ADNIC Medical Insurance Policy

Plan: Class 1: Adnic standard Gold (CAT A - AUH)

Policy No: 11420 - 1

Between

Abu Dhabi National Insurance Company

And

Policyholder: MOHAMED BIN ZAYED UNIVERSITY OF ARTIFICIAL INTELLIGENCE

DOH REF:NO:
Class 1 42930

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 Medical Insurance Policy
This Policy is entered on 18/11/2021 by and between:

Abu Dhabi National Insurance Company, a Public Joint Stock Company, incorporated in the United Arab
Emirates and duly registered in the United Arab Emirates as an insurance company under the United
Arab Emirates insurance Authority having its registration number 1, with registered offices at ADNIC
Building Khailfa Street, P.O.Box 839, Abu Dhabi, United Arab Emirates (hereinafter referred to as "the Insurance
Company")
AND
M/s MOHAMED BIN ZAYED UNIVERSITY OF ARTIFICIAL INTELLIGENCE (hereinafter referred to as 'the
Policyholder')

The Policyholder agrees to enter into this Policy with the Insurance Company in order to be provided with a
Group Medical Insurance Scheme coverage (hereinafter referred to as "the Group") whereby, in return for
payment of initial premium and subsequent premiums falling due during Policy term by the Policyholder, the
Insurance Company will pay benefits in accordance with the Table of Benefits, Additional Benefits, other
Provisions and Exclusions (as set out in this Policy) for all insured persons under this Group as per Eligibility
Conditions.

The Policyholder will ensure that copies of the Table of Benefits, Exclusions and Additional Benefits/Provisions as
currently applicable to members of the Group, and as varied by the effect of any specific provisions in this Policy,
will be notified and made available to Group members at all times. The Policyholder indemnifies the Insurance
Company against all costs, losses or damages sustained by the Insurance Company in relation to any present or
or former Group Member or Eligible Dependant, or any third party in consequence of the Policyholder's failure to
comply fully with this requirement.

Cover excludes all treatments and limits recoverable under any other policy/ies that might be valid at the time
medical expenses are incurred. However, excess amounts that exceed limits under such policies can be recovered
under this Policy subject to provisions, conditions and limitations here within.

Premiums and Benefits:

The Policyholder undertakes to pay on the date hereof and thereafter on each due date the Premiums set out in
Point no. 8.7 under Section VIII as may be amended from time to time. In the event of any Premiums due from the
Policyholder remaining unpaid during any year, the Insurance Company shall have the right to defer payment of
any claims for costs incurred during that year until it has received the outstanding Premiums in full.

Period of Cover:
Period of cover is from 18/11/2021 to 17/11/2022

Signed on behalf of /
ABU DHABI NATIONAL INSURANCE COMPANY

Signed on Behalf of/

MOHAMED BIN ZAYED UNIVERSITY OF ARTIFICIAL INTELLIGENCE

Dated: ……………………………

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 Policy Document Contents:
Section 1 : Definitions 4

Section II : General Provisions 10

Section III : General Terms and Conditions 14

Section IV : Enrolment & Effective Date of Coverage 19

Section V : Termination of the Policy 22

Section VI : Benefits Table 24

Section VII : Additional Benefits 26

Section VIII : Premiums 30

Section IX : Procedure for Obtaining Benefits 32

Section X : Reimbursement Procedure 34

Section XI : Audit 35

Section XII : Disclosure of Material Facts & 35

Misrepresentation

Section XIII : Standard Exclusions for Department 35

of Health – Abu Dhabi

Section XIV : Healthcare Services outside the Scope 36

of Health Insurance

Section XV : Standard Exclusions for Dubai Health 39

Authority

Section XVI : Healthcare Services outside the Scope 40

of Health Insurance

Exclusion of Certain Medical Facilities

Section XVII: 44
(Excluded Providers):
Section XVIII : Short Period Rating Schedule 45

Section XIX : Irrevocable Undertaking & Authorization 46

Section XXI: Appendix 47

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 Section I
Definitions

This section, which is in accordance with the mandatory health insurance law, by-laws, and all its related circulars,
defines the terms used throughout this Policy and is not intended to describe Covered or Uncovered services.

1.1 The Insurance The first party to this Policy licensed by DOH or DHA and UAE Local Authorities to operate in
Company the field of health insurance scheme in the Emirates of Abu Dhabi and the UAE. Entity
that assumes the coverage of risks subject to this Policy.

1.2 Policyholder The policyholder refers to contractual party, that is the employer or other legally
constituted group to whom the Policy is issued.

1.3 Authority Department of Health (DOH), Dubai Department of Health(DHA) or any other Competent
Regulatory Authority

1.4 Insured Member Either the Primary Insured or an enrolled Dependent mentioned in the policy docum-
ent while Coverage of such person under the Policy is in effect.

1.5 Dependent Any employee who has dependents shall be eligible for dependents insurance on the
date become insured or on the day the employee first acquires such dependent. The
term dependent refers only to the primary insured's legal spouse, and unmarried
dependent children under the age of 21. The principal place of residence of the legal
spouse and the unmarried dependent children must be with the Primary Insured
unless the Insurance Company approves other arrangements. The Policyholder and
the Primary Insured shall be jointly liable to reimburse the Insurance Company for any
Health Services provided to Dependents at a time when the Dependents did not satisfy
these conditions.

1.6 Primary Insured An Insured Member (other than the Dependent) who is properly enrolled for Coverage
under this Policy.

1.7 Enrolled
Dependent A Dependent who is properly enrolled for Coverage under the Policy.

1.8 Enrollment Date The original effective date of Coverage for an Insured Member.

1.9 Active at Work An employee who is employed on a full-time basis by the Policyholder and is currently
being paid a full-time salary, or is on formal paid or unpaid leave from the Policyholder.

1.10 Coverage The entitlement by an Insured Member to health services provided under the Policy,
subject to terms, conditions, limitations, and exclusions of the Policy. Health services
must be provided when the Policy is in effect prior to the date that any of termination
conditions of Section V occur, and when the Insured Member meets all eligibility
requirements specified in the Policy.

1.11 Insurance Card The identification card that the Insurance Company issue to every Insured Member
covered under the Policy that identifies him/her as eligible for Coverage.

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1.12 Premium Premium refers to the specified amount to be paid periodically by the Policyholder to
the Insurance Company for each Primary Insured and each Enrolled Dependent in
exchange for receiving Coverage for a defined period of time in accordance with the
terms of the Policy.

1.13 Amendment Any attached description of additional or alternative provisions to the Policy.
Amendments are effective only when signed by the Insurance Company.
Amendments are subject to all conditions, limitations and exclusions of the
Policy except for those, which are specifically amended.

1.14 Additional Any attached description of health services covered under the Policy or alternative
Benefits provisions to the Policy. Health services provided by Additional Benefits may be
subject to payment of additional Premium. Additional Benefits are effective only when
signed by the Insurance Company and are subject to all conditions, limitations and
exclusions of the Policy except for those, which are specifically amended.

1.15 Policy This document shall include the Corporate / Individual Policy, and all endorsement
forms, Amendments and Additional Benefits which constitute the agreement regard-
ing the Coverage, exclusions and other conditions between the Insurance Company
and the Policyholder.
The application form signed by the Policyholder or the Insured Member should be
considered as an integral part of the Policy.

1.16 Policy Period The period between commencement date and expiry date as specified in the policy
document.

1.17 Effective Date The date the coverage becomes effective, which may be either the enrollment date of
(Inception Date) an Insured Member or the date on which coverage commences.

1.18 Medical Facility/

Entity providing Hospital, Clinic or any other facility or individual licensed by DOH or DHA or by any other
Healthcare Services Competent Regulatory Authority to provide Healthcare services in the United Arab Emirates.

1.19 Network An entity licensed by DOH or DHA or by other Competent Regulatory Authority within the
Providers United Arab Emirates operating in Abu Dhabi or the UAE providing Healthcare Services to
beneficiaries on a direct billing basis at a pre-agreed tariff or on the basis of DOH's
Mandatory Tariff or any other Competent Regulatory Authority Mandatory
Tariff. The Insurance Company at its sole discretion has the right to change the
participation status of Providers from time to time and the Network providers'
status will be updated regularly according to the changed status.

1.20 Excluded Medical Facilities whose Health Services are excluded from the Coverage under this Policy.
Providers The Insurance Company is unconditionally entitled at its sole discretion to exclude the
Health Services of any Medical Facility from the Coverage under this Policy at any time.
The Insurance Company shall publish and keep updated a list of all Excluded Providers at its
website (www.adnic.ae) and at its mobile application (ADNICPlus).

1.21 Deductible and Deductible- Having regard to the rules, a fixed monetary amount stated in the sche-
Co-payment dule of Benefits or the Membership card which a Beneficiary is required to pay to the

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 Provider when receiving Healthcare Services under the schedule of benefits or
deducted by the Insurance Company when settling reimbursement claims. This is
applicable to all consultations including maternity and dental. Co-payment- The
percentage stated in the Schedule of Benefits or the membership card which a Benefi-
ciary is required to pay directly to the Provider or deducted by the Insurance Company
for reimbursement claims each time a certain type of Health Services is received.
Overseas coinsurance is applicable on top of standard inside network deductible i.e.
Standard inside network deductible will apply and then overseas coinsurance
applies on the net amount. Coinsurance applies on maternity medications and any
medication except dental medication which is subject to dental coinsurance.

1.22 Benefit package The extent or degree of Coverage of Healthcare Services forming Standard Table of
Benefits and Additional Benefits that Insured Members are entitled to receive based on
this Policy.
In case of benefits upgrade or downgrade after policy inception date, the Policyholder
is liable for any expenses may arise out of the originally agreed benefits.

1.23 Claim Form A form which must be completed by attending physician in order for the Insured
Member to obtain Coverage

1.24 Prior Approval/ The process by which the Providers submit request to the Insurance Company prior to
Authorization admitting / registering a patient on an inpatient or outpatient basis with respect to
those Healthcare Services that require pre-authorization under the Schedule of Benefits
and/or provider manual. The information contained in the prior Authorization request
defined by the prior Authorization transaction set defined by DOH or DHA or
any other Competent Regulatory Authority

1.25 Pre- A form that must be completed by the attending physician of the Insured Member and
Hospitalization Form approved by the Insurance Company prior to hospitalization.

1.26 Physician Any practitioner of medicine who is duly licensed and qualified under the law of the
country in which treatment is received.

