51 MD1 2023 000136

Group Medical Insurance policy

M/S:- Relief International (RI) - Yemen

Contract No.: 51MD1000136/2023

1
 51 MD1 2023 000136

Table of coverage within the hospital – In-patient Benefits

Level VIP
The highest annual limit per person $ 100,000
The highest annual limit per case for each $ 20,000
medical condition
Accommodation level in the hospital First Class
Accommodation First Class (Private Room) covered
Accommodation room rate per day (According to
the approved rate)
The intensive care unit and treatment of coronary
artery disease
Surgeon and anesthesiologist fees
Hospital services (surgery, operating room,
anesthesia, drugs, laboratory tests, radiotherapy,
etc.)
Doctor visits related to the main reason that made
the patient to enter the hospital Full Coverage 100%
Ambulance services in case if it is medically
necessary
Cost of accommodation for the accompanying
person insured under the age of 18 years
Special nursing care if it is medically necessary
with a ceiling of $ 2500
The cost of autopsy in case of death of the
insured person after entering the hospital and
during her/ his stay in the hospital due to injury
or physical illness

2
 51 MD1 2023 000136

Treatment coverage’s schedule for medical services outside of hospital:

This coverage includes medical costs for treatment of non-exempted medical conditions within the
limits of the coverage schedule as follows:

1. Medical Consultation:
This coverage is valid for non-exempted medical conditions requiring doctor’s review, any
diagnostic tests, and / or medicines and / or a natural treatment. This coverage represents the
payment of the paid medical consultation specified in the contract schedule.
2. Diagnostic Tests:
this coverage is valid as it’s specified in the contract’s schedule in non-exempted conditions
requiring diagnostic testing, including the following:
a. Radiology.
b. Laboratory.
c. Magnetic resonance imaging (MRI).
d. CT scan.
e. Cardiac catheterization, cardiac imaging echo, cardiac examination and control effort
ECG (Holter) and any other catheter or (Colored) imaging.
f. All kinds of endoscopy for: bladder, colon, stomach, knee, and any endoscopy diagnostic
or therapeutic purposes.

3. Medicines:
This coverage is valid as specified in the contract schedule in non-exempted medical
conditions requiring pharmacological treatment. Drug therapy includes all medicines and
vitamins recognized as treatments.

4. Physical Therapy:

This coverage is valid as specified in the contract schedule in non-exempted medical

conditions requiring rehabilitation through physiotherapy sessions determined by the treating
physician.

3
 51 MD1 2023 000136

Outpatient Coverage Schedule – Out-patient Benefits

Level VIP
The highest annual coverage amount per person, $ 10,000
pregnancy, and postnatal care
Number of outpatient reviews per person per year Unlimited

Doctor Consultation
Medicines
Diagnostic procedures (laboratory tests, endoscopes)
Ray, CT imaging, magnetic resonance imaging …
etc.
All catheters types
Physiotherapy – Number of sessions per year
Emergency dep. Visit (Diagnostic and non-
diagnostic procedures)
Ambulance services in case if it is medically 90% covered
necessary
Emergency dep. visit (medicines, laboratory, rays)

Pregnancy and Childbirth’s Benefits:

Level First
Natural childbirth Covered with limit of $ 3,000
Cesarean Section Covered with limit of $ 4,000
Legal Abortion $ 2,000
Nursery $ 3,000

4
 51 MD1 2023 000136

The above limits include maternity expenses and its complications just once a year.
Additional Benefits Schedule:
As it is understood and agreed the above coverage should not exceed the limits as it is mentioned in the insurance
contract, but the insurance company agrees to provide the following additional coverage:

1. Waiting period will be canceled for all the insured persons.

2. Bone fragility is covered except nuclear medicine and these cases that arise before or after the onset of
insurance.
3. Extracorporeal shock wave lithotripsy (ESWL).
4. Mammogram screening that linked with the cases surgical intervention.
5. Benign tumors and related treatments including surgical intervention.
6. Ophthalmopathy and routine sclera surgeries not related to the correction of the visual acuity. Also the insurance
covers squint but it has to be certified by medical report for all employees.
7. Circumcision within the ceiling of pregnancy and childbirth insurance coverage.
8. Newborns examination within the limits of pregnancy and childbirth and insured cases.
9. Strokes and complications.
10. Allergies.
11. Vitamins and calcium that related to pregnancies and these cases which is covered by insurance coverage.
12. Folic acid, iron, and its family are covered for pregnancy and the other cases that covered in the insurance
coverage.
13. Hemorrhoids, hemorrhoids and anal sphincter.
14. Tonsillitis, musculoskeletal, therapeutic deviation and nasal sinuses.
15. Needs and treatments related to headache.
16. Fibroids, hysterectomy and uterine lining.
17. Varicose veins, varicose veins and pelvis (water bags).
18. Back pain treatment and its surgery.
19. Cataract operations and high eye pressure.
20. All previous insurance cases will be covered and psychiatric treatment for all current and subsequent employees
and chronic diseases.
21. Heart diseases and coronary arteries.
22. Genetic hereditary diseases such as sickle cell anemia and thalassemia.
23. Glands disorders such as thyroid disorders.
24. Endocrine diseases such as diabetes.
25. Bleeding disorders such as: platelet deficiency and hemophilia.
26. Liver diseases and inflammation A and B.
27. Non communicable and communicable diseases.

