Table of Benefits

Effective date: 01 July 2018

Group renewal date: 01 July 2019
Treatment Guarantee (pre-authorisation) may be required for some benefits as indicated by a '1' or a '2' in the
table(s) below. Please refer to the "Notes" section for further details.

All benefit and deductible amounts are per person, per year of cover, unless otherwise indicated.

Benefit limit

Overall Maximum Benefit US$ 136,250

Atkins Cat 2 Gulf Direct Core Plan

Hospital accommodation - Private room Full Refund 1

Intensive care Full Refund 1

Prescription drugs and materials (in-patient and day-care Full Refund 1

treatment only) (Prescription drugs are those which legally can
only be purchased when you have a doctor’s prescription)

Surgical fees, including anaesthesia and theatre charges Full Refund 1

Physician and therapist fees (in-patient and day-care treatment Full Refund 1
only)

Surgical appliances and materials Full Refund 1

Diagnostic tests (in-patient and day-care treatment only) Full Refund 1

Psychiatry and psychotherapy (in-patient and day-care US$ 2,315 1

treatment only) 80% refund

Accommodation costs for one parent staying in hospital with an Full Refund 1
insured child under 18

Emergency in-patient dental treatment Full Refund

Day-care treatment Full Refund 2

Kidney dialysis Full Refund 2

Out-patient surgery Full Refund 2

Policy number: P002438781 Page 1 of 7

Orient Insurance PJSC, 02a Orient Building, Al Badia Business Park, Dubai Festival City, P.O. Box 27966, Dubai, United Arab Emirates.
 Atkins Cat 2 Gulf Direct Core Plan

Nursing at home or in a convalescent home (immediately after Full Refund 2

or instead of hospitalisation)

Local ambulance Full Refund

Medical evacuation: * Where necessary treatment is not Please refer to footnote below 2
available locally, we will evacuate the insured person to the
nearest appropriate medical centre, * Where ongoing treatment
is required, we will cover hotel accommodation costs, *
Evacuation in the event of unavailability of adequately screened
A
blood

- If medical necessity prevents an immediate return trip following 7 day limit

discharge from an in-patient episode of care, we will cover hotel
accommodation costs

A Please refer to footnote below 2

Expenses for one person accompanying an evacuated person

CT scans (in-patient and out-patient treatment) Full Refund

MRI, PET and CT-PET scans (in-patient and out-patient Full Refund 2
treatment)

Oncology (in-patient, day-care and out-patient treatment): Full Refund

- Chemotherapy (in-patient/daycare) 2
- Hospital accommodation 2
- Oncology diagnostic tests (in-patient) 2
- Oncology professional fees (in-patient) 2
- Purchase of a wig, prosthetic bra or other external prosthetic device for US$ 270 per member lifetime
cosmetic purposes
- Radiotherapy (in-patient/day case) 2

Routine maternity (in-patient and out-patient treatment): US$ 4,090

- Newborn care 2
- Other diagnostic tests (in-patient) 2
- Package 2
- Prescription drugs and materials 2
- Private room 2
- Professional fees 2
- X-rays (in-patient) 2

Complications of pregnancy and childbirth: Full Refund

- In the event of non emergency treatment 2

Newborn care (in-patient and out-patient treatment) 30 day limit 2

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Orient Insurance PJSC, 02a Orient Building, Al Badia Business Park, Dubai Festival City, P.O. Box 27966, Dubai, United Arab Emirates.
 Atkins Cat 2 Gulf Direct Core Plan

In-patient cash benefit (per night) (where treatment has been 20 day limit
received free of charge) US$ 175 per day

Emergency out-patient dental treatment (where these benefit Full Refund

amounts are reached, any additional costs may be reimbursed
within the terms of any separate Dental Plan)

Palliative care Full Refund 2

Long term care 90 day limit per member lifetime 2

Emergency treatment outside area of cover 60 day limit

Employee Assistance Programme (provided by Morneau Full Refund

Shepell) offers access to a range of 24/7 multilingual support
services as follows: Confidential professional counselling
(in-person, phone, video, on-line chat and email); Legal and
financial support services; Critical incident support; Wellness
website access

Organ transplant (including living donor medical costs) Full Refund 1

Travel Security Services (provided by red24) offers 24/7 access Full Refund
to personal security information and advice for all your travel
safety queries. This includes: Emergency Security Assistance
Hotline; Country intelligence and security advice; Daily security
news and travel safety alerts

Atkins Cat 2 Gulf Direct Out-patient Plan

B 80% refund
Medical practitioner fees
Please refer to footnote below

Prescription drugs (Prescription drugs are those which legally Full Refund
can only be purchased when you have a doctor’s prescription)

