , 6 ;1 0* 6 t2
knowingly provided the Company with false – 9 $ $& / ';1 0* /
material information, including, but not limited to,
6 $* - 6 2 1] >1 * 0*
information relating to another person's eligibility
for Coverage or status as a Dependant, Pre- 32 " W .51 0 6 ':& 58
Existing Conditions, or hazardous activities. The
.$*% & G 2
Company has the right to rescind Coverage back
to the Effective Date.
S , J H& 2 $ $+ G D.
B. The date specified by the Company that all
Coverage will terminate because the Primary O6 6 'J K 1 + 1&M U& &; K
Insured permitted the use of his or her Daman
Q >1 $+ 'R16 / $ P% +
Card, or any other health care authorization
document, by any unauthorized person or used .1] >1 1 + $*& 6 P%
another person's Daman Card.
"1 .& J H& 2 $+ G DV
C. The date specified by the Company that Coverage
would terminate due to material violation of the . O
terms of the Policy.
D. The date specified by the Company that Coverage . / K8 1 *M $+ G # D
will terminate due to the Company decides to */ 5 6
H 0+

discontinue this policy or one of the /several
.0F* 6 0 6 -# 6 2 0;#
Coverage Categories, Policy Benefits, Riders and
Amendments. . / K8 1 * # $+ G # c
E. The date specified by the Company that Coverage
6 6
1 + .& 2
3J & K
will terminate due to a resolution has been passed
or an order made for winding up of the Company. . $
F. The date specified by the Company that Coverage . / K8 1 * # $+ G # D
will terminate due to changes occur regarding the + # 02 ? .& 2
3J & K
National Health Insurance Law or other legal
/;S * U; 6
general regulations which affect the Policy
fundamentally so that subsequently no further .
0&&6 7 ? &&6 $
basics for the policy is given.
3.4 Return of Daman Cards and Claim Forms upon 2 3J .<=H +@ 4/ 8# +@ ٤-٣
Termination. Upon Termination of Coverage for " S& . $ '%& >1 O 1
any Covered Person, it is the Policyholder’s 0+ $ 6 K2 J &; K S 6
responsibility to insure that terminating Primary
Insured return all Daman Cards to the Company. . /
3.5 Payment for Health Services Incurred after the H& .<=H '
( +% =@ V 8+1 $ 25+ ٥-٣
Date of Termination. The Policyholder will be 0% P* 9S& .
responsible for reimbursement to the Company for
payment of any Health Services obtained by a >1 $+ J $ 01 6 $ J*#
Covered Person using their Daman Card after .2 3J * K 1 + 1& %&
Coverage termination.
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
SECTION 4: >: "

PREMIUM RATES #
4.1 Premiums. Premiums payable by or on behalf of
>1, 6 $+ -# & &+, .^( # ١-٤
Covered Persons are specified in Exhibit 4 to the
Policy entitled "Premiums". All Premiums must be &+6" 0 "# C " # 5 %&
paid using the currency referenced in the Policy
# J * $*& &+6 # -# .8 ."
schedule.
The Company reserves the right to change the . $8
schedule of rates for Premiums as described in % & &+6 d $8 2 " N%
Exhibit 4.
C " #
4.2 Computation of Premium. The Policyholder shall
pay the same fixed premium for every insured & a% $8& . -# .# ٢-٤
member as set forth in the Mandatory Health
Insurance Law for Expatriates and respective 74 + # & uS $
Bylaws at the date of Enrolment Any imposition of # 57 6 P# O6 . 0
1 #
or increase in Premium tax or other governmental
charges relating to or calculated in regard to "* # & 6 +F* 0
R1, & 6 &
Premium shall be automatically added to the .& / ; $ J# & &
Premium.
4.3 Notification of Coverage Changes. The sFM . H& .7( 8G+%(
% ٣-٤
Policyholder shall notify the Company in writing
'3J4 '$8& $*% & G @( Q # :1
within 31 days of the Effective Date of enrollments,
terminations, or other changes. .R1, 0F* 6
4.4 Payment of the Premium. The Premium is . $+ : -# "& & . 25+ ٤-٤
payable in advance by the Policyholder to the
Company as described in Exhibit 1. All Premium 0*# -8 "#& .( " # $% & /
payments shall be accompanied by supporting %& >1, 3&6 ' 0& &+,
documentation, which states the names of the
Covered Persons for whom payment is made. .J -#

The Policyholder shall reimburse the Company for 6 5 .*6 P* . H&
attorney's fees and any other costs related to
.51 &+6 $ "* R16 H
collecting delinquent Premiums.
4.5 Currency. All Premium paid by the Policyholder * & . $+ # &+, -8 .% ٥-٤
will be in the currency of U.A.E Dirham as
$8 #
& () 5 * 04
specified in the Schedule of Benefits.
.-#
Policy Wording
Abu Dhabi Plan
‫ ا‬
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SECTION 5: :` "
GENERAL PROVISIONS
@ "
5.1 Entire Policy. The Policy issued to the . . W

# ' . 5v* . $6 9P `
Policyholder, including the Policyholder's &; K S 1 0& 0 6 '
application, any individual Primary Insured
applications and Health Questionnaires, $ * >1 . ?6 0 0F* 'O%
Amendments and Riders and the most current . $8
Member Booklet constitute the entire Policy.
5.2 Administrative Services. The services necessary

54 01 H& .
+H 8+1 :P `
to administer this Policy and the Coverage
provided under it will be provided in accordance 4 0384 ?, : J8 57 2
with the Company's or its designee's most current . .
.J+ * 6 1 &
standard administrative procedures. If the
Policyholder requests that such administrative 0384
J H1 / 4 01 W $
services be provided in a manner other than in
; ' $+ 01 W / # 0 '&
accordance with these standard procedures, and
such services are agreed to by the Company, the *&6 .& 6 01 W $ . -# H&
Policyholder shall pay for such services or reports 6 01 W K # J $* J+ * 6
at the Company's or its designee's then-current
charges for such services or reports. .
5.3 Limitation of Action. If a dispute between Daman
and the Parties (includes Policyholder and / or +% "* # 6 e7 3 $ # .T
( ++ ;P `
Covered persons on behalf of Policyholder) * H -8 ':8 J* *
H,
∗
dealing in business with it arises out of or is related
to any Agreement, the concerned Party and .e7 $ $ $86 & - 0% O8
Daman shall meet and negotiate in good faith to
attempt to resolve the dispute. : ni * ':1 1^ H # 6 *6 $ #
If, after 30 days following that date, one Party :+ K e7 $ '$ e7 6 'G W