1.27 Out- Patient Out-Patient refers to procedures of Health Care Services and Supplies which do not
medically necessitate Hospitalization before, during and/or after the procedure.

1.28 Pharmaceuticals Pharmaceuticals which can only be obtained through a prescription written by a
/Prescribed Drugs licensed Physician. Medications not registered and medications related to excluded
medical conditions are not covered. Imported drugs are covered only if the ministry of
health approves the drug.

1.29 Emergency A medical or behavioral condition, the onset of which is sudden, and manifests itself
by symptoms of sufficient severity, including severe pain, that a prudent layperson,
possessing an average knowledge of medicine and health, could reasonable expect
the absence of immediate, medical attention to result in:
(a) placing the health of the person afflicted with such condition in severe jeopardy,
or, in the case of a behavioral condition placing the health of such person or others
in serious jeopardy, (b) serious impairment to such person's bodily functions;
(c) serious dysfunction of any bodily organ or part of such person; or (d) serious

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 disfigurement of such person.

1.30 Non- Emergency Any confinement which is not as a direct result of Emergency Health Services.
Hospitalization

1.31 Medically Healthcare Services that a Physician, exercising prudent clinical judgment, would
Necessary provide to a patient for the purpose of evaluating, diagnosing or treating an illness,
injury, disease or its symptoms, and that are:
- In accordance with the generally accepted standards of medical practice;
- Clinically appropriate, in terms of type, frequency, extent, site and duration, and
considered effective for the patient's illness, injury or disease; and
- Not primarily for the convenience of the patient or Physician, or other Physician, and
not more costly than an alternative service or sequence of services at least likely to
produce equivalent therapeutic or diagnosis results as to the diagnosis or treatment of
that patient's illness, injury or disease.
For these purposes, " generally accepted standards of medical practice" means:
-Standards that are based on credible scientific evidence published in Peer reviewed,
medical literature generally recognized by the relevant medical community.

-The views of Physicians practicing in the relevant clinical area; and

-Any other relevant factors

1.32 Day Care Shall mean the treatment / surgery carried out in a licensed hospital or day-care
Treatment/ Out facility and the patient is medically expected to remain confined for 6 to 12 hours in
Patient Surgery the day care section of the facility even if the patient remains in the facility past midnight.

1.33 In-Patient Inpatient is the patient who needs a treatment for which, for medical reasons, the
patient has to be admitted to hospital for more than 12 hrs. All In-patient treatments
are subject to Insurance Company's prior approval.

1.34 Geographical Are the geographical limits within which treatment may be covered under the Policy
Area (Territorial Limit) and are stated in the Table of Benefits.

1.35 Accident Refers to a sudden, unforeseen, unexpected, unintended event involving an external
force or impact to the body causing a severe physical bodily injury, which is usually
visually identifiable, and is documented by a competent authority such as law
authority such as law enforcement officer or Physician.

1.36 Pre-existing Any known/unknown Medical Condition which with reasonable medical certainty
Condition existed at the time of application for this Policy was made, whether or not previously
manifested or symptomatic, diagnosed, treated or disclosed prior to Effective Date,
including any subsequent, chronic or recurring complications or consequences related
thereto or arising there from.

1.37 Undeclared Pre- Any Pre-existing condition known to the Insured Member or Policyholder, which is not
Existing Condition declared on the medical questionnaire or Policy application in case a medical under-
writing has been applied.

1.38 Waiting Period Waiting Period refers to the period after the Effective Date that the Insurance Coverage

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 does not apply for certain Health Services for an Insured Person.

1.39 Chronic Medical Any health condition which requires medical attention, monitoring, or treatment for a
Conditions fairly long term and/ or a disease, illness or injury that has at least one of the following
characteristics:
a) it continues indefinitely and/or is permanent
b) it recurs or is likely to recur
c) it requires long term monitoring, consultations, check-ups, examinations or tests.

1.40 General The health Benefits and services excluded from coverage that are listed in section XIII
Exclusions of this Policy and apply to all Insured Members.

1.41 Annual Limit Shall mean the cumulative value of Benefits payable in respect of expenses incurred for
treatment provided to the Insured during the period of insurance.
Annual limit of emergency evacuation and repatriation is not included in the overall
annual limit of the policy.

1.42 Elective Elective treatment is that which does not need to be performed immediately and can
Treatment be scheduled for planned date because it does not involve a medical emergency.

1.43 Kidney Dialysis Dialysis treatment which is initiated at the end stage kidney failure presenting as
treatment chronic and irreversible failure of both kidneys to function.
(Haemodialysis/
Peritoneal Dialysis)

1.44 Second Medical Insurance Coverage for certain Health Services as Network Health Services may require
Opinion that the Insured Member consults a second Network Physician prior to the scheduling
of the Health Service. The Insurance Company will notify the Insured Member that a
particular Health Service is subject to a second opinion policy and will inform the
Insured Person of the required procedure for obtaining a second opinion at the
Insurance Company's expense.

1.45 Psychiatric
treatment Diagnosis, treatment, and prevention of mental disorders

1.46 Psychological The evaluation, assessment, amelioration, treatment, modification, or adjustment to a

Counseling Services disability, problem, or disorder of behavior, character, development, emotion,
personality or relationships by the use of verbal or behavioral methods with individ-
uals, couples, families or groups in private practice, group, or organized settings;

1.47 Visiting Doctor A medical doctor (typically from abroad) who works temporarily for a hospital in the
country or who uses temporary the operating theatre and/or the health facilities of a
hospital in the country,

1.48 Oral and Surgery related to diseases and injuries in the head, neck, face, jaws and the hard and
maxillofacial surgery soft tissues of the oral (mouth) and maxillofacial (jaws and face) region. Excluding any
cosmetic related procedures.

1.49 Dietitian Provide nutrition therapy to patients with a variety of health conditions, and provide

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Consultation dietary consultations to Insured Members

1.50 In-patient cash Payment of fixed flat amount as specified in the policy Table of Benefit against free

benefit (where In-patient medical services incurred in relation to non excluded medical condition.
treatment if free of charge)

1.51 ‘Home country’ Is the country of which the Insured has the nationality and is holding a passport.

Dietitian means advising and training of an Eligible Person through a health care
1.52 Dietician professional in diet programs, e.g. for diabetes treatment or weight control. Coverage
is given up to a maximum as described in the Schedule of Benefits.

1.53 Diabetic
Diabetic consumables include strips, syringes/ needles, lancets & swabs.
Consumables

A dental prosthesis is an intraoral prosthesis used to restore intraoral defects, which

1.54 Dental Prosthesis
includes dentures, crown, bridges and Dental implant

Routine dental check up includes the following, once per year:

-Consultation
1.55 Dental Check up - X-Ray,
- Scaling & Polishing.

Rehabilitation means a clinical program for the restoration of the health status of an
Eligible Person after a hospital stay. Coverage is only given if the rehabilitation is
1.56 Rehabilitation
depending on non-excluded conditions and if it is conducted in a medical facility.
Coverage is given up to the maximum limit as described in the Schedule of Benefits.

Medical equipment used externally from the human body which: (1) can withstand
1.57 Medical Equipment repeated use; (2) is not designed to be disposable; (3) is used to serve a medical
and Medical Appliances purpose; and (4) is used outside the Hospital.

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 DOH/DHA has specified a minimum level of benefits that must be provided in any
health Insurance plan offered in the Emirate of Dubai
A small number of companies have met additional requirements and have been
awarded Participating Insurer (“PI”) status. This allows them to sell what is known as
1.58 Essential Benefits Plan
the Essential Benefits Plan (“EBP”).
Only these companies can provide health insurance solutions for the pool of lower
salary workers. These are defined as those workers with a gross salary of 4,000 AED
per month or less

Any Health Insurance Plan which offers benefits that are significantly more
1.59 Enhanced Products
comprehensive than those required by the EBP is known as an Enhanced Product.

Third Party Administrator (TPA) is an organization that manage the network, processes
1.60 Third Party
claims and performs other administrative services in accordance with a service
Administrator
contract with ADNIC

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 Section II
General Provisions

The following are regulated by the Mandatory Health Insurance Law for the Emirate of
Abu Dhabi No. (23) of 2005 and its Implementing Regulation Decision No. 25 of 2006
and its Circulars and by any other Competent Regulatory Authority.

2.1 Entire Policy The insurance contract issued to the Policyholder, including the Policyholder's
application, any individual Primary Insured or Dependent applications and health
questionnaires, amendments and riders and the most current member booklet
constitute the Entire Policy.

2.2 Administrative The services and reporting necessary to administer this Insurance Policy, and the
Services and Reporting Coverage provided under it will be provided in accordance with the Insurance
Company's or its designee's most current standard administrative procedures. In case
the Policyholder requests certain administrative services or reporting in a manner not
in accordance with these standard procedures, and such services are agreed to by the
Insurance Company, the Policyholder shall pay for such services or reports at
Company's or its designee's then current charges for such services or reports

2.3 Limitation of If a dispute between the Insurance Company and the parties (includes Policyholder
Action and / or the Insured Member) arises out of or is related to this Policy, the concerned
Party and the Insurance Company shall meet and negotiate in good faith to attempt to
resolve the dispute.
In case the Parties are not able to resolve the dispute between themselves, the dispute
shall be submitted to DOH or DHA or any other Competent Regulatory Authority. for
an amicable settlement, and any other dispute resolution procedures shall be of
no force and effect unless and until the complaints procedure set out in DOH
or DHA or any other Competent Regulatory Authority. has been exhausted. If the dispute
or conflict is not resolved in accordance with the paragraph here- above, unless
otherwise agreed between both Parties, all disputes shall be referred to and
determined by the Abu Dhabi Courts, which shall have exclusive jurisdiction to settle any
dispute arising out of or in connection with the Policy. If legal proceedings or actions
against the Insurance Company are not brought within three years of the date the
Insurance Company notifies the other party of its final decision, the right to bring any action
against the Insurance Company is forfeited.

2.4 Relationship This Policy is an agreement between the Insurance Company and the Policyholder
among Parties solely. This means also that:
2.4.1. Only the Insurance Company and the Policyholder have legal rights under this
Policy and they only can enforce it; and
2.4.2. That this Policy creates no legal relationships between for instance:
The Insured Members and the Insurance Company or the Insurance Company
and any Health Care Providers or Network Providers;
2.4.3. The Policyholder is solely responsible for written declaration of any new Eligible
Member and Eligible Dependent for Insurance Coverage, and of changes
or termination in eligibility under this Insurance Contract.
2.4.4. The Policyholder is solely responsible for notifying Insured Members of the
terms and conditions, and if applicable their changes and the termination

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 of this Policy or the Coverage.
2.4.5. The relationship between a Provider and any Insured Member is that of Provider
and patient in which Insurance Company is not a party in whatever way.
The Insurance Company is not responsible in whatever way for services
provided by a Provider to an Insured Person.
Providers or Network Providers are not agents, designees or employees of the
Insurance Company.

