Schedule of Benefits (ADNOC Enhanced Plus Plan)

ADNOC Enhanced Plus Plan - ADNOC Group of

Plan Name
Companies
Annual Benefit Limit AED 1,000,000 Per Person Per Policy Year
UAE plus Home Country
Territorial Limit1 Extended to Worldwide for emergency Cases during business trip
(traveling outside UAE for ADNOC business purpose).
Network Within UAE: ADNOC Group NW,
CCAD & SSMC with 25% Copay on OP and 100% covered
IP.
In & Out-patient on direct billing in UAE
Vaccination covered at SEHA facilities, Al Ruwais Hospital and
Network (Allowing ADNOC Medical facilities only
direct billing at
designated provider) Government Hospitals: 100% covered at Government Hospitals
in UAE.

Network Outside UAE: Home Country

Network in respective Home Country
(Home Country is defined as the country that has issued
member’s passport on which UAE Residence Visa is stamped)
Pre-existing conditions Fully Covered
Network in
Dubai and Network in
Network in Non-
Inpatient Treatment2 Northern Home
Abu Dhabi network3
Emirates Country
(DNE)
Inpatient & Day Treatment 100% 80% 100%
Not covered
(including Pre & Post In Hospital Treatment Covered) covered covered covered
100% 80% 100%
Accommodation Type – Single Private Room covered covered covered
Not covered
100% 80% 100%
Hospital Accommodation & Services covered covered covered
Not covered
Consultant’s, Surgeon’s & Anesthetist’s Fees and 100% 80% 100%
Not covered
other fee covered covered covered
Ambulance Services
100% 100% 100% 100%
(in Medical emergency cases, subject to General
covered covered covered covered
exclusions)
Parent Accommodation for accompanying an Insured
100% 80% 100%
Child under 18 years of age covered covered covered
Not covered
(Maximum limit of AED 300 per day)
Companion Accommodation for Critical Illness 100% 80% 100%
Not covered
(Maximum limit of AED 300 per day) covered covered covered
Psychiatric Treatment 100% 80% 100%
Not covered
(Covered upto 10 days) covered covered covered
Nursing at Home, if medically necessary covered upto
100% 80% 100%
30 days Not covered
covered covered covered
(Immediately after or instead of hospital)
100% 80% 100%
Organ Transplant Not covered
covered covered covered
Medical Evacuation and Repatriation (through 100% 100% 100%
Not covered
International Assistance Service providers only) covered covered covered
Network in
Network in Network in Non-
Out-patient Treatment Abu Dhabi DNE
Home
network4
Country
Physician Consultation
(Within Abu Dhabi: Deductible AED 80 when any
100% 80% 100%
Diagnostics or Laboratory is prescribed; and AED 50 Not covered
covered covered covered
in all other cases)
(Deductible not applicable for follow up within 7 days)

National Health Insurance Company – Daman (PJSC) (P.O. Box 128888, Abu Dhabi, U.A.E. Tel No. +97126149555 Fax No. +97126149550)
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Schedule of Benefits (ADNOC Enhanced Plus Plan)

Diagnostics (X-Ray, MRI, CT-Scan, Ultra Sound, etc.),

Laboratory (Specialized investigation and scan 100% 80% 100%
Not covered
including but not limited to MRI, Scan, Endoscopies covered covered covered
with Pre-authorization only)
Medical appliances and Medical equipment2
(Maximum annual limit up to AED 5,000 per person 100% 80% 100% 80%
per annum for Medical Prosthetic Devices, Hearing covered covered covered covered10
Aids and Durable Medical Equipment)
Pharmaceuticals
(Long term medications to be dispensed up to 90 70% 70% 70%
Not covered
days without pre- authorization) covered covered covered
(Out of pocket limit of AED 400 Per prescription)
100% 80% 100%
Physiotherapy2 covered covered covered
Not covered

Psychiatric Treatment5,12
100% 80% 100% 80%
OP Psychiatric Treatment Covered up to
covered covered covered covered10
AED 10,000PPPY
100% 80% 100%
Outpatient Surgical Procedures Not covered
covered covered covered
Alternative Medicine5, 13
80% 80% 80% 80%
(including sessions/consultations up to AED 2,500 Per covered covered covered covered
Person Per Policy Year)
Dietician3
(Benefit offered for Employee only with BMI
100% 80% 100%
≥35) covered covered covered
Not covered
(Limited to 6 consultations per Policy Year, Max
limit per visit AED 200)
Network in
Network in Network in Non-
Other Benefits Abu Dhabi DNE
Home
network5
Country
Repatriation of Mortal Remains to country of origin 100% 100% 100% 100%
(AED 25,000) covered covered covered covered
100% 100% 100% 100%
Emergency Treatment
covered covered covered covered
Diagnostic and treatment services for dental and gum
100% 100% 100% 100%
treatment covered covered covered covered
(Medical emergency cases)
Hearing and vision aids, and vision correction by 100% 100% 100% 100%
surgeries and laser (Medical emergency cases) covered covered covered covered
Healthcare services for work illnesses and injuries as
per Federal Law No. 8 of 1980 concerning the 100% 100% 100%
Not covered
Regulation of Work Relations, as amended, and covered covered covered
applicable laws in this respect
Dialysis
(Chronic conditions requiring haemodialysis or 100% 80% 100%
Not covered
peritoneal dialysis, and related tests/treatments or covered covered covered
procedures).
100% 80% 100%
Hepatitis (A) and associated complications Not covered
covered covered covered
Hepatitis (B & C) and associated complications 100% 80% 100%
Not covered
(Maximum annual limit AED 100,000 Per Person) covered covered covered
Rehabilitation of non-excluded condition5
EXCLUDING Autism and Developmental Delay 90% 90% 90% 90%
(Maximum annual limit up to AED 3,000 per person covered covered covered covered
per annum)
Speech Therapy for Autism and Developmental
Delay5 80% 80% 80% 80%
(Maximum annual limit up to AED 5,000 per person covered covered covered covered
per annum)