notifies the other Party in writing, stating the
dispute is not resolved, it shall be submitted for $ "* R16 6 6 6 & 6 6 .8 :7
binding resolution pursuant to the relevant 0 / & 0* # 0 07
arbitration, mediation or other dispute resolution
provisions set out in the applicable legislation .N6 5 / e7 $ W
HF1 N6 5 #
pursuant to which Health Insurance requirements
are subject in the Emirate of Abu Dhabi, failing ?F $F1 " + R 6 038 + $ #
which, by the courts in Abu Dhabi.
';J + 1^ H sFM + G 0&
If legal proceedings or actions against Daman are
not brought within three years of the date Daman . R + " &
notifies other party of its final decision, the right to
bring any action against Daman is forfeited.
5.4 Cancellation due to non payment and / or -8 & ++ 5
1^( ++ "+% <7H >P `
delayed payment of Premium: All premium/s
stated in the Policy Schedule are payable in # e $+ 6 : $8 # 5
&+,
advance or / prior to any cover under Daman's . .8 2 6 #
Policy being provided.
The Policy is an annual contract and Policyholder $ & 9
: S& $ :& : *
is responsible for the whole year’s premium even if & d & () $+ $ # / O& &
the Company have agreed that Policyholder may
.0*# /
p.ay by installments
In the event of any delay or non-payment of @I $F1 K*# O6 6 & & 6 # 1 $ #
premium or any installment/s within 30 days from & 32/"* " '"&9 G :
the due date, the Company shall be entitled to
suspend/ cancel this Policy unilaterally/ 2 5 '>1 "# ' 78 .:;/ .8
automatically thereof. The Company may at its .:9 & & $ #
own discretion reinstate the cover if the premium is
subsequently paid.
& 7 $ %* 9 "*/32
A termination/ suspension of the Policy shall not
release the Policyholder from paying any sums/ . & 0*#/d ,
Policy Wording
Abu Dhabi Plan
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installment in full, owing to the Company. 6 . / .8 "*/324 W
$ $ #
In case of such termination/suspension the . J : &+6/d O6 -#
Policyholder will have to pay the due installment in
full without any effect of utilization therein. 9 ' 5 _ :# $+ "*/32 $ #
In the event of suspension/ termination by the S& $ 6 $ "
Company in conformity with the provisions laid
down herein the Policyholder shall not have any .P* 6
claim/ not incur any liability to the Company of
indemnification or and compensation.
5.5 Amendments and Alterations. Any change in
Coverage Category, Policy Benefits, Riders and ' -# '2 ;# / 02 6 .8
7( 8G+%( `P`
Amendments to the Policy made by the Company : $+ / 0F* "F
in accordance with the Mandatory Health
Insurance Law for Expatriates and respective & 1 K; # 74
Bylaws are effective only upon the renewal date 38 . $+ 8 G # $*%
specified by the Company. No change will be
made to the Policy unless it is made by an -+ '" 6 $* .8 ' / 2 O6
Amendment or a Rider, which is signed by an 6 2 F $ O6 W 9 . $ $S& $+
officer of the Company. No agent has authority to
.J 6 O6 $7
change the Policy or to waive any of its provisions.
The Health Authority, Abu Dhabi (HAAD) and/or a8 # / $ * N6 D ;J "
other relevant authorities may after the approval of
the Executive Council implement changes to the 74 + / 02 38 O
%
Mandatory Health Insurance Law for Expatriates & 02 W $ U H& .1 K; #
and respective Bylaws. Such changes will become
.* $*% & G $*%
effective as with the effective date of the respective
laws.
5.6 Relationship among Parties. The relationships 0+F* O7 0+F* .T
#G% AP `
between the Company and Network Providers and
relationships between the Company and +* # +* 0+F ' .6
Policyholder are solely contractual relationships %N 6 3F .6 O7 * 9 .&
between independent contractors. Network
Providers and Policyholder are neither agents nor HN 6 $ J# HN O6 6 * 9 ' R
employees of the Company, nor is the Company or . .6 6 O7 R
any employee of the Company an agent or
employee of Network Providers or Policyholder. .P 7 +F %& >1 7 +F*
The relationship between a Provider and any >1 O6 / J 01 # $S& 7
Covered Person is that of Provider and patient.
The Provider is solely responsible for services .%&
provided to any Covered Person. . +F %& >1, . +F*
The relationship between the Policyholder and # & R16 2 ;% 6 $* 6 HN $
Covered Persons is that of employer and
employee, Dependant or other Coverage Category # 02 $S& . * .
as defined in the Policy. The Policyholder is solely %& >1 2 3J W
# ) 2 ;# $8&
responsible for enrollment and Coverage Category
sF ' # &+, -# '( $F1
changes (including termination of a Covered
Person's Coverage through the Company), for the . 3J %& >1,
timely payment of the Premium to the Company,
and for notifying Covered Persons of the terms and
conditions and termination of the Policy.
5.7 Records. Policyholder and Covered Persons must 7 %& >1, . / .8 .8G6 aP `
furnish to the Company in a timely fashion all J + 04 0* -8 0+ #
information and proofs which it may reasonably
require regarding any matters pertaining to the . / * . J $* $
Policy. The Policyholder should notify the >1 O, $* - 6 # 2 O6 $ sF
Company of any change in address or employment
status of any Covered Person within 31 days of the .2 38 G @( Q # %&
change.
%& >1, P% ' .8 2 $
By accepting Coverage under the Policy, Covered
Persons authorize and direct any person or >1, / 01 0+ &&S 6 >1 O6 K8
Policy Wording
Abu Dhabi Plan
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institution that has provided services to Covered G& 6 0F8& 0* # O 7 '%&
Persons, to furnish the Company any and all
information and records or copies of records .%& >1, / 01 * 0F8&
relating to the services provided to Covered $ 0*
. " N%
Persons. The Company has the right to request
this information whenever reasonably required. W
# '%& >1, -8 / "
.$*
This applies to all Covered Persons, including . / -+ 6 + 3& '$8& $* >1
Enrolled Dependants whether or not they have
.&; K S
signed the Primary Insured's application.
The Company agrees that such information and
records will be considered confidential. The W .& 0F8& 0* W / "#
Company has the right to release any and all 01 1 0F8& # O6 H "
records concerning health care services, which are
necessary to implement and administer the terms *8 6 5
% '
of the Policy or for appropriate medical review or .58 6 ;F
quality assessment.
The Company or its Network Providers are
permitted to charge Covered Persons reasonable * & .& J 1 O7 6 U&
fees to cover costs for completing requested 6 081& ;* H 2 %& >1, /
medical abstracts or forms which Covered Persons
have requested. Such reasonable fees shall be in 6 .8 .%& >1, $+ V

accordance with the Mandatory Health Insurance 74 * & W $
Law for Expatiates and respective Bylaws, as set
D ; $+ J* & '1 K; #
forward by the Health Authority of Abu Dhabi
(HAAD) and/or other relevant authorities and N6 54 O
% a8 $+ N6
approved by the Executive Council of the Emirate
of Abu Dhabi.
In some cases, the Company will designate other R16 0; 6 >16 * H& '09 P* #
persons or entities to request records or %& >1, * 6 0* 6 0F8& .
information from or related to Covered Persons
and to release those records as necessary. The $+ * W .5 .& 0F8& W H
Company's designees have the same rights to this .0*
J " a%
information as does the Company.
During and after the term of the Policy, the $*& +F* 0
0;J " ' 5 * $F1
Company and its related entities may use and ? PQ, $F1 J*8 0* $
transfer the information gathered under the Policy
for research and analytic purposes. .$
5.8 Examination of Covered Persons. In the event of 3 6 0&%& 8 $ # .+&( 1 5 bP `
a question or dispute concerning Coverage for 6 " ' 01 1 2 "* e7
Health Services, the Company may reasonably
require that a Network Physician acceptable to the >% $ . 6 $* $ .
Company examine Covered Persons at the .1 % / %& >1,
Company’s expense.
5.9 Clerical Error. Clerical error shall not deprive any .8 2 # O6 * 1 .% ^1 FP`
individual of Coverage under this Policy or create a 3J d # "%14 .-# # " b 6

right to Benefits. Failure to report the termination of
Coverage shall not continue such Coverage K# 3J4 J G * / 2 W 2
beyond the date it is scheduled to terminate ;F $* O6 M# '* 1 H .

according to the terms of this Policy. Upon
discovery of a clerical error, any necessary W
$ U ' . S8 & &+, / O
appropriate adjustment in Premiums shall be . / $+ 2 6 &+, # $*
made. However, no such adjustment in Premiums
1 W
*4 G 2 XI ,
or Coverage shall be granted by the Company to
the Policyholder for more than 60 days of .*
Coverage prior to the date the Company received
notification of such clerical error.
5.10 Conformity with Statutes. Any provision of the O
6 O6 $* K8 H& . "-(H 9KP `
Policy which on its Effective Date, is in conflict with 6 0 - P* '$*% & G #
the requirements of governmental statutes or
regulations (of the jurisdiction in which delivered) is 1 ; >14 6) U;
hereby amended to conform to the minimum
Policy Wording
Abu Dhabi Plan
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requirements of such statutes and regulations. .U; W $ 0 /, " (J
5.11 Notice. Written notice given by the Company to an
authorized representative of the Policyholder is $ O6 / $+ 1 *4 * .8
%H 99P `
deemed notice to all affected Primary Insured and * &; >1, -8 / :* . P%
their Enrolled Dependants in the administration of
this Policy, including termination of this Policy. The 3J W
# '
5 # 8& J+ *
Policyholder is responsible for giving notice to / * 9
: S& . .