2.5 Amendments and Any changes in Coverage, Category, Policy Benefits, Riders and Amendments to the
Alterations Policy made by the Insurance Company in accordance with the Mandatory Health
Insurance law in the Emirates of Abu Dhabi No. (23) of 2005 and its implementing
Regulation Decision No. (25) of 2006 and its related circulars and any other Competent
Regulatory Authority authorities are effective with date of the respective Laws or upon
signature by an authorized officer of the policyholder or as agreed Mutually by Both Parties
or on renewal, whichever is applicable.
No changes will be made to the Policy unless it is made by an Amendment or a
Rider, which is signed by both Parties. No agent has authority to change the Policy or
to waive any of its provision. Health Services provided by a Rider maybe subject to
payment of additional Premiums.

2.6 Information and The Policyholder and/or Insured Persons must furnish to the Insurance Company in a
Records timely fashion all information and proofs which it may reasonably require regarding
any matters pertaining to the Policy. The Policyholder should notify the Insurance
Company of any change in address or employment status of any Insured Person within
31 days of the change. By accepting Insurance Coverage under this Policy, Insured
Members (including Insured Dependents) authorize and direct any person or institu-
tion that has provided services to Insured Members, to furnish the Insurance Company
any and all information and records or copies of records relating to the services
provided to the Insured Member. The Insurance Company has the right to request this
right to request this information whenever reasonably required. The Insurance
Company agrees that such information and records will be considered confidential.
The Insurance Company has the right to release any and all records concerning health
care services and supplies, which are necessary to implement and administer the terms
of this Policy or for appropriate medical review or quality assessment related to this
Policy and / or the Insured Persons.
The Insurance Company or its Network Providers are permitted to charge Insured
Members reasonable fees to cover costs for completing requested medical abstracts
or forms which Insured Members have requested. Such reasonable fees shall be in
accordance with the Mandatory Health Insurance Law for the Emirate of Abu Dhabi
and/or other any other Competent Regulatory Authority
In some cases, the Insurance Company will designate other persons or entities to
request records or information from or related to Insured Members and to release
those records as necessary. The Insurance Company's designees have the same rights
to this information as does the Insurance Company. During and after the term of the
Policy, the Insurance Company and its related entities may use and transfer the
information gathered under the Policy for research and analytic purposes.

2.7 Notice Any notices, formal communications, information and reports given or disclosed by
one Party to the other Party under this Policy shall be in writing, and is deemed notice

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 to all affected Primary Insured and their Enrolled Dependents in the administration of
this Policy, including termination of this Policy. The Policyholder is responsible for
giving notice to Insured Members.

2.8 Currency All Premiums paid by the Policyholder will be in the currency of UAE Dirham as
specified in the Table of Benefits.

2.9 Conformity with Any provision of this Policy that is in conflict with the requirements of governmental
UAE governmental statutes or regulations (of the jurisdiction in which delivered) shall be amended to
statutes or conform to the minimum requirements of such statutes and regulations.
regulations

2.10 Applicable Law This Policy is governed exclusively by the Laws of the United Arab Emirates.

2.11 Renewal of the The Policy is an annual contract and could be renewed for a new policy period if the
Policy Insurance Company and Policyholder agree to the renewal and is effective upon the
payment of the newly agreed Premium. The Insurance Company shall notify the
Policyholder thirty (30) days prior to the Expiry Date of the Policy that his Policy is due
to expire. Within this thirty (30) days period, the Policyholder is required to inform the
Insurance Company if he does not want to renew his Policy. The Policyholder must
ensure that renewal takes place on the day after the Expiry Date of this Policy to secure
that the Insured Members under this Policy obtain continuous coverage for Health
Services.

2.12 Clerical Error Clerical error is usually minor, inadvertent negligence in computing a figure, or
recording or copying a fact or statement and shall not deprive any Covered Member
of Coverage under this Policy or create a right to Benefits. Upon discovery of a Clerical
Error, any necessary appropriate adjustment in Premiums shall be made. However,
such adjustments in Premiums or Coverage shall occur between the Insurance
Company and the Policyholder within sixty (60) days of discovery of this error, after
such Clerical Error has been notified by the Insurance Company to the Policyholder or
vice versa.

2.13 Payment of
Stamps and Taxes The Policyholder/ Insured Member shall be liable for payment of any stamps or taxes
required by required by government entities on the provision of health care Benefits.
Government Entities
Value Added Tax "VAT" Clause
1. It is hereby declared and agreed that the insurance premium and any other
amounts due to the Insurer in relation to this insurance policy are subject to
the Value Added Tax (VAT) pursuant to the applicable laws and regulations,
and that the tax invoice to be issued by the Insurer to the Insured in relation
to the insurance premium and any other amounts due to the Insurer shall
mention the VAT amount and its percentage.

2.The Insured undertakes to pay the due VAT in accordance with the applicable
laws and regulations and to indemnify the Insurer for any damages or penalties
imposed as a result of any delay or failure to pay any VAT amounts on the due

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 dates.

3. The Insured acknowledges that failure to pay the VAT amount or any
part thereof on the due date is considered as failure to pay the insurance
premium and entitles the Insurer to terminate this insurance policy.

2.14 Medical Expert Any differences in respect of medical opinion will be settled between two medical
Arbitration experts one appointed by each of two parties to the dispute in writing. Any differences
of opinion between the two medical experts shall be referred to an Arbitrator who
shall have been appointed in writing at the outset by the two medical experts.

2.15 Subrogation Subrogation is the substitution of one person or entity in the place of another with
reference to a lawful claim, demand or right. The Insurance Company shall be entitled
to all rights of recovery for the reasonable value of services and benefits provided by
the Insurance Company to any Insured Member, from any third party or entity that
either provides or is obligated to provide Benefits or payments to the Insured Member.

2.16 Duplication of Duplication of Benefits applies when a person has health care coverage under more
Coverage than one coverage plan (including Coverage under a non-profit charity health care
program). Benefits payment will be coordinated with the other coverage according to
the standard administrative practices of the Insurance Company. Under no circumstan-
ces will an Insured Member be reimbursed for more than 100% of eligible charges
from all insurers. The Insured Member agrees to cooperate with the Insurance
agrees to cooperate with the Insurance Company in providing documentation
of benefits paid by other insurers.

The insured Member agrees to execute and deliver such documents (including a written confirmation of
assignment, and consents to release medical records), and provide such help as may be reasonably requested by
the Insurance Company.

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 Section III
General Terms and Conditions

The Specific Terms and Conditions are specific to the Policyholder and have always
priority over the General Terms and Conditions, both forming an integral part of the
the Policy.
The Insurance Company advises to read both carefully and in their entirety. Indeed, as
many provisions are interrelated, reading only part of it may not provide an accurate
understanding of the insurance Coverage, terms and conditions. Many words used in
this Policy have specific meanings as defined throughout the documents.

3.1 Health Insurance The Insurance Company offers different types of Health Insurance Plans, each with its
Plan specific insurance coverage, extensions, limitations and exclusions. The Health
Insurance Plans applicable for this Policy together with their terms and conditions are
specified in the Specific Terms and Conditions which have priority over the General
Terms and Conditions.

3.2 Insurance The object of this Policy is the provision of "Insurance Coverage" by the Insurance
Coverage Company to the Policyholder/ Insured Members which consists of paying or
reimbursing all or part of the Eligible Expenses following Health Services incurred by
or provided to an Insured Member, subject to the limitations, terms and conditions set
forth in this Policy. Payment or reimbursement of Eligible Expenses is subject to any
Deductible and/or Co-payment and limited to the amounts as specified in the Specific
Terms and Conditions. The Policyholder agrees to pay the Premiums to the Insurance
Company in exchange for receiving the Insurance Coverage.

3.3 Health Services Health services described in this section are covered when such services are Medically
Necessary and Justified,
Provided by or under the direction of a Physician or other appropriate Provider as
specifically described in Section VI ; and not excluded as described in Section XIII
"Standard Exclusion".

3.4 Network Benefits Are subject to the payment of any deductible and / or Co-payment listed in the Table
of Benefits. Network Benefits include medically necessary, emergency health services
for covered under the Policy.

3.5 Non-Network Non-Network Benefits are covered only if agreed and listed in the Table of Benefit,
Benefits otherwise only Emergency Health Services or Health Services which are approved by
the Insurance Company are covered in Non-Network. Benefits are subject to the
payment of any deductible and / or Co-payment listed in the Table of Benefits.

3.6 Out-Patient Out-Patient Physiotherapy refers to short-term physiotherapy services, provided on an

Physiotherapy Outpatient basis, and provided these services are provided by a licensed physiothera-
pist, under the direction of a Physician for a confirmed diagnosis and provided Prior
Approval from the Insurance Company.

3.7 Diagnostic and Diagnostic tests and services like surgery, laboratory, radiology and therapeutic
Therapeutic Services interventions and services like chemotherapy, provided by or through a Physician on
an Outpatient basis which are medically necessary and justified.

Page 15 of 47
3.8 In-Patient Hospital This refers to Hospitalization, including room and board, and Health Care Services and
and Related Health Supplies provided during the Hospitalization. Health Care Services and Supplies must
Services be provided by or through a Physician and all Non-Emergency Hospitalizations must
get Prior Approval from the Insurance Company.

3.9 Hospitalization The class of hospitalization for which Insured Members are eligible is defined in the
Class Table of Benefits. The selection by the Policyholder of coverage for a specific
/Accommodation Hospitalization Class does not guarantee the availability of that class of
Type accommodation for an admission into the Hospital. If an Insured Member is admitted
into a more expensive class of hospitalization accommodation, he or she will be
responsible for all charges in excess of those that would have been incurred under the
Hospitalization Class indicated in the Table of Benefits.

3.10 Nursing at home Nursing at home refers to nursing care administered outside a Hospital and provided
by a registered nurse, if prescribed by the treating Physician, which is received directly
after and related to In-Patient Health Services or Day-Care Health Services. The
Insurance Coverage is available only if agreed and listed in the Table of Benefits and
limited to an amount per day and is limited in time as specified in the Specific Terms
and Conditions. This benefit is on reimbursement basis.