5
 51 MD1 2023 000136

Additional Benefits Schedule:

Level VIP
Benefit of glasses (Frames and lenses) Covered up to $ 200
Teeth (Extraction, decay, nerve filler pull Covered up to $ 700
the gum treatment)
chronic diseases per Person Per Month (Chronic Medicines)Covered up to $ 200
Note: Follow-up of chronic and pre-insurance conditions is
covered within a roof outside the hospital per month.
Pre/existing and chronic Covered
Treatment outside Yemen  Medical treatment outside Yemen it’s just for
intractable condition with the prior approval
of the insurance company.
 Travel approval it is just under intractable
condition and when the medical treatment is
unavailable in Yemen. Also it has to have a
prior approval from the insurance company
and this medical treatment should be in the
same insurance coverage of the insurance
company.
Public Hospital
Corpse Transportation Cost The cost of transporting the body from the country
where she / he died to Yemen in case of death due
to a covered disease in the insurance.
Physicians Consultants Visiting Covered with the insurance limits and within the
insurance network.

6
 51 MD1 2023 000136

Additional Benefits Schedule: _

Class VIP ‫الذرجت‬

Pre/existing and chronic Covered ‫األيشاض انسابقة ٔانًزيُة‬
Treatment outside Yemen
Medical treatment outside Yemen it's just for Intractable
:‫العالج خارج اليمه‬
condition with the prior approval of the insurance ‫ٌكٌٕ انعالج خاسج انًٍٍ نهحاالت انًسحعصٍة‬
company, Without travel tickets. ‫ٔبًٕافقة يسبقة يٍ انششكة ارا نى ٌحٕفش انعالج‬
‫داخم انًٍٍ ٔبذٌٔ جزاكش ٔضًٍ جذٔل انُافع‬
Areas Covered :‫مىطقت التغطيت‬
All governorates of the Republic of Yemen and outside the ‫جًٍع يحافظات انجًٕٓسٌة انًٍٍُة ٔخاسج انجًٕٓسٌة انًٍٍُة‬
Republic of Yemen and (Egypt, Jordan, India) )‫(يصش ٔاألسدٌ ٔانُٓذ‬
ٍ‫انعالج خاسج انًٍٍ نهحاالت انصعبة جحث جقشٌش طبً ي‬
‫انشبكة انطبٍة ٔبًٕافقة يسبقة يٍ انششكة بذٌٔ جزاكش إرا نى‬
.ًٍٍ‫ٌكٍ ُْاك عالج داخم ان‬
Outside Yemen network :‫مىاطق التغطيت خارج اليمه‬
(Egypt, Jordan, India) )‫ انُٓذ‬، ٌ‫ األسد‬، ‫(يصش‬
General/non private hospitals :‫الذفع الىقذي الحكىمي‬
covered under the policy ‫بحذ‬ ‫يغطى فً يسحشفى حكٕيً نحانة يشًٕنة بانحغطٍة‬
( maximum 30 days) ‫ ٌٕو‬30 ‫اقصى‬
Corpse Transportation cost :‫تكاليف وقل الجثت‬
The cost of transporting the body from the country where she / he ً‫جكهفة َقم جثة انًشحشك يٍ انبهذ انزي جٕفً فٍّ انى انًٍٍ ف‬
died to Yemen 2500$ ِ‫خال ٔفاجّ يٍ جشاء يشض يشًٕل بانحغطٍة أ َقهّ انى بهذ‬
.‫ دٔالس‬2500 ‫ارا كاٌ غٍش ًًٌُ بسقف‬
Additional Benefits From CAC Insurance ‫التغطياث اإلضافيت الممىىحت مه شركت كاك للتأميه‬
Benefit limit ‫المىفعت‬
Covered with limit $6,000per person. ‫زراعت األعضاء‬
Organ Transplant ‫ دوالر للشخص الىاحذ‬6000 ‫مغطاة بحذود‬
Cancer Treatment Covered with limit $6,000per person. ‫معالجت السرطان‬
‫ دوالر للشخص الىاحذ‬6000 ‫مغطاة بحذود‬
Hearing Aids Covered with limit $400 per person. ‫السماعاث الطبيت‬
‫ دوالر للشخص الىاحذ‬400 ‫مغطاة بحذود‬
Covered with limit $4,000per person. B & C ‫التهاب الكبذ الفيروسي‬
Hepatitis B&C ‫ دوالر للشخص الىاحذ‬4000 ‫مغطاة بحذود‬
Covered with limit $4,000per person. ‫الفشل الكلىي والغسيل الكلىي‬
Renal failure and dialysis ‫ دوالر للشخص الىاحذ‬4000 ‫مغطاة بحذود‬

Industrial limbs
Covered with limit $4,000per person. ‫األطشاف انصُاعٍة‬
‫ دوالر للشخص الىاحذ‬4000 ‫مغطاة بحذود‬
Covered with limit $4,000per person.
Congenital Disease ‫األيشاض انخهقٍة‬
‫ دوالر للشخص الىاحذ‬4000 ‫مغطاة بحذود‬

7
 51 MD1 2023 000136

Medical Plan Exclusions:

1. Self-inflicted injury, dangerous Sports injuries, biologic disasters and epidemic disease and War
injury.

2. Cosmetic or plastic surgery unless necessitated by accidental bodily injury occurring while insured ,
surgery for errors of refraction , Squint , bariatric surgery , alopecia , hair fall , vitiligo , skin
discoloration and any cosmetic preparation not approved as medical drug.

3. Non prescribed drugs , traditional medicine and vaccination.

4. Examinations for check-up purposes not incidental to, or necessary to diagnose illness or accidental
bodily injury; general health examinations , investigations and treatment of infertility , contraceptive
and Rest cures.

5. treatment of alcoholism and drug addiction.

6. Venereal diseases, infertility , impotence, abnormal hormonal disturbance and sterility disorders.