Covered Persons.
.%& >1,
Any notice sent to the Company under this Policy / $& * O6
.8 / $& * O6
and any notice sent to the Policyholder shall be
addressed as described in Exhibit 1. .j " # $% & KJ8 & .
5.12 Payment of Stamps and Taxes required by H& . 8R= $# R
2 25+ 9:P`
Government Entities. The Policyholder shall be
liable for payment of any stamps or taxes required .; 6 - 6 -# $S& .
by government entities on the provision of health . -# $ 0;J $+
care Benefits.
5.13 Renewal of the Policy. The Policy is an annual
58 5 8 &: * . ++6( 9;– `
contract and could be renewed for a new Policy 8 $*% & 6 8 / . 0#
period if the Company and Policyholder agree to
the renewal. The renewal is effective only upon the -# 2 ;# &+, . $+ 8 G
renewal date specified by the Company. 6 .8 # 0F* 0
Premiums, Coverage Category, Policy Benefits,
Riders and Amendments to the Policy could be 1 K; # 79 :
adopted and have to be in accordance with the $+ N6 D ; $+ J* &
Mandatory Health Insurance Law for Expatriates
.N6 54 O
% a8
and respective Bylaws, as set forward by the
Health Authority of Abu Dhabi (HAAD) and/or
other relevant authorities and approved by the
Executive Council of the Emirate of Abu Dhabi
Policy Wording
Abu Dhabi Plan
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SECTION 6:
:A "
PROCEDURES FOR OBTAINING NETWORK
BENEFITS 25 B@ $ 8<
6
6.1 Health Services Rendered by Network
Providers. Covered Persons are eligible for >1, . .+- $# + 8+1 9PA
Coverage for Health Services listed as Network -# 8 01 2 S %&
Benefits in the Member Booklet of this Policy if
such Health Services are Medically Necessary and 01 W $ 0

J >1 * . #
are provided by a Network Physician or other 7 6 . $+ :
Network Provider. All Coverage is subject to the
0 03& ' ' *1 2 $ .1]
terms, conditions, exclusions and limitations of the
Policy. .
Health Services, which are not provided by a
Network Physician or other Network Provider, are 7 6 . $+ J 9 ' 01
not Covered as Network Benefits, except in g 09 # 3&M ' -# 52 9 '1]
Emergency situations or referral situations
" #
& $+ :& * $ 6
authorized in advance by the Company as
mentioned in Exhibit 2. Enrolling for Coverage 01 9 .8 2 $8& .=
under the Policy does not guarantee Health O7 ;+ .7 # * 7
Services by a particular Network Provider on the
list of Providers. This list of Network Providers is # 1 7 R 9 .2 *1

subject to change. When a Provider on the list no 14 %& >1, / .8 ' -
longer has a contract with the Company, Covered
Persons must choose among remaining Network . -# / $ $86 1 O7
Providers in order to obtain Network Benefits.
2 &+, -# *1 01 2
Coverage for Health Services is subject to
payment of the Premium required for Coverage .1 O6 $ & 6 $ d -# ' .8
under the Policy and payment of the Deductible or
Co-insurance specified for any service.
S& %& >1, .U 2 J ( :PA
6.2 Verification of Participation Status. Covered
Persons are kindly requested to verify the 1 O7 6 /%& 6 . & - "
participation status of a Physician, Hospital or W
.7 & - 2 + 1, 0+ K, 1^
other Health Services as from time to time the
participation status of a Provider may change. .8 $4 6 >1 4 -+ $F1
Covered Persons can verify the participation status H* 0+ 6 J 0+ 7 %& >1, /
from our website or by calling the Company.
Covered Persons must show their ID cards or / $ J# 5 $ # + #
similar documents along with the Daman Card . 01
every time they request Health Services.
If failure to verify participation status or the failure # "%14 6 & - " # "%14 .& $ #
to show an ID card or similar documents results in 038M # "; 6 J + 7
non-compliance with required Company
09 W $ # 'P# + -# 2 M# '
procedures, Coverage of Network Benefits may be
denied and in such cases insured members shall & - -# $ J S 3, -# H&
pay for Network Benefits with the fees stipulated
.W $ 2 & J >
for non holders of such a medical insurance policy.
6.3 Prior Approval Does Not Guarantee Benefits.
6 / # .25 ( Y 5 ;PA
The fact that the Company authorizes services or
supplies does not guarantee that all charges will N% .0% -8 2 6 9 07J8 6 01
be covered. The Company reserves the right to
$ 09S& 6 W
$ *8 "
review each claim if there are questions regarding
Medical Necessity. Under these circumstances, P* 2 P# 'HN
$N # . J
Coverage of some health care services and >1, * H& .07J8 01
supplies may be denied. Covered Persons will be
notified in writing of any subsequent adjustment of . *8 8 9 0F* :1 %&
Benefits as a result of the claim review.
6.4 Limitations on Selection of Providers. If a 01 %& >1 /
.+-
(1 B@ +# >PA
Covered Person is receiving Health Services in a
& ' 6 5 6
S 6
harmful or abusive quantity or manner or with
Policy Wording
Abu Dhabi Plan
‫ ا‬
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harmful frequency, as determined by the Company J 6 K . KM# ' -# / $ .Q
and wishes to obtain Network Benefits, he or she
may be required to select a single Network . K ) /%& . 1
Physician and a single Network Hospital (with .& 01 "& (
which the single Network Physician is affiliated) to
provide and coordinate all future Health Services.
/%& . . 14 # "%14
Failure to make the required selection of a Network
Physician and a single Network Hospital within 31 / 8 $ 1 *4 G @( Q #
days of written notice of the need to do so shall /%& . . / OS H& W

result in the designation of the required single
Network Physician and Network Hospital for the .%& >1
Covered Person.
In the case of a medical condition which, as
determined by the Company, either requires or 6 . + O
' O
' - #
could benefit from special services, a Covered %& >1 . + KM# '1 01 %& 6
Person may be required to receive Covered Health
. $+ 7 $F1 52 01
Services through a single Network Provider
designated by the Company.
Following selection or designation of a single 01 2 M# ' 7 * 6 14 : 9
Network Provider, Coverage of Health Services as
Network Benefits is contingent upon all Health 01 -8 / * -#
Services being provided by or through written . 7 6 * "# / 1 $ $F1 6 $+
referral of the designated facility or Provider.
6.5 Referral Health Services Rendered by . 4
1 +1 .+- $# + 8+1 $ ( `PA
Non-Network Providers. In the event that specific 7 $F1 6 $+ 5 01 9 $ #
Health Services cannot be provided by or through
a Network Provider, Covered Persons may be S + %& >1, M# ' 1
eligible for Network Benefits when Medically : 01 / $ -#
Necessary Health Services are obtained through
non-Network Providers. Health Services obtained 01 / # .8 . V1 O7 $F1
through non-Network Providers must be authorized $F1 :& V1 O7 $F1 J $
in advance through referral documentation as
designated by the Insurance Company. All Health -8 . $+ & 1 $
Services are subject to other limitations and # 5 R1, 03&4 *1 01
exclusions of the Policy.
.
6.6 Emergency Health Services by Network
Providers. The Company provides Coverage of 2 .+1 .+- $# R
8+1 APA
Eligible Expenses for Medically Necessary 5 - ' ; 01 & H
Emergency Health Services, subject to the terms,
conditions, exclusions, and limitations of the . '03& ' '
Policy.
Eligible Expenses for Emergency Health Services
J "% & ; 01 & H
are the agreed fees with Network Providers for the
Health Services described in Section 9 of this
Z & # 01 O7 -
Policy provided during the course of the 01 W 6 .8 .g - "& #
Emergency. Such Health Services must be
Medically Necessary for stabilization and initiation .8 .VF* 3 P &4 :
of treatment. The Health Services must be .. H 0 6 $+ 01
provided by or under the direction of a Physician.
6.7 Emergency Health Services by Non-Network . 4
1 +- $# R
8+1 [DX
Providers. Covered Persons obtaining Emergency ; 01 /
%& >1,
Health Services by Non-Network Providers inside
the “Territorial Cover” as described in Exhibit 2, " # J% .& "2 " # V1 7
must notify the Company within 24 hours or as .$* 0+ .+6 # 6 & =C $F1 sF J * m
soon as reasonably possible. At the Company's
request, they must make available full details of $% 7 ' . 'J *
the Emergency Health Services received in order
2 $86 W
J ; 01
for such Health Services to be covered as Network
. -# 01
Benefits.
Coverage for continuation of care after the 8 $7 * & 1 2
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
condition no longer is an Emergency requires . $+ & # . :& . ;
coordination by a Network Physician and the prior
authorization of the Company. If a Covered Person 78 '/%& $1 VF / %& >1 $ $ #
is hospitalized, the Company may elect to transfer W
K# 0+ .+6 # /%& / K 1 6
him or her to a Network Hospital as soon as it is
Medically Appropriate to do so. .: ;F
Services rendered by non-Network Providers are -# 52 0& V1 7 $+ 01
not Covered as Network Benefits if Covered
V1 "# # 3 %& >1, 1 $ #
Persons choose to remain in a non-Network facility
after the Company has notified them of the intent &4 . "# / J J J26 6 *
to transfer them to a Network facility. A continued *% 2 $ + V1 "# # +4 #
stay in a non-Network facility may be covered as a
Non-Network Benefit. . V1
6.8 Second Opinion Policy. Coverage of certain
-# 5 01 2 V + . .
bPA
Health Services as Network Benefits may require
that Covered Persons consult a second Network $+ 1] . 5&M %& >1, + /
Physician prior to the scheduling of the Health 1 JQFM H& . 1
Service. The Company will notify them that a
particular Health Service is subject to a second . 384 J2 H& '1^ O6 && *1 5
opinion Policy and will inform them of the required . O6 / $
procedure for obtaining a second opinion.
6.9 Denial of Already Approved Services. If the
VF / & 0#
.=@ J5 8+1 E5
FP A
Company first approved a treatment and at a
later stage the condition is discovered as a Q - J6 / >1 9 # >1 Q
Non-covered condition, in such a situation the
P# " W W $ %# '2 -1
Company has the right to decline this case
from beginning or the maximum liability of the .>1 S& /+, H+ H&
Company shall be up to the diagnosis. The .>1 * R1, H -8 S >1 -# H&
Insured Member shall pay all other expenses
after the diagnosis.
6.10 Recovery: The Policyholder is liable for all -8 + & $S& . :++
(H ji DX
claims paid by the Company on direct
settlement basis to any of its Medical Providers O7 O, $+ # 0
Network which are: : , 01
• In excess of the individuals Benefit Limits, % 01 ;# 78 •
• For excluded Treatments *
2 & 08* •
• Claims made by Members who are no longer
eligible for cover 2 S *
>1, $+ 0 •
• Fraudulent use of Daman cards 0+ 1& •
*Refer to clause 11 - exclusions