3.11 Local Ambulance Services refers to terrestrial ambulance transportation in case of

Emergency Emergency by a licensed ambulance service to the nearest Hospital where
Transportation Emergency Health Services can be rendered. Coverage is only provided in the event
of an Emergency. Transportation from hospital to patient's home following treatment
is excluded.

3.12 Maternity Maternity Services refers to maternity-related Health Care Services and Supplies. These
Services are treated as any other Inpatient or Outpatient Health Services.
3.12.1. Out-Patient Maternity Services includes prenatal and postnatal care (45 days
from delivery) provided by a Physician on an Outpatient basis.
3.12.2. In-Patient Maternity Services includes Health Services provided for child
birth through a vaginal delivery or a Medically Necessary cesarean section, for any
complications of pregnancy or delivery and for miscarriage and legal abortion.

The Insurance Coverage is only applicable to married females and is limited to the
amount as specified in the Specific Terms and Conditions.
3.12.3. Maternity Services: refers to maternity- related Health Care Services and
Supplies. These are treated as any other Inpatient or Outpatient Health Services.
Insured Members are subject to six (6) months waiting period for Inpatient Maternity
Services coverage, if indicated in the Table of Benefits. This provision only applies to
Insured Members undergoing initial enrollment. Failure to renew the Policy within
thirty (30) days from the Expiry Date may result in the waiting period to recommence
on the Effective Date of the new policy and this new Policy shall not be considered as a
renewal of this Policy. The waiting period will also apply to existing Insured Members
who become eligible for this Benefit under the existing Policy and the six (6) months
period shall commence from the date on which such eligibility arises.

3.13 Parent Parent Accommodation refers to the extra charges incurred for the room for one

Page 16 of 47
Accommodation parent accompanying the Hospitalization of an Insured Member under 10 years of age
unless and otherwise specified in the Table of Benefits. This benefit is covered up to a
maximum limit as described in the Table of Benefits

3.14 Accidental Dental Services refers to dental-related Health Care Services and Supplies. The
Dental Services coverage under this Policy is restricted to the cases resulting from Accidents incurred
during the validity of the Policy and provided it concerns sound natural teeth.
Other Dental Services are optional and only provided if the services are specified as
part of the Insurance Coverage stated in the Specific Terms and Conditions and
subject to the specified limited amount. Dental expenses related to accidents are
covered under general treatment and do not fall under the dental limit if applicable.

3.15 Dental Services In case opted for, the following services are part of the Dental Insurance Coverage
Health Services: X-rays, extractions, amalgam/composite filling, root canal treatments,
and prescribed drugs for these services. The following services are always excluded,
unless explicitly specified "as included in the coverage" in the Specific Terms and
Conditions: dental consultations incl. routine medical examination and annual check-
up, scaling and polishing, gum treatments, denture, crowns and bridges, periodontitis,
orthodontics and dental prosthesis.

3.15.1 - Routine Dental Dental Insurance Coverage Health Services:, Consultation, X-rays, extractions,
amalgam/composite filling, root canal treatments, prescribed drugs for these services
and scaling and polishing for gum treatment. Dental coinsurance is applicable on
dental consultation, pharmaceuticals and treatment. Limit is included in the annual
limit.

3.15.2 - Major Dental Denture, crowns and bridges, periodontitis, orthodontics and dental prosthesis
Treatment

3.16 Optical Services Optical Services refers to optical-related Health Care Services and Supplies. The
coverage under this Policy is restricted to the cases resulting from Accidents incurred
during the validity of the Policy.

3.17 Optional Optical Other Optical Services are optional and only provided if the services are specified as
Services part of the Insurance Coverage specified in the Specific Terms and Conditions and
subject to the specified limited amounts and services as listed in the Table of Benefits.
External Devices meant to improve the vision acuity and limited to lenses, frames and
contact lenses. Including Vision test subject to prescription of optometrist. Lasik
treatment is excluded. Benefit is on Reimbursement basis.

3.18 Alternative Alternative Medicine Services refers to therapeutic and diagnostic treatment outside
Medicine Services conventional medicine services as an alternative or complementary to this. Such
medicine services include chiropractic treatment, osteopathy, Ayurveda, acupuncture
acupressure, homeopathic treatments and drugs, Alternative Medicine Services are
excluded from the Insurance Coverage unless specified as part of the Insurance
Coverage stated in the Specific Terms and Conditions. Benefit is on Reimbursement basis.

3.19 Repatriation Repatriation refers to the charges incurred to repatriate the mortal remains to the

Page 17 of 47
of Mortal Remains country of origin in case an Insured Member passed away but limited to the amount
specified in the Specific Terms and Conditions. This is not part of the Insurance
Coverage if the limitation amount is not specified. This includes cost of air ticket for
accompanying person.

Please refer to attached "Assist America" guide for services (only if Global Assistance
Benefit is available in Table of Benefits Section VI)

Only Repatriation of Mortal Remain is covered under Bronze Product on Reimbursem-

ent basis and not the full Global Assistance Program. Bills to be submitted to ADNIC
Directly.

3.20 Health care As per Federal Law No-8 of 1980, regulating Labour , as amended and applicable laws
services for work in this respect for all policies issued or renewed from 22/03/2010 onwards as per the
related illnesses decree No. (/2010/4/‫ )ج‬issued by the executive committee of the Executive Council.

3.21 Birth Defects An anatomical or physiological defect disease or malformation……etc which may be
and Congenital either hereditary/familial/genetic or due to an influence occurring during gestation up
Conditions to birth, and may or may not be obvious at birth. Availability of cover during the first
thirty (30) days of birth only if life threatening.

3.22 Medical Medical Appliance and Equipment used externally from the human body which:
Appliances and (1) can withstand repeated use; (2) is not designed to be disposable; (3) is used to
Equipment serve a medical purpose; (4) is generally not useful to a person in the absence of a
Sickness or Injury; and (5) is used outside of the Hospital. These are subject to
recommendation of the treating doctor and are on reimbursement basis.

3.23 Vaccination Approved Vaccines by local Health Authorities including Mandatory and Non
Mandatory Vaccines subject to the specified limits in the Policy Table of Benefits.
Benefit is on Reimbursement basis.

3.24 Organ The incurred charges on transplantation surgery for the beneficiary being the
Transplant recipient of the transplant of an organ. The covered amount includes doctor's fees,
hospital accommodation and other beneficiary's related medical expenses during
hospital stay. Excluded are costs related to search for donor, cost of acquisition of
organ and costs incurred for removal of organ from donor.

3.25 Routine Health Cover is for Chest X-ray, Rest ECG, Blood Picture, Urine Analysis, Lipid Profile, Liver
Check-up Enzymes and blood sugar.

The Insurance Coverage is limited to one Routine Examination per Insurance Year;
however the insured person is not covered for routine health screening examinations
for issuing medical certificates which is otherwise a professional or contractual
requirement, unless these benefits are specified as part of the Insurance Coverage in
the Specific Terms and Conditions

3.26 Annual Female (Above 35 years): Breast cancer screening: For females above 35 years,
Screening including a) Clinical Exam b) Mammogram c) Pelvic Sonogram and d) CA 15.3

Page 18 of 47
 Male (Above 45 years) Prostate cancer screening; For males above 45 years, including
a) Clinical exam b) PSA c) Rectal sonogram
For Both Females & Males (applicable for males and females > 50 years) Colon Cancer
Screening including FIT (Fecal Immunochemical Test) and Colonoscopy:
a) Clinical exam b) Rectal sonogram - On Reimbursement Basis
Benefit is on Reimbursement basis.

3.27 Emergency If the Insured Member sustains an injury or suffers a sudden and unexpected illness
Medical Evacuation and adequate medical treatment is not available in the Insured Person's current
location, The Medical Assistance Service (Assist America) will arrange and pay for a
medically supervised evacuation to the nearest medical facility they determine to be
capable of providing appropriate medical treatment. The Insured Member's medical
condition must be such that, in the professional opinion of the health care provider
and the Medical Assistance Service, the Insured Member requires immediate
emergency medical treatment, without which there would be a significant risk of death
or serious impairment and subject to the approval by the Insurance Company.
Funeral and burial expenses are not covered.

Please refer to attached "Assist America" guide for services (only if Global Assistance
Benefit is available in Table of Benefits Section VI)

3.28 Air Ticket for Air Ticket will be covered for Insured Members in respect of Elective Treatment
Outside UAE subject to the following:
Treatment
Cost of treatment outside UAE for the required medical procedures is less than 70%
of UAE Customary rates with a minimum difference of AED 3,000/- , covered up to
a maximum of AED 2,000/- on reimbursement basis.

This benefits are covered only for in-patient treatment for economy class round
trip ticket only for patients (i.e. accompanying persons are not covered)

Page 19 of 47
 Section IV
Enrollment and Effective Date of Coverage

4.1 Enrollment Insured Members will be enrolled after the Policyholder sends notification of their
eligibility for Coverage to the Insurance Company In addition, new Primary Insured
and new Dependents may be enrolled as described below in Sections 4.7 and 4.8
Except as set forth in this section, Primary Insured and/or Dependents shall be
enrolled after a written authorization of the Insurance Company. Dependents of a
Primary Insured may not be enrolled unless the Primary Insured is also enrolled for
Coverage under the Policy.

4.2 Addition The Policyholder has the right to require from the Insurance Company, by
completing and signing a subsequent application form, accompanied with
supporting documents, the addition of new Primary Insured and/or Dependents
within 30 days from the date the new insured member become eligible for cover.
The Premium relating to these additions shall be calculated on a pro-rata basis.

4.3 Deletion For DOH / HAAD Compliant Plans: The Policyholder has the right to require from the Insurance
Company, by completing and signing a subsequent request form, supported with the
respective Insurance Cards, to delete Insured Members such as deceased or terminated
employees within 30 days from the date the deleted insured member ceased to be eligible for
the cover.
The Premium refund related to any approved deletion shall be calculated pro-rata
(subject to the Insurance Company approval) calculation net of claims based
on the Insurance Company policy i.e. the amount of claims paid / outstanding to the
terminated members shall be deducted from the pro-rata refund of premium , unless
explicitly approved to the contrary by Insurance Company.
Premiums will not be refunded by the Insurance Company to the Policyholder, if the relevant
Insurance Card(s) has not been returned to the Insurance Company. An exception may be
made, at the Insurance Company's sole discretion, in the form of a no objection letter issued by
the Insurance Company or if the Policyholder sends a guarantee letter to the Insurance
Company that all incurred claims after the deletion date will be borne by the Policyholder.
However, the insurance company reserves the right to revise the running policy terms in
case the deletion of insured members in one request or accumulative of all deletions requests
exceeds 5% of the total number of members at policy inception date.