B 80% refund
Specialist fees
Please refer to footnote below

Diagnostic tests Full Refund

Preventive services. Checks are limited to Full Refund

- Annual pap smear Max. 1

- Diabetes tests (every three years for members aged 30+) Max. 1 for a period of 3 years
- Diabetes tests (yearly for members aged 18+ if there is a high risk of Max. 1
diabetes developing)

Psychiatry and psychotherapy US$ 410

80% refund

Policy number: P002438781 Page 3 of 7

Orient Insurance PJSC, 02a Orient Building, Al Badia Business Park, Dubai Festival City, P.O. Box 27966, Dubai, United Arab Emirates.
 Atkins Cat 2 Gulf Direct Out-patient Plan

Complementary treatments including spa treatments such as US$ 1,360

massage therapy or rolfing

Health and wellbeing. Checks are limited to: * Physical US$ 400
examination * Blood tests (full blood count, biochemistry, lipid
profile, thyroid function test, liver function test, kidney function
test) * Cardiovascular examination (physical examination,
electrocardiogram, blood pressure) * Neurological examination
(physical examination)
B 80% refund
- Medical practitioner or specialist fees
Please refer to footnote below

Prescribed physiotherapy Full Refund

Sleep apnoea treatment Full Refund

Vaccinations (for insured members aged 18 and younger) Full Refund

B 80% refund
- Vaccination (professional fee)
Please refer to footnote below

A These benefits are grouped and are subject to a combined limit of US$ 38,150
B These benefits are grouped and are subject to a maximum co-payment of US$27.
These benefits are grouped and are subject to a 20% co-payment.

NOTESHospital network
.
.
The name of the provider network applicable to your cover is indicated on your personal Access Card and a list
of the medical providers included in your network was issued with your membership pack.
.
.
Your provider network includes a large number of clinics/hospitals and pharmacies that have contractual
arrangements in place with us. Upon presentation of your Access Card (plus a Pharmacy Services Claim
Form, in the case of pharmacies) each of these clinics/hospitals and pharmacies will provide their services and
products without seeking immediate payment from you, unless the prescribed treatment is specifically excluded
under your policy.
.
.
Please note that under some benefits, cover may be available on a reimbursement basis only, i.e. you will have
to pay for eligible treatments and then complete and submit a Claim Form. For further details please refer to
“Getting treatment” section of the “Quick start guide” which is attached to the end of your Employee Benefit
Guide.
.
.
Pre-authorization
.
For certain benefits listed in your Table of Benefits, you are required to submit a completed Pre-authorization
Form in advance of receiving your treatment. Following approval by us, cover can then be guaranteed. In the
Table of Benefits, benefits which require pre-approval through submission of a Pre-authorization Form are
indicated by either a 1 or a 2.
.
Policy number: P002438781 Page 4 of 7

Orient Insurance PJSC, 02a Orient Building, Al Badia Business Park, Dubai Festival City, P.O. Box 27966, Dubai, United Arab Emirates.
.
If you choose to be treated within your provider network, then your medical provider will automatically deal with
us directly for Pre-authorization, where necessary.
.
.
However, where you choose to be treated outside of the provider network, you will need to ensure that you
contact us for the necessary Pre-authorization. Full details of our Pre-authorization process are provided in the
Employee Benefit Guide issued at policy inception. Please note that:
.
.
•If Pre-authorization is not obtained for the benefits listed with a 1, we reserve the right to decline a claim. If
the respective treatment is subsequently proven to be medically necessary, we will pay only 80% of the eligible
benefits.
.
•If Pre-authorization is not obtained for the benefits listed with a 2, we reserve the right to decline a claim. If
the respective treatment is subsequently proven to be medically necessary, we will pay only 50% of the eligible
benefits.
.
•In the case of an emergency, you don’t need to submit the Pre-authorization Form in advance but we should be
informed within 48 hours of the event to ensure that no Pre-authorization penalty apply to your claim.
.
.
For further details please refer to our Benefit Guide, or simply contact our Helpline.
.
.
Chronic conditions
.
Chronic conditions are covered within the limits of the selected plan during the Insurance Year.
.
.
Pre-existing conditions
.
Pre-existing conditions are covered within the limits of the selected plan during the Insurance Year.
.
.
Benefit limits
.
There are two kinds of benefit limits shown in the Table of Benefits. The maximum plan benefit , which applies
to certain plans, is the maximum we will pay for all benefits in total, per member, per Insurance Year, under that
particular plan. Some benefits also have a specific benefit limit , which may be provided on a "per Insurance
Year" basis, a "per lifetime" basis or on a "per event" basis, such as per trip, per visit or per pregnancy. Where
a specific benefit limit applies or where the term "Full refund" appears next to certain benefits, the refund is
subject to the maximum plan benefit, if one applies to your plan(s). All limits are per member, per Insurance
Year, unless otherwise stated in your Table of Benefits.
.
.
Policy terms and conditions
.
Your Table of Benefits provides an outline of the cover we provide under each plan. Cover is subject to our
policy terms and conditions, as detailed in our Employee Benefit Guide which is issued to members upon policy
inception.
.
.
Policy endorsement(s)
.
If there are any policy terms and conditions unique to your policy they will be listed below. Please read carefully
in conjunction with our Employee Benefit Guide.