03&9 – jj e8
Policy Wording
Abu Dhabi Plan
‫ ا‬
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SECTION 7: :C "
COVERED HEALTH SERVICES 7 8+1
Health Services described in this section are :01
$ '52 &
# 01
covered when such services are:
A. Medically Necessary (refer to definition in Section T(( & # H* N6) : –6
1);
& ;F 1 7 6 . K8 6 $+ – .
B. Provided by or under the direction of a Physician
or other appropriate Provider as specifically T $
described; and
." 03&" '(i & # 5& Q –V
C. Not excluded as described in Section 10,
"General Exclusions."
Network Benefits are subject to the payment of # 6 / $ d O6 -# *1 25
any Deductible and/or Co-insurance listed in 01 / -# $ .= " # 5
Exhibit 2. Network Benefits include Medically
.X & # & : ;
Necessary Emergency Health Services as
described in Section 6. 0
# V1 2 ) 4
1 25
Non-Network Benefits (coverage for Non-
01 # /2 W
# = " # 5 S 01
Network-Benefits is only provided if the services
are assured in Exhibit 2, otherwise only ( $+ J "# 01 3R
Emergency Health Services or Health Services " # 5 $ & 6 / $ d O6 -# *1
which are approved by the Company covered) are
subject to the payment of any Deductible and/or .=
Co-insurance listed in Exhibit 2
# 5 S 01 0
# 52 81 0* -#
Out-of-Hospital Benefits are only covered if the
services are assured in Exhibit 2. .= "
7.1 Medical Services in a Physician's Office. These 6 $+ 01 . ( 5 8+1 9Pa
are Health Services provided by or through a
6 5 # -+ . . + .K # . $F1
Physician in the Physician's office. A Physician’s
office may be located in a clinic or Hospital. ./%&
7.2 Emergency Outpatient Health Services. Health 01 .6
1 8+% %6
R
8+1 :PC
Services for stabilization or initiation of treatment of ; 09 VF # 3 6 - & HJ
Emergency conditions provided on an outpatient
basis at a Hospital. ./%& # 81 0* *8 a&6 /
7.3 Outpatient Prescription Drugs. Coverage is only >1 # 2 .6
1 B
5 + ;Pa
provided for prescription drugs prescribed by a
licensed Physician. Imported drugs are covered /2 5& , .>1 . $+ # ,
only if the Ministry of Health approves the drug. . 57 $+ 3 $ # #
7.4 Outpatient Physiotherapy. Short-term physical
therapy services. Coverage is limited as stated in 5+ * VF* 01 .6
1 B
% 4G% >Pa
Exhibit 2, Schedule of Benefits. Physical therapy .-# $8 '= " # & 5 2 .$8,
must be provided under the direction of a
$+ :& . K8 0 * VF* .8
Physician and approved in advance by the
Company. .
7.5 Diagnostic and Therapeutic Services. Health 8 >1 01 .6G% 1( 8+1 ٥Pa
Services for outpatient surgery, laboratory, R1, 1 >% *, '1 '81 0* #
radiology and other diagnostic tests and
therapeutic treatments (such as chemotherapy) 6 $+ (O VF* $) *8 08F*
provided by or through a Physician. .. $F1
7.6 Day Treatment. Services and supplies provided in
'/%& # 07J8 01 .+ " 4G@ APa
a Hospital setting, when there is no overnight
Confinement. This Benefit only applies to services, / # *%
" ./%& # 0 W 9
which cannot be provided in an outpatient facility, .. . $ '81 5 # J 9 '01
such as a Physician’s office.
7.7 Inpatient Hospital and Related Health Services. 8/ 8+1 B&( 5 E
+ 8+1 a –a
Confinement, including room and board, and 07J8 01 '08 0 W
# '0 .#G%
services and supplies provided during
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
Confinement in a Hospital. Health Services must 01 .8 ./%& # 0 36
be provided by or through a Physician and all Non-
Emergency Hospitalizations must be authorized in /%& $1 VF* / # .8 '. $F1 6 $+
advance by the Company through completion of an 5& ;* $F1 $+ :& ; 09 2
Authorization Form prior to the hospitalization.
Certain Health Services rendered during a 01 P* ./%& $1 / # .
Covered Person's Confinement are subject to *% *1 /%& # %& >1 0 36
separate Benefit restrictions and/or Deductibles
6 # & $ & 6 / $ 6 / %
and/or Co-insurance as described elsewhere in
this Policy. .
R16
7.8 Professional Fees for Surgical and Medical J .*, .
6 8+1 1 = %( bPa
Services. Professional fees for surgical services
$+ R1, 8 01 1
and other medical care provided by or through a
Physician. Health Services must be provided in a # 01 6 .8 .. $F1 6
Hospital setting. ./%&
7.9 Hospitalization Class. The class of hospitalization
for which Covered Persons are eligible is defined " /%& $1 VF* ;# .B&( $1+ 4G% R5 FPa
in Exhibit 2, Schedule of Benefits. $8 '= " # 5 J :# +4 %& >1_
The selection by the Policyholder of Coverage for a .-#
specific Hospitalization Class does not guarantee
the availability of that accommodation class for an /%& $1 VF ;# / 2 . 1
admission into the Hospital. If a Covered Person is $1
./%& $1 W +4 8 # 9
admitted into a more expensive Hospitalization
W % 6 /%& $1 VF 8 / %& P
Class than has been contracted for by the
Policyholder, the Covered Person will be 9;& & %& >1 M# ' . J +*
responsible for all charges in excess of those that 8 & W 7 H $
would have been incurred under the
Hospitalization Class indicated in Exhibit 2, .-# $8 '= " # 5 /%& $1 VF*
Schedule of Benefits.
7.10 Ambulance Services. Emergency ambulance $+ : g H*& & $ .T%H
8+1 9KPa
transportation by a licensed ambulance service to
the nearest Hospital where Emergency Health 01 K# /%& .+6 / 1 H*& 1
Services can be rendered. Coverage is only .g # # 2 .;
provided in the event of an Emergency.
7.11 Maternity Services. For a Covered Person, 01 '%& >1 & .+Y $ 8+1 99Pa
maternity-related medical, Hospital and other
52 01 /%& 59 $ +F* 0
Covered Health Services are treated as any other