The Policyholder is fully responsible for the deletion of any member while this member
is entitle for medical insurance coverage under this Policy as per the Mandatory Health
Insurance law in the Emirates of Abu Dhabi No. (23) of 2005 and its Implementing
Regulation Decision No. (25) of 2006 and its related circulars. and any other Competent
Regulatory Authority

Page 20 of 47
 For DHA Compliant / Other Plans: The Policyholder has the right to require from the Insurance
Company, by completing and signing a subsequent request form, to delete Insured Members
such as deceased or terminated employees prior to or on the date the deleted insured member
ceased to be eligible for the cover. Backdating a deletion request is not allowed. The Premium
refund related to any approved deletion (subject to the Insurance Company
approval) shall be calculated pro rata- net of claims; based on the Insurance Company's policy
i.e. the amount of claims paid / outstanding towards the terminated members shall be deducted
from the pro-rata refund of premium, unless explicitly approved to the contrary by Insurance
Company. Once the visa is cancelled the sponsor shall show proof of the cancellation in order to
request a refund, this is with consideration to the 30 day grace period for the individual to leave
the country Or the refund (subject to the Insurance Company approval) can be requested
upon attaining the policy expiry- Whichever is earlier. The refund must be calculated (subject
to the Insurance Company approval) at minimum on a monthly basis, and if the visa
cancellation is during part of a month, then that whole month should be considered.

The Policyholder is fully responsible for the deletion of any member while this member is entitle
for medical insurance coverage under this Policy as per the Mandatory Health Insurance law in
the Emirates of Dubai - Dubai Health Insurance Law 11 of 2013, in Emirates of Abu Dhabi
No. (23) of 2005 and its Implementing Regulation Decision No. (25) of 2006 and its related
circulars.

4.4 Upgrade of Benefits or The upgrade of benefits / Change of category for any member during the term of the
Change of Category policy will be solely on discretion of ADNIC.
during the Term of the During the tenure of the policy, ADNIC has the right to repudiate the request for
Policy: upgrade of benefits / change of category for any member if (but not limited to):
- the Insured Employee / Dependents are already admitted or diagnosed with any
ailment.
- the main purpose of upgrade is to utilize the enhanced Annual Limit / Benefits /
Network which are not part of the existing plan benefits.

4.5 Eligibility The eligibility and enrollment conditions stated in the Law and as legally set forward by
Conditions DOH or DHA or any other Competent Regulatory Authority are in addition to those
specified in the Policy.

The enrollment for Coverage under the Policy is open only for the following:
- Eligible Primary Insured are the employees of the Policyholder as fully described in
Annexure "A".,
- Eligible dependants are the spouse and unmarried, unemployed children up to the
age of 21 years unless specifically excluded by the Policyholder.
- At the option of the Policyholder, Over-Age children (who shall be defined as Primary
Insured s unmarried and unemployed children up to age of 30 years.) subject to terms
to be defined by the Insurance Company.
- At the option of the Policyholder, widows, widowers and other Eligible Dependants
of deceased Policyholder employees.

Provided that all such persons have been accepted for Coverage by the Insurance Company.

4.6 Omission of In case of a discontinuation of the eligibility requirements, as stated in the Law
Eligibility and/or other circulars of the Emirate of Abu Dhabi and any other Competent
Regulatory Authority the Eligibility expiresautomatically. The Policyholder shall inform the
Insurance Company, in writing, of those Insured Members who no longer meet the Eligibility
criteria.

Page 21 of 47
4.7 Effective Date of Coverage for Insured Members is effective as specified in the Policy, after Premium has
Coverage been paid. In no event will payment for Health Services rendered or delivered before
the Effective Date of Coverage be covered. Any request by the Policyholder for the
enrollment of an Eligible Person must be in accordance with the Law and/or other
circulars of the Emirate of Abu Dhabi and any other Competent Regulatory Authority.

4.8 Coverage for a Newly eligible Primary Insured shall have the same Coverage Benefits as specified in
Newly Eligible the Policy. Coverage is effective under the following conditions: If the Insurance
Primary Insured Company is notified of such Addition within thirty (30) days of the Primary Insured's
eligibility date and receives any required Premium and the completed health
questionnaire if required and the individual is accepted for Coverage by the Insurance
Company. If the individual is accepted for Coverage by the Insurance Company,
written notification of acceptance will be sent to the Policyholder.

4.9 Coverage for New Coverage for a new Dependent acquired by legal adoption, placement for adoption,
Dependents (Except court or administrative order, or marriage shall take effect on the date that such event
Newborn Children). is legally recognized by the applicable authorities under the following conditions:

If the Insurance Company is notified of such Addition within thirty (30) days of the
new Dependent's eligibility for Coverage and receives any required Premium and
completed health questionnaire (if required) and the new Dependent is accepted for
Coverage by the Insurance Company, written notification of acceptance will be sent
to the Policyholder.

4.10 Effective Date of Newborn Children will become eligible for Coverage on the date of their birth.
Coverage for Coverage will become effective on the date of eligibility under the following
Newborn Children conditions:
(1) If the Insurance Company is notified within thirty (30) days of the newborn child's
birth, and (2) the Insurance Company receives any required Premium, and
(3) a completed health questionnaire (if required), and (4) the Newborn Child
is accepted for Coverage by the Insurance Company, written notification of acceptance will
be sent to the Policyholder.

Coverage for the New Born Children born out of UAE will become effective on the
date of arrival to UAE under the following conditions. (1) If the Insurance Company is
notified within thirty (30) days of the newborn child's arrival within UAE and (2) the
Insurance company receives any required Premium, and (3) completed health
questionnaire (if required),and (4) the newborn child is accepted for Coverage by the
Insurance Company, written notification of acceptance will be sent to the Policyholder.

Page 22 of 47
 Section V
Termination of the Policy

5.1 Conditions for This Policy and all Coverage under this Policy shall automatically terminate on the
Termination of this earliest of the dates specified below:
Entire Policy
A. On the date specified by the Policyholder, after at least 31 days prior written notice
to the Insurance Company, that this Policy shall be terminated.

B. On the date specified by the Insurance Company, by written notice to the

Policyholder that this Policy shall be terminated, due to the Policyholder's violation
of the terms and conditions of the Policy.

C. On the date specified by the Insurance Company in written notice to the

Policyholder that this Policy shall be terminated because the Policyholder provided
the Insurance Company with false information material to the execution of this Policy
or to the provision of Coverage under this Policy. The Insurance Company has the right
to rescind this Policy back to the Effective Date.

D. On the date specified by the Insurance Company in written notice to the

Policyholder that this Policy shall be terminated because the Policyholder did not pay
the Premium.

E. On the date specified by the Insurance Company in written notice to the

Policyholder that the Policy will terminate due to amendments in the Law or other
legal general regulations, which affect the Policy so fundamentally that subsequently
no further basics for the Policy is given.

F. If the Policyholder has become insolvent, wound up, is unable to pay debts or has its
authorization withdrawn.

G. If the Policyholder has lost the whole or any part of its paid up capital.

H. If any claim submitted by the Insured Member or Dependent is false, fraudulent,

intentionally exaggerated or if fraudulent means or methods have been used by Insured
Member or Dependents, any medical service provider in cooperation with any of the foregoing
or anyone acting on their behalf to obtain benefits under this Policy, the Insurance Company
reserves the right to reject such claims in part or in full, without prejudice to the rights of the
Insurance Company to terminate the Policy from the Effective Date as stated in this Clause.

In addition to the Insurance Company’s right to reject the fraudulent claims as stated above,
the Insurance Company shall have the right to terminate the Policy or the Coverage of any
Insured Member or Dependent from the Effective Date in the event of fraud, abuse, false
statement or illegitimate use of the Medical Card by the Policyholder, Insured Member or
Dependent.

The Policyholder, Insured Member or Dependent shall be jointly and severally liable to the
Insurance Company for any claims or losses arising out of the Policyholder, Insured Member

Page 23 of 47
 or Dependent’s fraud, abuse or false statement.

The amount of any such claim settlement made before the fraudulent act or omission was
discovered, shall be settled by the Policyholder, Insured Member or Dependent to the Insurance
Company on notification. The Insurance Company shall have absolute discretion to exercise
its right to claim the amounts settled for any fraudulent claims from the Policyholder directly
or from the Insured Member or Dependent.

The Policyholder undertakes to extend all necessary support and provide all relevant
information requested by the Insurance Company to detect and prevent such fraudulent claims.

- Insurance Companies has to inform DOH or DHA or any other Competent Regulatory
Authority. immediately in case of proven fraud
- High Loss Ratio is not a reason for termination of the contract

Upon any termination of this Policy, the Policyholder shall be and shall remain liable
to the Insurance Company for the payment of any and all Premiums, which are unpaid
at the time of termination.

If this Policy terminated based on the Policyholder request, Premium refund will be
calculated on Short Period Scale basis. (please refer to the attached Short Period Scale)

If this Policy is terminated based on t he Insurance calculated on pro-rata basis.

The Insurance Company may deliver the Termination notice to the Policyholder
personally, or post it by registered or certified mail (to the Policyholder's broker or to
the address the Policyholder last gave to the Insurance Company). Proof that the
Insurance Company mailed the notice is sufficient proof that the Policyholder received
the Termination notice.

5.2 Fraud, Rejection If any claim is false, fraudulent, intentionally exaggerated or if fraudulent means or
and Termination methods has been used by Insured Member or his/her Dependants or anyone acting
on their behalf to obtain benefits under this Policy, ADNIC holds the right to reject
such claims in partial or full. The amount of any such claim settlement made before the
fraudulent act or omission was discovered, should be settled to ADNIC on notification.

Eligible Person’s coverage shall automatically terminate on:

A. The date specified by ADNIC in written notice, due to material violation by the Eligible
Person of the terms of the Policy.
B. The date specified by ADNIC in written notice, in the event that the Eligible Person commits
an act of fraud and/or abuse in relation to the benefits he receives under the Policy or
the Primary Insured permitted the use of his or her ADNIC Card, or any other healthcare
authorization document, by any unauthorized person or used another person’s ADNIC card.
C. The date specified by ADNIC in written notice due to fraud, misrepresentation or because
the Eligible Person knowingly provided ADNIC with false materials information, including but
not related to information relating to another person’s eligibility for Coverage or status as a
Dependant, Pre-Existing Conditions or hazardous activities. ADNIC even holds the right to
rescind the coverage back to Effective Date.
D. In all the above cases, Policy Holder is liable for all claims incurred to ADNIC in this regards.

