MEDICAL INSURANCE - MEMBER L

Name of Employee EMPLOYEE / GENDER

SL.NO Company Number DEPENDANT' NAME DESIGNATION D.O.BIRTH (DD/MM/YYYY) NATIONALITY (M/F) RELATIONSHIP (E,S,C)

1 ABC DS130 xxxx Project Manager 5/28/1968 Omani Male Employee

2 ABC DS243 xxxx Dependant 8/2/1970 Omani Female Spouse
3 ABC DS376 xxxx Dependant 11/8/1998 Omani Male Child
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BER LIST
City of Maternity Any other benefits
Residence Medical Cover Optical Cover Dental Cover Cover Type of Network required
Muscat RO 5,000 RO 200 RO 100 NA Middle Network (RN 1) No
Muscat RO 5,000 RO 200 RO 100 No Middle Network (RN 1) No
Muscat RO 5,000 RO 200 RO 100 NA Middle Network (RN 1) No