Inpatient or Outpatient Benefit. Maternity Benefits - 81 5* -8 6 P *% J $* R1,
Outpatient includes prenatal and postnatal care 81 0* # 59 $ -# .R16
provided by a Physician in an outpatient setting.
Maternity Benefits - Inpatient covers Health 59 * $+ 81 0* -8
Services provided during childbirth or 59 $ -# 2 .81 5 P . $+
complications of pregnancy. The total amount
reimbursable for Inpatient and Outpatient maternity 59 36 01 %& $1 P
care is indicated in the Schedule of Benefits, $ * &f $ d 8 .$ 0% 6
Exhibit 2.
'-# $8 # /%& V1 $1 P 59
.= "
7.12 Parent accommodation. For a covered person M# '0& (I & %& >1_ & .+ # 9:Pa
under 10 years of age, extra charges for the room
$% # 6 >1 #2 #4 H
for one parent accompanying the child are covered
up to a maximum as described in Exhibit 2. .= " # & /+6 / 52
7.13 Pre-authorization. The following services must be

$+ 01 / # .8 . 5 9; Pa
pre-approved by the Company: :
Pre-authorization is required for any Non- ) /%& $1 3R Q VF O, & #
Emergency hospitalization (medical and/or surgical 6 3& (59 $ "* 6/ 8 6
and/or maternity related) whether or not a Network
Provider (if coverage for Non-Network-Provider is # 5 S V1 7 2 0
) O7
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
assured in Exhibit 2) as well as for the other $ HJ #

R1, 038F W
m "
following procedures. This pre-authorization review
is mainly to help the patient P 5& &;
Understand their medical care choices .J 1 01 J#
Avoid unneeded hospital stays and surgery ./%& # Q 8 +9 O%
Receive maximum benefits from the plan .` 01 /+,
Find network providers. .1 O7 8
: $+ 01 / :& # .8

The following services must be pre-approved by
the Company:
$ "* 6/ 8 6 ) /%& $1 VF
Inpatient hospitalization (medical and/or
surgical and/or maternity related) ( 59
MRI, CT scans, endoscopies. (if the services O &2
are assured in Exhibit 2)
(m" # 5 S 01 0
) N
Physiotherapy(if the services are assured in
Exhibit 2) .(m" # 5 S 01 0
) * VF*
Long term medication for more than 60 days (if
J+ 78 % 6 : Xi , $8, $ VF*
the services are assured in Exhibit 2)
.(m" # 5 S 01 0
) Lii
All Emergency cases do not require prior approval but
should be notified to the Company within 24 hours.
1 7 5 B 4( (Y <c
8Y 26
.@ d> X 5 =^

Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
SECTION 8: :D "
REIMBURSEMENT
E%(
8.1 Reimbursement of Eligible Expenses from . .+- $# ( T
@ E%( 9PD
Network Providers. Network Providers are
responsible for submitting a request for payment of & H -# . S& O7
Eligible Expenses directly to the company. In the HF1 & 6 .&M 7 + $ # . / 5
event a Network Provider charges any fees other
than Deductible or Co-insurance, the Covered $4 %& >1 / M# '$ & 6 $ d
Person should contact the Company. .
The Company is not responsible for payment of 52 Q ' 01 6 $ -# S& Q
any rendered services, which are not covered
under the provisions of this contract. The 9S& . H& .*
6 .8
Policyholder will be responsible for collecting 6 P* &; K S *# $
payment from the Primary Insured and for
reimbursement to the Company, of any charges 6 .8 52 Q '%& >1 $+ 5 H
incurred by the Covered Person, which are not 1 7 / $+ J*# '*

covered under the provisions of this contract, and
have been paid by the Company to the Provider on .%& >1
behalf of the Covered Person.
4
1 +- $# ( T
@ E%( :Pb
8.2 Reimbursement of Eligible Expenses from
Non-Network Providers. The Company shall %& >1, P* H& .
reimburse Covered Persons for Eligible a&6 / V1 7 - 5 & H
Expenses incurred with non-Network
Providers on the same basis as a Network 01 6 ; 01 >1 # 7
Provider, only for EMERGENCY HEALTH . $+ 5* %
SERVICES OR SERVICES AUTHORIZED
OR APPROVED BY the Company in R1, & H -8 %& >1, P*
accordance with the terms, conditions, , 5 - *% % a&6 / V1 O7
limitations and exclusions of the Policy unless
otherwise assured in Exhibit 2, Schedule of . # 5 03&4
Benefits.
The Company is not responsible for payment for Q 01 6 $ -# S&
any services provided that are not covered under
the provisions of this contract. .*
6 .8 52
8.3 Filing Claims for Reimbursement of Eligible +- ( T
@ E%( R%( ;Pb
Expenses from Non-Network Providers.
5 + V 8+1 8 / 5 B7 E%( . 4
1
Coverage for Reimbursement is only provided
if the services are assured in Exhibit 2. The : S& K S &; >1 .d J
$& 9
Primary Insured is responsible for sending a 81 5* # VF*
. . / P* .
request for reimbursement to the Company’s
office. If Outpatient Treatment is assured in Exhibit *8 6 % O6 .8 'm " # S
2, any drug prescription or outpatient claim must '+F* 0
>% `; # 6 1& / 81 0*
be submitted in original along with all related test
results, itemized cost & medical report that has . $+ K;* O
.& %
been completed by the attending Physician of the K S >1 .%& >1 / H
Covered Person. Unless the Primary Insured is
/ 0*
# "%14 M# '+ + Q &;
legally incapacitated, failure to provide this
information to the Company within this timeframe .1 >1 % 2 H& 7 4 #
shall cancel Coverage for that service.
>1 / 5 OS& 52 01 >1 P*
Reimbursement for Covered Services will be made
directly to the Primary Insured. .&; K S
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
SECTION 9:
:e "
COORDINATION OF BENEFITS, SUBROGATION
AND REIMBURSEMENT E%( $G H I25 J(
9.1 Coordination of Benefits Applicability. This - -# "& " .25 J( J( 9PF
Coordination of Benefits (COB) provision applies
when a person has health care Coverage under 2 ` 6 .8 2 >1
more than one Coverage plan (including Coverage Q O1 ` .8 2 W
# )
under a non-profit charity health care program).
Benefit payment will be coordinated with the other : R1, 2 - *% -# "& H& .(
Coverage according to the standard administrative # >1 O6 P* . & 4 0&
practices of the Company. Under no
circumstances will a Covered Person be & 0% %(II HN HN O6
reimbursed for more than 100% of eligible charges - "& / %& >1 "# . 0 -8
from all insurers. The Covered Person agrees to
cooperate with the Company in providing 0 $+ -# " #
documentation of Benefits paid by other insurers. .R1,
9.2 Subrogation and Reimbursement. Subrogation

is the substitution of one person or entity in the >1 $ &&S 6 >1 $ $F4 .E%( $G H :PF
place of another with reference to a lawful claim, H& .& 9 *
1, - R16 &&S 6
demand or right. The Insurance Company shall be
-# 01 * & "
entitled to all rights of recovery for the reasonable
value of services and Benefits provided by the H O6 '%& >1 O6 / $+
Insurance Company to any Covered Person, from / 0*# 6 -# 076 6 01 3& ; 6 ?
any third party or entity that either provides or is
obligated to provide Benefits or payments to the .%& >1
Covered Person.
The Covered Person agrees to execute the
W
# ) "; -8 & -+ / %& >1 "#
process and deliver such documents (including
undertaking to reimburse such covered expenses $ '( 0F8& H / # '1 $7
to the Company a written confirmation of . $+ ' + & '5& W
assignment, and consents to release medical
records), and provide such help as may be
reasonably requested by the Insurance Company.
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
SECTION 10:
GENERAL EXCLUSIONS : fK "
The following Treatments including Medical Conditions, % 8<(H