Page 24 of 47
5.3 Return of Upon Termination of Coverage for any Primary Insured or Dependent or termination
Insurance Cards upon of the Policy, it is the Policyholder's responsibility to ensure that terminated Primary
Termination Insured and/or Dependent return all Insurance Cards to the Insurance Company.

5.4 Payment for

Health Services The Policyholder will be responsible for reimbursement to the Insurance Company for
Incurred after the payment of any Health Services obtained by an Insured Member using their Insurance
Date of Termination Card after Coverage or Policy termination.

Page 25 of 47
Period of Cover: DOH REF NO:

Period of cover is from 18/11/2021 to 17/11/2022 Class 1 :42930

SCHEDULE OF BENEFITS – SOB

ALL BENEFITS MENTIONED BELOW ARE TO BE READ IN CONJUNCTION WITH "GENERAL TERMS AND
CONDITIONS"

Benefits Table
Plan: ADNIC Standard Gold - Class 1 (STUDENTS PLAN)

Annual Limit AED 300,000/-

Elective & Emergency: United Arab

Geographical Limit Emirates + Home Country Covered on
Reimbursement basis.

Cover outside UAE (Home Country) is

Coverage Criteria for Treatment outside UAE limited to 60 days per treatment during a
business trip or vacation.

Pre-existing and Chronic conditions Covered

Inpatient Benefits

Inpatient Benefits Subject to prior approval

Accommodation (Upgrading up on patient request or in case of non

availability of covered Room Type is at the expenses of insured Ward room
member)

Accommodation Costs for one parent staying with a child aged less
than 10 years (Excluding telephone and any extra expenses other Up to AED 200 per day
than included in Accommodation rates)

Accommodation Costs for one accompanying family member in case

of critical medical conditions subject to treating doctor
Up to AED 200 per day
recommendation (Excluding telephone and any extra expenses other
than included in Accommodation rates)

Page 26 of 47
 Outpatient co-insurance/ deductibles

Emergency Treatment Outside Network Inside

Within Network
& Outside UAE Reimbursement on Actual Cost

AED 20/- Deductible. Access to

Consultation Deductible Specialists in hospital only upon referral
(For any services other with an additional AED Not Applicable for Elective Treatment
than Maternity). 10/- Deductible.

Consultation Deductible
AED 20/- Deductible Not Applicable for Elective Treatment
For Maternity.

Lab and Scan / X-Ray

Nil Deductible Not Applicable for Elective Treatment
Deductible

Pharmaceuticals Co-
Insurance (Applicable on
Maternity,
Dental and any other
services requires
Pharmaceuticals)
20% Co-insurance Not Applicable for Elective Treatment
As per DOH Circular
UA/27/18, if Regulations
warrants – All
Pharmaceuticals shall be
subject to Generic
Medications

Medical Providers Network

Inside UAE ADNIC GOLD Plus SEHA Facilities

Outside UAE (Covered for Home Country) Covered on Reimbursement basis.

You are kindly requested to visit ADNIC website (www.adnic.ae) to stand on our new medical network
categorization. in case you faced any difficulty exploring the website, please refer to ADNIC representative to
obtain a soft copy of our new medical network

Page 27 of 47
 ADDITIONAL BENEFIT

Maternity
Subject to Deductible of AED 500/- Per Delivery Within UAE: Covered up to Annual limit.
Outside UAE : Not Covered

Covered only if medically necessary &

Vitamins
prescribed by the treating physician

Physiotherapy Covered

Covered as per DOH guidelines (Only if

Birth Defects and Congenital Conditions
medically necessary)

Medical Expenses related to Work related Accidents, Injuries

and Illness Covered

Hepatitis A Covered

Ophthalmology: Limited to eye consultation and any medical

condition related to it (Illness/Injury) excluding vision, sight test & Covered
refraction error.

Cover is extended to include the following only in emergency cases:

• Diagnostic and treatment services for dental and gum treatments. Covered
• Hearing and vision aids, and vision correction by surgeries and laser.

Circumcision is covered for new Muslims subject to the following:

• The member is insured with ADNIC.
• The member declared his Islam in the Emirate of Abu Dhabi in line Covered
with all the legal formalities in this aspect along with a letter from
Judicial Department in Emirate of Abu Dhabi.

All sports activities (other than professional and hazardous sports

Covered
activities) are covered.

Visiting Doctor (Subject to agreed network tariff ) Covered

Page 28 of 47
Dietician Covered only if medically necessary

Rehabilitation Covered only if medically necessary

Hepatitis B,C and D Covered

Covered up to AED 5,000/- Per Person Per

Psychiatric treatment other than mandated by DOH
year.

Covered up to AED 2,000 per person per

year (20% co-insurance)
Cover includes: Consultation, X-rays,
extractions, amalgam/composite filling, root
Routine Dental Care
canal treatments, Scaling & Polishing for
Gum Bleeding and prescribed Drugs for
these services.

Covered up to AED 1,000 per person per

year (20% co-insurance)
(Covered on Reimbursement basis and
Optical Cover
Includes Frames, Lenses & Optical Lenses
only.

Page 29 of 47
 Section VIII
Premiums

8.1 Computation Each Premium shall be calculated based on the number of Primary Insured and
of Premium Dependents in each Coverage category. The Insurance Company shows in its records
at the time of calculation the Premiums that are then in effect.
For new members whose enrolment occurs on a day after the Effective Date of the
Policy the Premium shall be calculated on a pro-rata basis.
Any imposition of or increase in Premium tax or other governmental charges relating
to or calculated in regard to Premium shall be automatically added to the Premium.

8.2 Notification of The Policyholder shall notify the Insurance Company in writing within thirty one (31)
Coverage Changes days of the Effective Date of enrollments, terminations, or other changes.

8.3 Payment of The Premium is payable in advance by the Policyholder to the Insurance Company as
the premium agreed. All Premium payments shall be accompanied by supporting documentation,
which states the names of the Insured Members for whom payment is made.
The Policyholder shall reimburse the Insurance Company for attorney's fees and any
other costs related to collecting delinquent Premiums.

8.4 Premium The Company and the Insured hereby agree that notwithstanding any provision to the
payment contrary within this Policy or any endorsement hereto in respect of non-payment of
Clause premium, only the following clause shall apply:
• The Insured undertakes that the premium will be paid in full to the Company by the due
date(s) stipulated in the Schedule of this Policy.
• If the premium due under this Policy has not been so paid to the Company by its due
date(s), the Company shall have the right to terminate this Policy by giving the Insured
a prior Notice of Termination of fifteen (15) calendar days.
• If the premium due is paid in full to the Company before the period of the Notice of
Termination expires, the said Notice shall automatically be revoked.
• If the premium due is not paid in full to the Company before the period of the Notice of
Termination expires, this Policy shall automatically terminate at the end of the period of the
Notice with no further notice or court judgment.
• In the event of termination, premium is due to the Company on a pro rata basis for
the period that the Company is on risk, but the full Policy premium shall be payable to the
Company in the event of a loss or occurrence prior to the date of termination which gives
rise to a valid claim under this Policy.
• Any premium paid by the Insured to their Insurance Broker shall not be considered in any
respect as being paid to the Company unless it has actually been received by the Company.

8.5 BASMAH The BASMAH Initiative charges are a fixed allocation additionally charged or included as
Program Contribution part of the premium upon any new enrollment or any addition of a Dubai visa based
(Only for DHA member as required by the Dubai Health Authority (DHA). These funds are not be
Compliant Plans) refunded in part or in whole upon the deletion of a member.

8.6 Currency All Premiums paid by the Policyholder will be in the currency of U.A.E Dirhams as
specified in the Schedule of Benefits.
8.7 Annual
Premium (Per

Page 30 of 47
person)

Annual Premium per age

Class 1
Band

Employees (18 - 40)

6,353
Employees (41- 59 )
6,353

Employees 60 and above

10,450
Dependent ( 0 -17)
10,450
Dependent (18 - 40)
10,450

Dependent (41 - 59)

10,450

Dependent 60 and above

10,775
Maternity premium per
married Female (18-50) 903

Issuing fees (0.50% of total gross premium)

Mass deletions during policy cover period will result
in premium modification.

It is a warranty under this Policy that the Premium due should be paid in 4 installments as follows:-

01st Installment :- 25 % on 06/12/2021

02nd Installment :-25 % on 28/02/2022
03rd Installment :- 25 % on 28/05/2022
04th Installment :- 25 % on 28/08/2022

Signed on behalf of/

Abu Dhabi National Insurance Company
Date : 22/11/2021

Page 31 of 47

Procedures for Obtaining Benefits
9.1 Health Services Rendered
by Network Providers
9.2 Verification of
Participation Status
9.3 Prior Approval Does
Not Guarantee Benefits
9.4 Denial of Already
Approved Services
Section IX
Insured Members are entitled for Coverage for Health Services listed as
Network Benefits in the Table of Benefits, if such Health Services are
Medically Necessary and are provided by a Network Physician or other
Network Provider, All Coverage is subject to the terms, conditions,
exclusions and limitations of the Policy.
Health Services, which are not provided by a Network Physician or other
Network Provider, are not covered as Network Benefits, except in Emergen-
cy situations or referral situations authorized in advance by the Insurance
Company, as mentioned in the Table of Benefits. Failure to comply with all
administrative procedures required by Network Provider may result in
denial of coverage. Enrolling for Coverage under the Policy does not
guarantee Health Services by a particular Network Provider on the list of
Providers. This list of Network Providers is subject to change. When a
Provider on the list no longer has a contract with the Insurance Company,
Insured Members must choose among remaining Network Providers in
order to obtain Network Benefits.
Coverage for Health Services is subject to payment of the Premium required
for Coverage under the Policy and payment of the Deductible or
Co-insurance specified for any service.
The Policyholder shall ensure that Insured Members are informed that they
are requested to verify the participation status of a Physician, Hospital or
other Health Services as the participation status of a Provider may change
from time to time. Insured Members can verify the participation status from
the website of the Insurance Company or by calling the Insurance Company
Insured Members must show their ID cards or similar documents along with
their Insurance cards every time they request Health Services. In cases
where the Covered Persons fail to present their Insurance Cards to a
Provider , the coverage on direct billing will be denied and the Insurance
Company will reimburse the Insured Member the agreed percentage of the
cost as the service provided shall be assumed to be from a Non-Network
Provider.
The fact that the Insurance Company authorizes Health Services
and/or supplies does not guarantee that all charges will be covered.
The Insurance Company reserves the right to review each claim, if there are
questions regarding Medical Necessity. Under these circumstances
Coverage of some Health Services and/or supplies may be denied. Insured
Members will be notified in writing of any subsequent adjustment of
Benefits as a result of the claim review.
If the Insurance Company first approved a treatment and at a later stage the
condition is discovered as a Non- Covered condition, in such a situation the
Insurance Company has the right to decline this case from beginning or the
Page 32 of 47
 maximum liability of the Insurance Company shall be up to the diagnosis.
The Insured Member shall pay all other expenses after the diagnosis.