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Orient Insurance PJSC, 02a Orient Building, Al Badia Business Park, Dubai Festival City, P.O. Box 27966, Dubai, United Arab Emirates.
.

The Employee Assistance Programme Services are made available through AWP Health & Life Services
Limited (“AWP”) and provided by Morneau Shepell Limited, subject to your acceptance of AWP’s terms and
conditions.
.
.
The Travel Security Services are made available through AWP Health & Life Services Limited (“AWP”) and
provided by red24 Operations Limited, subject to your acceptance of AWP’s terms and conditions.
.
.
The following additional definitions shall apply:
.
.
Living donor medical costs refer to donor medical expenses for organ transplants carried out as in-patient or
day-care treatment It also includes all necessary testing to determine compatibility, once a potential donor has
been identified. Costs will be covered only in cases where the member is the recipient of the donor organ.
.
.
Sleep apnoea is a sleep disorder characterized by pauses in breathing or periods of shallow breathing during
sleep. If “Sleep apnoea treatment” is indicated in your Table of Benefits, we will provide cover for the medical
necessary treatment and diagnostic procedures related to a confirmed or suspected sleep apnoea diagnosis.
The costs which are covered under this benefit include professional fees, a medical necessary sleep study,
other necessary diagnostic tests, medical aids and drugs, up to the limits indicated on your Table of Benefits.
Please note that prove of the medical necessity is required.
.
.
The following amended exclusion shall apply:
.
.
Treatment of sleep disorders, including insomnia, narcolepsy, snoring and bruxism. Sleep apnoea treatment
is not covered, unless this is listed as a specific benefit in your Table of Benefits.
.
.
The following existing exclusion shall not apply:
.
.
Complementary treatment, with the exception of those treatments indicated in the Table of Benefits.
.
.
The following amended definitions shall apply:
.
.
Complementary treatment refers to therapeutic and diagnostic treatment that exists outside the institutions
where conventional Western medicine is taught.
.
.
Medical necessity refers to medical treatment, services or supplies that are determined to be medically
necessary and appropriate. They must be:
.
a.Essential to identify or treat a patient's condition, illness or injury.
.
b.Consistent with the patient's symptoms, diagnosis or treatment of the underlying condition.
.
c.In accordance with generally accepted medical practice and professional standards of medical care in the
medical community at the time. This does not apply to complementary treatment methods if they form part of
your cover.
.
Policy number: P002438781 Page 6 of 7

Orient Insurance PJSC, 02a Orient Building, Al Badia Business Park, Dubai Festival City, P.O. Box 27966, Dubai, United Arab Emirates.
d.Required for reasons other than the comfort or convenience of the patient or his/her physician.
.
e.Proven and demonstrated to have medical value. This does not apply to complementary treatment methods if
they form part of your cover.
.
f.Considered to be the most appropriate type and level of service or supply.
.
g.Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for the
treatment of a patient’s medical condition.
.
h.Provided only for an appropriate duration of time.
.
As used in this definition, the term “appropriate” shall mean taking patient safety and cost effectiveness into
consideration. When specifically applied to in-patient treatment, medically necessary also means that diagnosis
cannot be made, or treatment cannot be safely and effectively provided on an out-patient basis.
.
.
.
Hospital network: Standard Plus Network
.
.
Treatment inside your country of residence but outside of the network is subject to a 20% co-payment
by the member
.
.
Alternative Out-patient co-payments:
.
.
• HOSPITALS: 20% co-payment from the member for all OP services.

Contact details

Should you have any questions or require any assistance, please do not hesitate to email us at:
middleeast.services@international-healthcare.com. Alternatively, our Helpline is available on: 800 6334 (toll-free
from the UAE) or on: + 971 56 681 9977 (from inside or outside the UAE).

Policy number: P002438781 Page 7 of 7

Orient Insurance PJSC, 02a Orient Building, Al Badia Business Park, Dubai Festival City, P.O. Box 27966, Dubai, United Arab Emirates.