Items, Supplies, Procedures and all their related or
consequential expenses are excluded from this Policy: # 0384 '07J8 ' ' 09 W
# 08F*
a) Health Services, which are not Medically :
5& * 6 +F* 0
J%
Necessary.
.: 9 ' 01 (6
b) All expenses relating to dental treatment, dental
prostheses and orthodontics. &, 6 '&, VF* +F* 0
H # (.
c) Custodial care; domiciliary care; private duty .&,
nursing; respite care; rest cures. (Custodial care
means (1) non-health related services, such as Ta% T>1 P T7 T578* (V
assistance in activities of daily living, or (2) * Q 01 (j) * 578* ) . $8,
health-related services which do not seek to cure or
which are provided during periods when the medical 01 (m) 6 ' 5 0 # 5& $ '
condition of the patient is not changing or (3) 9 0# $F1 6 3% / HJ 9 *
services which do not require continued
. 9 01 (n) 6 'P J# 2
administration by trained medical personnel.)
d) Personal comfort and convenience items or .(: >16 .8 5
services such as but not restricted to television,
telephone, barber or beauty service, guest service 9 $ $& / 1 01 (
and similar incidental services and supplies. H 1 '$8 6 +F 1 'HJ '7% '
e) Health Services and associated expenses for . * 07J8 01
cosmetic procedures. Cosmetic procedures are
those procedures which improve physical .$8 038M 0
H 01 (c
appearance. (“Cosmetic” surgery is not surgery JN & / #J 0384 W # >1 $8 038
which is incidental to an Injury, Sickness or
congenital anomaly when the primary purpose is to P ' O6 8 8 8 "$8" 8) .&8
improve physiological functioning of the involved 8&% %N & J a; HJ ? 1 K 6
part of the body.) Breast reconstruction following
mastectomy for cancer is covered. Replacement of 38 * 5 .(&8 * *
an existing breast implant is excluded. 3 O6 $& .52 O & $;&4 8
f) Health Services and associated expenses for the .5& # e7
surgical treatment and non-surgical, medical
treatment of obesity (including morbid obesity), 8 Q' 8 VF* 5;* H 01 (
and any other weight control programs, services or 01 '` 6 '( & W
# ) & 6
supplies.
.7 R16 07J8 6
g) Health Services and associated expenses for
Experimental, Investigational or Unproven 6 '8 01 0
H 01 (7
Services, treatments, devices and pharmacological
regimens. The fact that an Experimental, VF* N6 57J8, '08F* '5* Q 6 ;&9
Investigational or Unproven Service, treatment, 'K Q 6 ;&9 '8 01 .+*
device or pharmacological regimen is the only
available treatment for a particular condition will # VF* +* VF* N6 57J8, '08F*
not result in Coverage if the procedure is '8 384
J2 / OS 5
considered to be Experimental, Investigational or
Unproven in the treatment of that particular .5 W VF # 0 Q 6 ;&
condition.
h) Health Services that are performed outside of the P2 ' V1 36 01 (h
Network, unless for Emergency Health Services as .X & # & ; 01
described in Section 6.
'- '* - 0
H 01 6 (
i) Any Health Services and associated expenses for
alopecia, baldness, hair falling, dandruff, wigs, or .*& * 6 'a6 5+ '* +&
toupees.
4 VF 1 H+ ` 1 07J8 01 (O
j) Services and supplies for smoking cessation
programs and the treatment of nicotine addiction .5& /
are excluded.

0.Z

X 9 $;& 0# (W
k) Non-Medically Necessary amniocentesis. Health
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
Services and associated expenses for sex H 01 .: Q &8 6 8
transformation operations, voluntary sterilization
and for reversal of sterilizations. Contraceptive $;& >1 * 'a8 $ 0* 0
supplies or services. All services related to +F* 0

01 -8 .$ - 01 6 07J8 .*
fertility/infertility as varicocele or polycystic ovary/
ovarian cyst or hormonal disturbances etc. and * P ' O $ $ 1 /1
sexual dysfunction. &8 78* 'J $1 6 P & ' 0&
.G.....
l) Prosthetic Devices and Durable Medical
Equipment, unless approved by the Company. '; 57J8, *+ 8 57J86 ($
m) All costs relating to hazardous activities, including
but not limited to: . $+
$ $& / $ '51 0 5;* H # (
D : 9
1. Any form of aerial flight (including light aircraft,
monoplanes, ballooning, hang-gliding, '%%1 0; W
# ) O8 e O6 D j
parachuting)
' 0; ' 'U& , 0;
2. Participation in any kind of power-vehicle race,
( N 7%
rally or competition
3. Water sports (powerboats, water skiing, jet 6 0 '0& 0+& e O6 # D m
skiing, diving) 0&#
4. Horse riding activities (hunting, jumping, polo, . '3 / "7 '. "&) ; .*,D n
racing)
(>2 '; 08
5. Climbing activities (mountaineering, rock-
climbing, pot holing, abseiling) ("& ' '7% ') $1 . 0D C
6. Violent sports (Judo, boxing, karate, wrestling (, -+ '1 "& '$8 "&) "& 0D L
and other martial arts of any kind.)
7. Bungee jumping R1, 0 'K ' F '8D X
8. Any professional sports activities J O6
$ 7%+D k

n) Growth hormone therapy, unless medically J 0 6 D r
necessary.
. J VF* (
o) All expenses related to hearing and sight
correction tests, audiovisual aids and optometry. ' U -& >% +F* 0
H # (a
p) Naval or military operations of the armed forces or . a * ># -& S 5& $;&
air force and participation in operations requiring
the use of arms or which are ordered by military 8 0 6 & 0 &* 6 0* (e
authorities for combating terrorists, rebels and the . 6 hF& 1& . 0* #
like;
0* '.4 # &* 0&
%
q) Wars and circumstances comparable with a state
.
of war, invasion, act by a foreign enemy, hostilities
and warlike events (with or without a declaration of * $6 '72 '. J e, . (H
war), civil war, riot, mutiny, revolution, confiscation 6 -) . J ?, ;* $, '81
or nationalization by order of any public or local
government or authority; any act of a person acting '* '.2 $ ', . '(. F
in the name of or in connection with any & 6 6 6 5 $6 '5
organization whose activities aim to overturn a de
jure or de facto government violently; $ # 6 &M H >1 H O6 ' 6
6 *% ; N .+ / J# HJ 0N
r) Nuclear risks: e.g. exposure to nuclear energy .5

(nuclear reactions, radiation, contamination) or
nuclear waste of any type or chemical 'e*4 '0F%) + P* $ : 1 (>
contamination; TO ? 6 J 6 0%1 6 (O ?
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
s) Natural perils: such as but not limited to