9.5 Examination of In the event of a question or dispute concerning Coverage for Health
Insured Members Services and/or supplies, the Insurance Company may reasonably require
that a Network Physician acceptable to the Insurance Company examines
the Insured member at the Insurance Company's expense.

9.6 Recovery The Policyholder is liable for all claims paid by the Insurance Company on
direct settlement basis to any of its Medical Providers Network which are:

Applicable for claims settled in excess of Annual Limit per Insured Member.

9.7 Non-Network Benefits Non-Network Benefits apply when an Insured Member decided to obtain
Health Services from Non-Network Providers. A claim must be filed with the
Insurance Company for reimbursement of such eligible expenses. If
Co-insurance applies to Non-Network Benefits, the amount of Co-insurance
will be deducted from the amount reimbursed to the Insured Member.

In some cases, such as but not limited to cases of suspected fraud or abuse
committed by a Non-Network Provider, the Insurance Company reserves
the right to reject reimbursement of claims or preauthorization for Health
Services rendered by the Non-Network Provider if the Insurance Company
has informed the Eligible Insured Member that claims for reimbursement
will not be accepted from the specified Non-Network Provider.

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 Section X
Reimbursement Procedure

10.1 Reimbursement Network providers are responsible for submitting request for payment of Eligible
of Eligible Expenses Expenses directly to the Insurance Company. In the event a Network Provider charges
from Network any fees other than Deductible or Co-payments, the Insured Member should contact
Providers Insurance Company.

The Insurance Company shall reimburse Insured Member for eligible expenses
incurred with Non-Network Providers on the same basis as Network Provider, only for
Emergency health Services or services authorized or approved by the Insurance
Company in accordance with the terms of the Policy. The Insurance Company shall
reimburse Insured members for all other Eligible expenses from Non-Network
Providers on an actual cost basis, subject to the terms, conditions, exclusions, and
limitation of the Policy. The Insurance Company is not responsible for payments for
any services provided that are not covered under the provisions of this Policy.
Written proof of each claim must be reported to the Insurance Company. All necessary
10.2 Reimbursement documents should be reported original documentation, supporting invoices and
of Eligible Expenses receipts must be submitted with a fully completed Insurance Company's claim form,
from Non-Network signed by the treating Physician.
Providers These Claims are paid directly to the Insured Member or Policyholder and will be
subject to the co-insurance rate mentioned in the Table of Benefits for each and every
claim after satisfying the plan deductible.

In any case, claims have to be received by the Insurance Company no later than 120
days from date of service giving rise to the claim occurred and in case of additional
documents required by Insurer, resubmission of same claims is no later than 30 days
from date of additional requirements letter issued by Insurer. Beyond this maximum
term of 120 days, no claim will qualify for payment by the Insurer.

Page 34 of 47
 Section XI
AUDIT

Representatives of the Insurance Company shall at any reasonable time have the right to inspect and examine
the risk and the Policyholder shall provide the representatives of the Insurance Company with all requested details
and information.

Section XII
Disclosure of Material facts and Misrepresentation

DISCLOSURE

It is a condition of this Coverage that the Insured Member and/or the Policyholder has disclosed to the Insurance
Company, before the Policy was concluded, every material circumstance which was known to the Insured
Member, and the Policyholder is deemed to know every circumstance which, in the ordinary course of business,
ought to be known by him. If the Insured Member and/or the Policyholder has failed to make such disclosure,
the Insurance Company may avoid this Policy. Every circumstance is material which would influence the
judgment of a prudent Insurance Company in fixing the Premium, or determining whether it will take the risk.
It is also a condition of this Policy that the Insured Member and/or the Policyholder shall notify the Insurance
Company during validity of this Policy, and before the renewal(s) are concluded and during the validity of each
renewal, of any changes in the material circumstances which may increase the risk to be borne by
the Insurance Company.

MISREPRESENTATION

Every material representation made by the Insured Member and/or the Policyholder or his representatives to the
Insurance Company during the negotiations for the Policy and/or its renewal (and during the currency of the
Policy must be true. If any material representation provide to the Insurance Company is untrue and/of false the
Insurance Company may avoid the Policy. A representation is material which would influence the judgment
of a prudent Insurance Company in fixing the Premium, or determining whether he will take the risk.

Page 35 of 47
 Section XIII
Standard Exclusions for Department of Health – Abu Dhabi
(Applied on DoH/HAAD Compliant and other Non DHA Policy Holder(s))

The following Health Care Services and Supplies, Medical Conditions and other specifications and also all their
related, associated or consequential expenses are excluded as Insurance Coverage for this Insurance Contract,
unless explicitly approved to the contrary by Insurance Company in the Specific Schedule of Benefits:

1 Healthcare Services, which are not medically necessary

2 All expenses relating to dental treatment, dental prostheses, and orthodontic treatments.

3 Domiciliary care; private nursing care; care for the sake of travelling.

4 Custodial care includes

- Non medical treatment services; or
- Health related services which do not seek to improve or which do not result in a change in the
medical condition of the patient.

5 Services which do not require continuous administration by specialized medical personnel.

6 Personal comfort and convenience items (television, barber or beauty service, guest service and similar
incidental services and supplies).

7 Healthcare Services and associated expenses for replacement of an existing breast implant. Cosmetic
operations which improve physical appearance and which are related to an Injury, sickness or
congenital anomaly when the primary purpose is to improve physiological functioning of the involved
part of the body. Breast reconstruction following a mastectomy for cancer is covered.

8 Surgical and non-surgical treatment for obesity (including morbid obesity), and any other weight
control programs, services, or supplies.

9 Medically non-approved experimental, research, investigational healthcare services, treatments, devices

and pharmacological regimens.

10 Healthcare Services that are not performed by Authorised Healthcare Service Providers, apart from
Healthcare Services rendered in a Medical Emergency.

11 Healthcare services, treatments & associated expenses for alopecia, baldness, hair falling, dandruff or
wigs.

12 Supplies, Treatment and services for smoking cessation programs and the treatment of nicotine
addiction.

13 Non-medically necessary Amniocentesis

14 Treatment, services and surgeries for sex transformation, sterility and sterilization

Page 36 of 47
15 Treatment and services for contraception

16 Treatment and services related to fertility / sterility (treatment including varicocele / polycystic ovary /
ovarian cyst / hormonal disturbances / sexual dysfunction).

17 Prosthetic devices and consumed medical equipments, unless approved by the insurance company.

18 Treatments and services arising as a result of hazardous activities, including but not limited to, any
form of aerial flight, any kind of power-vehicle race, water sports, horse riding activities,
mountaineering activities, violent sports such as judo, boxing, and wrestling, bungee jumping and any
professional sports activities.

19 Growth hormone therapy.

20 Costs associated with hearing tests, vision corrections, prosthetic devices or hearing and vision aids.

21 Mental Health diseases, in-patient and out-patient treatments, unless the condition is a transient mental
disorder or an acute reaction to stress.

22 Patient treatment supplies (including elastic stockings, ace bandages, gauze, syringes, diabetic test
strips, and like products; non-prescription drugs and treatments, excluding such supplies required as
a result of Healthcare Services rendered during a Medical Emergency).

23 Preventive services, including vaccinations, immunizations, allergy testing and desensitization; any
physical, psychiatric or psychological examinations or testing during these examinations.

24 Services rendered by any medical provider relevant of a patient for example the Insured person and
the Insured member's family, including spouse, brother, sister, parent or child.

25 Enteral feedings (via a tube) and other nutritional and electrolyte supplements, unless medically
necessary during treatment.

26 Healthcare services for adjustment of spinal subluxation, diagnosis and treatment by manipulation of
the skeletal structure, by any means, except treatment of fractures and dislocations of the extremities.

27 Healthcare services and treatments) by acupuncture; acupressure, hypnotism, rolfing, massage

therapy, aromatherapy, homeopathic treatments, and all forms of treatment by alternative medicine.

28 All Healthcare services & Treatments for in-vitro fertilization (IVF), embryo transport; ovum and male
sperms transport

29 Elective diagnostic services and medical treatment for correction of vision

30 Nasal septum deviation and nasal concha resection.

31 All chronic conditions requiring haemodialysis or peritoneal dialysis, and related test/treatment or
procedure.

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32 Treatments and services related to viral hepatitis and associated complications, except for treatment
and services related to Hepatitis A.

33 Birth defects, Congenital diseases for newborn &/or Deformities unless life-threatening.

34 Healthcare services for Senile dementia and Alzheimer's disease

35 Air or Terrestrial Medical evacuation except for Emergency cases or unauthorised transportation services.

36 Circumcision healthcare services.

37 Inpatient treatment received without prior approval from the insurance company including cases of
Medical Emergency which were not notified within 3 working days from the date of admission.

38 Any inpatient treatment, tests and other procedures, which can be carried out on outpatient basis
without jeopardizing the Insured Person's health

39 Any test or treatment, for purpose other than medical such as tests related for employment, travel,
licensing or insurance purposes.

40 All supplies which are not considered as medical treatments including but not limited to: mouthwash,
toothpaste, lozenges, antiseptics, milk formulas, food supplements, skin care products, shampoos and
multivitamins (unless prescribed as replacement therapy for known vitamin deficiency conditions) and
all equipment not primarily intended to improve a medical condition or injury, including but not
limited to air conditioners or air purifying systems, arch supports, convenience items / options, exercise
equipment and sanitary supplies.

41 More than one consultation or follow up with a medical specialist in a single day unless referred by
a physician.

42 Health services and associated expenses for organ and tissue transplants, irrespective of whether the
Insured Person is a donor or recipient.