avalanches, earthquake, volcanic eruptions, 57J '0% ' 9 $ $& / :* ? ("
tsunamis, hurricanes, tornados or any other kind of 1] e O6 H* ' , '& ' ',
natural hazard;
T* 1
t) Any act of terrorism. For the purpose of this
endorsement an act of terrorism means an act, '$ * 4 $* M# 'h9 P2 . $ O6 (
including but not limited to the force or violence J 6 / H* 6 5 – – W
#
and/or the threat thereof, of any person or group(s)
(08) 8 6 >1 O6 .8 'J1&M
of persons, whether acting alone or on behalf of or
in connection with any organization(s) or O $ # 6 6 % * 3& '>1,
government(s), committed for political, religious, .&6 6 H 7 '(0 ) 6 (0N) N
ideological, or ethnic purposes or reasons
including the intention to influence any government / .&6 6 + 6 '; ' '&&
and/or to put the public, or any section of the .. # 'K 378 O6 6 'J8 - 6 / O6
public, in fear;
u) Criminal act of a covered person, violation or "1 6 "1 '/2 >1 .8 84 $* (t
attempted violation of law and resistance to lawful .W
` 8& O6 6 $4
arrest or any resultant imprisonment;
v) Mental Health diseases, including /%& # VF* ', W
# '&% P6 (0
pharmaceuticals, in-patient and out-patient 5 $*# 5 6 &% . '81 0*
treatments, unless it is a transient mental disorder
or an acute reaction to stress. .2 /
w) Outpatient prescribed or non-prescribed medical 0* # -8 # Q 6 # 07J8 (?
supplies including but not limited to elastic
U; '`& 't ' 0 W
# '81
stockings, ace bandages, gauze, syringes, diabetic
test strips, and like products; non-Prescription Q 08F* , T 08 'O & >#
Drugs and treatments. (Bandages, gauze etc. are 378 0
52 * K#F1 t '0) .#
covered as a part of emergency treatment given at
any appointed Network provider) .(* 7 O6 $+ g VF*
x) All preventive cares, including vaccinations,
'P, '0* W
# ';+ $ (x
immunizations, allergy testing & desensitization;
any physical, psychiatric or psychological &% 6 '&8 ># 6 T&& 7 && >#
examinations or testing during these examinations. .0%
$F1 S8 01 6
y) Services rendered by a Provider with the same
legal residence as a Covered Person or who is a +4 $ a% 7 $+ 01 (
member of a Covered Person's family, including '%& >1 ; # 6 O
6 %& >1
spouse, brother, sister, parent or child.
.$% 6 '01, 'x, 'V7 W
#
z) Enteral feedings (infusion formulas via a tube into
the upper gastrointestinal tract) and other J 7J8 / . $F1
2 $) 1
2 (P
nutritional and electrolyte supplements, unless
Medically Necessary during treatment. 378 $ '
2 $ Q (O*
aa) Services and supplies for analysis and /%& # VF #
adjustments of spinal subluxation, diagnosis and
treatment by manipulation of the skeletal structure, * # ;78 -1 $* $ 1 07J8 01 (6 6
or for muscle stimulation by any means (except 6 '/N* $ J & VF* >1 0 'O%
treatment of fractures and dislocations of the
extremities). .(O, -1 6 & VF 3&M) $;& 0F* 7%
bb) Acupuncture; acupressure; hypnotism, rolfing; VF T&2 T2 8* T4 71 8* (. 6
aromatherapy; homeopathic treatments;
homeopathic drugs; spa treatments, relaxing , T VF* T
* VF* TV& 0F*
massages and other forms of alternative treatment VF* R1, $ , W T* VF* T
unless otherwise specified in Exhibit 2, Schedule
of Benefits . d# " # , m " # 5
0
9 $
cc) Health Services and associated expenses for In- '., & .1 0
H 01 (V6
Vitro Fertilization (IVF), Gamete Intra-Fallopian h $ 038 '.# 0+ # 0 $ 038
Transfer (GIFT) procedures, and Zygote
Intrafallopian Transfer (ZIFT) procedures, and any 0 e T8, $ ' 0
08F O6 '.# 5+
related prescription medication treatment; embryo $ W
# ' 0
H 0
transport; donor ovum and semen and related
costs, including collection and preparation. .
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
dd) Elective non-accident related surgery for correction & 4 316 U ? Q 14 8 ( 6
of refraction errors and/or Improvement of vision
VF ' '$ ( ) S & 6 /
(quantitative or qualitative) such as but not
restricted to radial keratotomy, photo keratectomy .7 8 6 VF '*,
or laser surgery.
.H, 5 $;& TH, 8 H ( 6
ee) Nasal septum deviation; nasal concha resection.
ff) All chronic conditions requiring hemodialysis or '"% 57 6 57 . 7 09 $ ( 6
peritoneal dialysis, and related test/treatment or .+F* 0
0384 6 VF* />%
procedure.
> a# VF* 0
H 01 6 (7 6
gg) Any Health Services and associated expenses for
.>1 * T+F* 0
09 $ 74 '&
HIV, AIDS and all related medical conditions; after
confirming diagnosis. 3&M 'K% &% .JM 0
01 # (h 6
hh) All cases related to viral hepatitis & the .6 .J
complication except hepatitis A.
6 / 1 ' P, .* '59 . ( 6
ii) Birth defects, hereditary defects/sicknesses,
Congenital Anomalies &/or deformities for new .5 / J $ 0
born unless representing a life threat.
1& '$ / 4 8 09 $ (O 6
jj) All cases resulting from alcoholism, use of drugs &
hallucinatory substances. .&J 01
kk) Senile dementia and Alzheimer’s disease .7 P 11 H1 (W 6
ll) Air ambulance transportation and terrestrial Q 09 # O $ $ O8 H*&4 $ ($ 6
transportation in non-emergency cases or by non-
.>1 Q H*&4 01 6 g
licensed ambulance services.
mm) Health care services for work illnesses and injuries .8 $* 04 P6 8 01 ( 6
as per Federal Law no.8 of 1980, concerning the
regulation of work relations, as amended and .8 $* 0+F U; "* # (yri & r +
applicable laws in this respect. .(
# *
nn) Circumcision and any complications or related .+F 0
H 6 0* 6 1 ( 6
expenses.
oo) All cases related to Maternity in respect of Q ?_ & 59 $ +F* 0
09 $ (a 6
unmarried females. .087
pp) All cases requiring non-emergency In-Hospital
'/%& # ; Q 01 /VF / V 09 $ (e 6
treatment/services, which have not been approved
by the Company prior to admission. ./%& $1 $+ $+
qq) All cases requiring emergency In-Hospital
treatment/services, which have not been notified to '/%& # ; 01 /VF / V 09 $ (H 6
the Company within 24 hours from admission. ./%& $1 & mC $F1 J sF
rr) Any test and/or treatment not required by a .. $+ . Q VF 6 / ># O6 (> 6
medical Physician.
ss) Any In-Hospital treatment, tests and other '/%& # R16 038 0# 'VF O6 (" 6
procedures, which can be carried out on Out-of-
Hospital basis without jeopardizing the Insured’s K S >1 P* /%& V1 J
health. .1
tt) Any test or treatment, which is not related to a
specific symptom and/or disease. This includes
. P 6 / P* "* Q 'VF 6 ># O6 ( 6
examinations required for employment, travel, '58J '%& '$* PQ, 0%
immigration, licensing or insurance and related
reports. .+F* 0
6 >1
uu) Any pharmaceutical products, which are not, Q 6 / * P VF * 9 '6 08 6 (t 6
considered as specific treatment for a particular
disease and/or not prescribed by an approved .* . $+ #
Physician.
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
vv) All substances which are not considered as '% $&2 '$ 6 * 9 # (06
medicines such as but not restricted to 08 '
Q, '. '0J '0* '&, 8*
mouthwash, toothpaste, lozenges, antiseptics, milk
formulas, food supplements, skin care products, $ VF* J% ) 0% '5 *
shampoos and vitamins (unless prescribed as J Q 0* # (#* % > 09
replacement therapy for known vitamin deficiency
states) and all equipment not primarily intended to – – $ 4 6 - & F6
improve a medical condition or injury such as but 01 / ' a+ ; '3J N6 6 3J 0%
not restricted to air conditioners or air purifying
systems, arch supports, convenience . 07J8 57J86 '
items/options, exercise equipment and sanitary
supplies.
ww) More than one Physician consultations in non- 6 # 5& Q 09 # 5& 6 (? 6
excluded cases in a single day or during free follow K `* . $+ $ '8 *8 5# $F1
up period unless referred by his/her initial treating
.: $
doctor & the referral if medically justified.
.0
3
6 4 09 8 , (x 6
xx) Lesions resulting from attempted suicides or self-
infliction. '`& 3, e7 0
H 01 (
6
yy) Health services and associated expenses for . 6 e >1
N H
organ and tissue transplants, irrespective if insured
person is a donor or recipient. 6 / * N) & J H* ;, (P6
.(
zz) Officially (WHO and/or national law) recognized
epidemics/pandemics. .52 Q 01 5 8 0% (6 .
aaa) Complications directly arising from services
not covered. / 5 09 VF 6 / * ` e6 $ (. .
bbb) All kind of educational programs and/or .*
learning disabilities treatments. " .& :&8 P, H1 8* (V .
ccc) Treatment of venereal diseases transmitted
.
by intercourse as medically accepted.
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
: ff "
SECTION 11:
1

SPECIAL CONDITIONS
11.1 Schedule of Benefits. The Schedule of Benefits & 6 / $ d (() (= ") -# $8 .25 $+6 9P9f
(Exhibit 2) (1) outlines the Deductible and/or Co-
insurance that a Covered Person is required to pay (=) 01 K*# %& >1 . $
for Health Services (2) describes any maximum .8 52 01 ." + R+ *% O6 U
Benefit that may apply. Health Services Covered
under the Policy are described in Section 8, ."52 01" '\ & #
"Covered Health Services."
When Deductible and/or Co-insurance are e# d M# '$ & 6 $ d .&
charged, the amount paid for Health Services from *&6 ; & & O7 01
Network Providers is determined as a percentage
of the negotiated contract rates between the ; & a '1 7 J P% *
Company and the Provider rather than as a - K P% *& $* .7 5# J &
percentage of the Provider's billed charges. The
Company's negotiated rate with the Provider is .5# J 7 & $+6 5 1 7
ordinarily lower than the Provider's billed charges.
0
09 O6 / J6 X J N 5# " .
(H 8
(5 mDjj
11.2 Waiting period. For any major high-cost medical
conditions, a waiting period of 6 months will be 5# 3 J*% O& -# $ $& / '*% %
applied, i.e. benefits come into force once the .$8& G
W
: jri c
waiting period of 180 days has elapsed, starting
from the Enrolment date.
However, if an Insured Person has held a valid & + $ O
K S >1 6 9
health card or Health Insurance Policy in the United $+ 5 * 04 # 6 $*%
Arab Emirates immediately prior to his current
N J6 X 5# M# '5
Health Insurance Policy, the 6-month waiting
period set out above shall not apply in respect of . 09 W O6 / "Y 9 5
any such medical conditions.
Policy Wording
Abu Dhabi Plan
‫ ا‬
‫"! أ‬#$
EXHIBIT 1 9 J
1. Parties. The parties to this Policy are _________ .") _____ (" ") ____
# .# D(
("Company") and ____________ ("Policyholder"). .("
2. Effective Date. The Effective Date of this
$*% & G .$*% & G D=
Policy is __________ .
. ____________
3. Policy Period: ___________
(__________ to _________ ). ________ : 5 D@
.(_______ / _______ )
4. Premiums. The Company reserves the right to
change the schedule of rates for Premiums, after a " N% .1 # 8& 8 >1_ & *& .& DC
31-day prior written notice, on the first anniversary of 1 8 G nj . "& sF9 ,*&9 $8 2
the Effective Date of the Policy specified in the
application. .
5. Computation of Premium Charge for New . 8 %& *& .& DL
Persons Enrolled in the Plan.
%& >1, JF1 %& , / .& '& &+
A pro-rata Premium, calculated on the number of days
Covered Persons are actually Covered under this G -
%& >1_ K& & '
.8 *#
Policy, shall be charged for Covered Persons whose >1_ 6 '2 5# Q G # J2 $*% &
Effective Date of Coverage falls on a date other than
the first of the payment period. .-# 5# J Q G # J2
%&
6. Payment of the Policy Premium. The annual Policy $+ : -# "& O& &+ . &+ -# DX
Premium is payable in advance by the Policyholder to
the Company as described below. . 6 & / .
7. I/We hereby assure that all members under this health , 53 H& %& >1, $ 6 /6 –[
insurance policy will read the Policy wording, Schedule
of Benefits and other relevant legal documents. .R16 * "; O6 -# $8
8. Initial Enrollment Period. The Initial Eligibility Period G # , , 5# 6 H& ., $8& 5# Dr
shall begin on ___________ and shall end
on ___________ . .___________ G # J _________
9. Effective Date of Coverage for Eligible .S >1_ & 2 $*% & G Dy
Persons.
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.8 / $& * O6 .0*4 Dji
10. Notice. Any notice sent to the Company under
this Policy shall be addressed to:
–
5 * 09 – N6 jmrrrr "
National Health Insurance Company - Daman
P.O.Box 128888 Abu Dhabi - UAE +ykj m XjCyLLL : %
Tel. +9712 6149555 +ykj m XjCykkL : a %
Fax. +9712 6149775
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.8 . / $& * O6
Any notice sent to Policyholder under this Policy
shall be addressed to:
: "
P.O.Box :
: %
Tel :
Fax : : a %

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Policy Wording

Abu Dhabi Plan

Policy Holder : : 

Policy Effective Date :

()   

Upon acceptance of the Policyholder's application and & 

1. The Policyholder’s application  . . – (

This Coverage may be modified by the attachment of Riders

Many words used in this Policy have special meanings. These

Network and Non-Network Benefits

Network Benefits - These Benefits apply when a Covered

Section 6 describes the procedures for obtaining Covered

Non-Network Benefits - These Benefits apply when a

The information in Sections 1 through 5 and Sections 9

Section 12 and Exhibit 2 describe all special conditions, e.g.

Health Services Covered Under the Policy

Only Health Services provided in the Territorial Coverage

The Company is responsible for interpreting the Benefits

The Company reserves the right to change, interpret, modify,

8(  $+6

SECTION 1: DEFINITIONS………………………………- 6 - …………………………………………………..8&

SECTION 2: ENROLLMENT AND EFFECTIVE DATE OF …………………………7( $%& 

SECTION 3: TERMINATION OF COVERAGE………- 16 - …………………………………………….. 7( <= :; "

SECTION 4: PREMIUM RATES……………………….- 18 - …………….……………………………………. # :> "

SECTION 5: GENERAL PROVISIONS……………….- 19 - …………………………………………………@ "  :? "

SECTION 6: PROCEDURES FOR OBTAINING

…………………………………….. 7  8+1 :C "

SECTION 8: REIMBURSEMENT………………………- 29 - ………………………………………………….. E%( :D "

SECTION 9: COORDINATION OF BENEFITS, …………………………….. E%( $G H I25 J( :F "

………………………………………….. @ 8<( :9K "

“Company- National Health Insurance Company

“Congenital Anomaly” – An anatomical or physiological

“Out-of-Hospital Benefits” – Benefits offered under this $ 01  2

Authority (HAAD) and/or other relevant authorities .N6 54 O

on the earliest of the dates specified below: :96

SECTION 4: >: "

5.1 Entire Policy. The Policy issued to the . . W

*Refer to clause 11 - exclusions

Covered Health Services are treated as any other

7.13 Pre-authorization. The following services must be

assured in Exhibit 2) as well as for the other $  HJ #

:  $+   01 / :& # .8

9.2 Subrogation and Reimbursement. Subrogation

The following Treatments including Medical Conditions, % 8<(H

supplies or services. All services related to +F* 0

 $ 7%+D k

r) Nuclear risks: e.g. exposure to nuclear energy .5 

s) Natural perils: such as but not limited to

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Policy Holder : :

()

Upon acceptance of the Policyholder's application and &

1. The Policyholder’s application . . – (

8( $+6

SECTION 1: DEFINITIONS………………………………- 6 - …………………………………………………..8&

SECTION 2: ENROLLMENT AND EFFECTIVE DATE OF …………………………7( $%&

SECTION 3: TERMINATION OF COVERAGE………- 16 - …………………………………………….. 7( <= :; "

SECTION 4: PREMIUM RATES……………………….- 18 - …………….……………………………………. # :> "

SECTION 5: GENERAL PROVISIONS……………….- 19 - …………………………………………………@ " :? "

…………………………………….. 7 8+1 :C "

SECTION 8: REIMBURSEMENT………………………- 29 - ………………………………………………….. E%( :D "

SECTION 9: COORDINATION OF BENEFITS, …………………………….. E%( $G H I25 J( :F "

………………………………………….. @ 8<( :9K "

“Out-of-Hospital Benefits” – Benefits offered under this $ 01 2

Authority (HAAD) and/or other relevant authorities .N6 54 O

on the earliest of the dates specified below: :96

SECTION 4: >: "

5.1 Entire Policy. The Policy issued to the . . W

assured in Exhibit 2) as well as for the other $ HJ #

: $+ 01 / :& # .8

The following Treatments including Medical Conditions, % 8<(H

supplies or services. All services related to +F* 0

$ 7%+D k

r) Nuclear risks: e.g. exposure to nuclear energy .5

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