43 Services and educational program for handicaps.

Page 38 of 47
 Section XIV
Healthcare Services outside the Scope of Health Insurance

1 Injuries or illnesses suffered by the Insured Person as a result of military operations of whatever type.

2 Injuries or illnesses suffered by the Insured Person as a result of wars or acts of terror of whatever type.

3 Healthcare services for injuries and accidents arising from nuclear or chemical contamination.

4 Injuries resulting from natural disasters (including but not limited to) earthquakes, tornados and any
other type of natural disaster.

5 Injuries resulting from criminal acts or resisting authority by the Insured Person.

6 Healthcare services for patients suffering from AIDS and its complications.

7 All cases resulting from the use of alcohol, drugs and hallucinatory substances.

8 Any test or treatment not prescribed by a doctor.

9 Injuries resulting from attempted suicide or self-inflicted injuries

10 Diagnosis and treatment services for complications of exempted illnesses.

11 All healthcare services for internationally and locally recognised epidemics.

12 Venereal sexually transmitted diseases. A list with respect thereto will be set out by the General
Authority of Health Services.

Page 39 of 47
 Section XV
Standard Exclusions for Dubai Health Authority
(Applied for DHA Compliant Policy Holder(s))

The following Health Care Services and Supplies, Medical Conditions and other specifications and also all their
related, associated or consequential expenses are excluded as Insurance Coverage for this Insurance Contract,
unless explicitly approved to the contrary by Insurance Company in the Specific Schedule of Benefits:

1 Healthcare Services which are not medically necessary

2 All expenses relating to dental treatment, dental prostheses, and orthodontic treatments

3 Care for the sake of travelling

4 Custodial care includes

- Non-medical treatment services;
- Health related services which do not seek to improve or which do not result in a change in the
medical condition of the patient.

5 Services that do not require continuous administration by specialized medical personnel

6 Personal comfort and convenience items (television, barber or beauty service, guest service and similar
incidental services and supplies)

7 All cosmetic healthcare services and services associated with replacement of an existing breast implant.
Cosmetic operations which are related to an Injury, sickness or congenital anomaly when the primary
purpose is to improve physiological functioning of the involved part of the body and breast
reconstruction following a mastectomy for cancer are covered

8 Surgical and non-surgical treatment for obesity (including morbid obesity), and any other weight
control programs, services, or supplies

9 Medical services utilized for the sake of research, medically non-approved experiments, investigations,
and pharmacological weight reduction regimens

10 Healthcare Services that are not performed by Authorized Healthcare Service Providers

11 Healthcare services and associated expenses for the treatment of alopecia, baldness, hair falling, dandruff or
wigs

12 Health services and supplies for smoking cessation programs and the treatment of nicotine addiction.

13 Treatment and services for contraception

14 Treatment and services for sex transformation, sterilization or intended to correct a state of sterility or
infertility or sexual dysfunctionSterilization is allowed only if medically indicated and if allowed
under the Law

Page 40 of 47
15 External prosthetic devices and medical equipment

16 Treatments and services arising as a result of professional sports activities, including but not limited to,
any form of aerial flight, any kind of power-vehicle race, water sports, horse riding activities,
mountaineering activities, violent sports such as judo, boxing, and wrestling, bungee jumping and any
other professional sports activities

17 Growth hormone therapy unless medically necessary

18 Costs associated with hearing tests, prosthetic devices or hearing and vision aids

19 Mental Health diseases, both out-patient and in-patient treatments, unless it is an emergency condition.

20 Patient treatment supplies (including for example: elastic stockings, ace bandages, gauze, syringes,
diabetic test strips, and like products; non-prescription drugs and treatments,) excluding supplies
required as a result of Healthcare Services rendered during a Medical Emergency.

21 Allergy testing and desensitization (except testing for allergy towards medications and supplies used
in treatment); any physical, psychiatric or psychological examinations or investigations during
these examinations.

22 Services rendered by any medical provider who is a relative of the patient for example the Insured
person himself or first degree relatives.

23 Enteral feedings (via a tube) and other nutritional and electrolyte supplements, unless medically
necessary during in-patient treatment.

24 Healthcare services for adjustment of spinal subluxation

25 Healthcare services and treatments by acupuncture; acupressure, hypnotism, massage therapy,

aromatherapy, ozone therapy, homeopathic treatments, and all forms of treatment by alternative medicine.

26 All healthcare services & treatments for in-vitro fertilization (IVF), embryo transfer; ovum and sperms transfer.

27 Elective diagnostic services and medical treatment for correction of vision

28 Nasal septum deviation and nasal concha resection.

29 All chronic conditions requiring haemodialysis or peritoneal dialysis, and related investigations,
treatments or procedures

30 Healthcare services, investigations and treatments related to viral hepatitis and associated
complications, except for the treatment and services related to Hepatitis A & C.

31 Any services related to birth defects, congenital diseases and deformities unless if left untreated will
develop into an emergency

32 Healthcare services for Senile dementia and Alzheimer's disease

Page 41 of 47
33 Air or terrestrial medical evacuation and unauthorized transportation services.

34 Inpatient treatment received without prior approval from the insurance company including cases of
medical emergency which were not notified within 24 hours from the date of admission.

35 Any inpatient treatment, investigations or other procedures, which can be carried out on outpatient
basis without jeopardizing the Insured Person’s health.

36 Any investigations or health services conducted for non-medical purposes such as investigations related
to employment, travel, licensing or insurance purposes

37 All supplies which are not considered as medical treatments including but not limited to: mouthwash,
toothpaste, lozenges, antiseptics, milk formulas, food supplements, skin care products, shampoos and
multivitamins (unless prescribed as replacement therapy for known vitamin deficiency conditions) and
all equipment not primarily intended to improve a medical condition or injury, including but not
limited to air conditioners or air purifying systems, arch supports, exercise equipment and sanitary supplies.

38 More than one consultation or follow up with a medical specialist in a single day unless referred by
the treating physician.

39 Health services and associated expenses for organ and tissue transplants, irrespective of whether the
Insured Person is a donor or recipient. This exclusion also applies to follow up treatments and complications.

40 Any expenses related to immunomodulators and immunotherapy unless medically necessary

41 Any expenses related to the treatment of sleep related disorders.

42 Services and educational programs for people of determination, this also includes disability types such as
but not limited to mental, intellectual, developmental, physical and/or psychological disabilities.

Page 42 of 47
 Section XVI
Healthcare Services outside the Scope of Health Insurance
(In Emergency cases as defined by PD 02 - 2017, the following must be covered until stabilization at minimum)

1 Injuries or illnesses suffered by the Insured Person as a result of military operations of whatever type.

2 Injuries or illnesses suffered by the Insured Person as a result of wars or acts of terror of whatever type.

3 Healthcare services for injuries and accidents arising from nuclear or chemical contamination.

4 Injuries resulting from natural disasters (including but not limited to) earthquakes, tornados and any
other type of natural disaster.

5 Injuries resulting from criminal acts or resisting authority by the Insured Person.

6 Injuries resulting from a road traffic accident

7 Healthcare services for work related illnesses and injuries as per Federal Law No. 8 of 1980
concerning the Regulation of Work Relations, its amendments, and applicable laws in this respect.

8 All cases resulting from the use of alcoholic drinks, control substances and drugs and hallucinating
substances.

9 Any investigation or treatment not prescribed by a doctor.

10 Injuries resulting from attempted suicide or self-inflicted injuries

11 Diagnosis and treatment services for complications of exempted illnesses.

12 All healthcare services for internationally and locally recognised epidemics.

13 Healthcare services for patients suffering from (and related to the diagnosis and treatments of )
HIV – AIDS and its complications and all types of hepatitis except virus A and C hepatitis.

Page 43 of 47
 Section XVII
Exclusion of Certain Medical Facilities (Excluded Providers):

All Health Services provided by any of the Excluded Providers shall be excluded from the Insurance Coverage under this
Policy. The Insurance Company shall publish and keep updated a list of all Excluded Providers at its website (www.adnic.ae)
and at its mobile application (ADNICPlus). Such list of Excluded Providers shall contain all Medical Facilities whose Medical
Services are excluded from Insurance Coverage under this Policy. Before visiting any Medical Facility, the
Policyholder/Insured Members are obliged to visit the Insurance Company’s website (www.adnic.ae) or its mobile application
(ADNICPlus) to ensure that such Medical Facility is not mentioned under the updated list of Excluded Providers. The
Policyholder/Insured Members understand and acknowledge that the Insurance Company shall not be obliged, for any
reason whatsoever, to cover or to pay any reimbursement for Health Services provided by such Excluded Providers

Page 44 of 47
 Section XVIII
SHORT PERIOD RATING SCHEDULE

PERIOD (NOT EXCEEDING) RATE

3 WEEKS 25% OF THE ANNUAL RATE

1 MONTH 30% OF THE ANNUAL RATE

6 WEEKS 35% OF THE ANNUAL RATE

2 MONTHS 40% OF THE ANNUAL RATE

3 MONTHS 50% OF THE ANNUAL RATE

4 MONTHS 60% OF THE ANNUAL RATE

5 MONTHS 70% OF THE ANNUAL RATE

6 MONTHS 75% OF THE ANNUAL RATE

7 MONTHS 80% OF THE ANNUAL RATE

8 MONTHS 85% OF THE ANNUAL RATE

9 MONTHS 90% OF THE ANNUAL RATE

OVER 9 MONTHS 100% OF THE ANNUAL RATE

NOTES:

1. Policies issued for a short period may not be extended upon payment of the difference between the premium
for the short period and that for the extended period.
2. Premiums are payable in advance and in full.

Page 45 of 47
 Section XIX
Irrevocable Undertaking & Authorization

We the undersigned irrevocably undertake to repay to Abu Dhabi National Insurance Company (ADNIC) any
amounts paid by the latter to the Medical Providers for cases related to the Insured Member under this Insurance
Policy in excess of the annual limit per Insured Member; and we irrevocably authorize ADNIC to debit our account
accordingly.

For/
M/S MOHAMED BIN ZAYED UNIVERSITY OF ARTIFICIAL INTELLIGENCE

Page 46 of 47
 Section XXI
APPENDIX

Renewal in line with ADNIC's standard procedures is subject to:

DOH & DHA Standard Exclusion List shall apply.

As per DHA Regulations, additional premium of AED 37 PMPA shall be charged for all Dubai Visa Holders towards PSP Fund.

The whole VAT amount for the Annual Premiums will be part of the initial invoices and should be settled upfront.

The Premium refund related to any approved deletion shall be calculated net of claims.

Census variance of 5% & above (higher or lower than the quoted census) upon business confirmation or during the policy
period will result in re- evaluation & change in the premium.

Terms are subject to ADNIC General Terms & Conditions

Page 47 of 47