National Health Insurance Company – Daman (PJSC) (P.O. Box 128888, Abu Dhabi, U.A.E. Tel No. +97126149555 Fax No. +97126149550)
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Schedule of Benefits (ADNOC Enhanced Plus Plan)

Passive War, Passive Terrorism outside UAE

100% 100%
(Cover limited during business trip and/ or vacation Not Covered Not Covered
Covered Covered
only)
Dermatological Treatment
Prescribed medically necessary treatment for un-
100% 80% 100%
excluded medical conditions. Coverage includes, but covered covered covered
Not covered
not limited to, Warts; Acne and other non cosmetic
conditions
Hormonal Replacement Therapy (Prescribed medically
100% 80% 100%
necessary Hormonal replacement therapy for un- Not covered
covered covered covered
excluded medical conditions)
Medical Checkup5 100% 80% 100%
Not covered
(Maximum annual limit of AED 3,000 per person) covered covered covered
Annual Breast Cancer Screening (Applicable for 100% 100% 100%
Not covered
females> 35 years)2,6 covered covered covered
Annual Prostate Cancer Screening (Applicable for 100% 100% 100%
Not covered
males> 45 years)2,7 covered covered covered
Colorectal Cancer Screening 100% 100% 100%
Not covered
(applicable for males and females> 40 years)2,8 covered covered covered
Vaccinations as per HAAD list
100%
(Benefit only at SEHA providers, Ruwais Hospital and covered
Not covered Not covered Not covered
ADNOC Medical Facilities only )
Cervical Cancer Screening2,11 100% 100% 100%
Not covered
(applicable for females aged 25-65 years) covered covered covered
Network in
Network in Network in Non-
Maternity Abu Dhabi DNE
Home
network
Country
Inpatient Maternity1,2
(Deductible AED 500 Per delivery applicable within
100% 80% 100% Not
UAE + Home Country)
covered covered covered covered3
Birth defects and/or Congenital diseases2
(Maximum annual limit of AED 3,000 per person)
Outpatient Maternity
(Within Abu Dhabi: Deductible for Physician
Consultation AED 80 when any Diagnostics or 100% 80% 100% Not
Laboratory is prescribed; and AED 50 in all other covered covered covered covered4
cases)
(Deductible not applicable for follow up within 7 days)
Network in
Network in Network in Non-
Dental Module 1 Abu Dhabi DNE
Home
network5
Country
Dental2,9 80% 80% 80% 80%
(Maximum Annual limit of AED 3,000 Per Person) covered covered covered covered 10
100% 100% 100% 100%
Accidental dental treatment
covered covered covered covered
Other Services covered (Through Service Providers Only)
Tele-consultation healthcare services
(Deductible Nil)
Trudoc Concierge services
International non-emergency assistance
services
Second Opinion facility for specified conditions

1
Please note: (1) Coverage outside UAE is limited to 240 days per treatment. (2) A single holiday or business trip may not exceed 240 days.
2
Pre-authorization required to avail this benefit. All Emergency cases do not require pre-authorization but should be notified to Daman within
24 hours.
3
Benefit available on reimbursement only. Covered In-patient treatment not available in Network will be 100% covered when approved in
advance.
4
Benefit available on reimbursement only. Covered Out-patient treatment not available in Network will be 100% covered. Covered
Pharmaceuticals not available in Network will be 70% covered.
5
Benefit available on reimbursement only.
6
Includes: a) Clinical Examination b) Mammogram c) Pelvic Sonogram (if medically indicated) d) CA 15.3 (if medically indicated)

National Health Insurance Company – Daman (PJSC) (P.O. Box 128888, Abu Dhabi, U.A.E. Tel No. +97126149555 Fax No. +97126149550)
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Schedule of Benefits (ADNOC Enhanced Plus Plan)

7
Includes: a) Clinical Examination b) PSA c) Rectal sonogram
8
Includes: a) FIT (Fecal Immunochemical Test) every 2 years; b) Colonoscopy every 10 years
9
Following services are covered: a) X-Rays, b) Extractions; c) Amalgam / Composite Fillings; d) Root Canal Treatments; e) Consultations; f)
Prescribed Drugs for the above mentioned services (70% covered as part of Outpatient Pharmaceuticals within Network and Non-Network).
10
Benefits are covered on reimbursement within Non-Network, , if network provider (UAE and Home Country) is not available, then treatment
in non-network provider is covered 100% on Actuals.
11 Papanicolaou test (Pap test) - Every 3 years for women aged 25-49 years, every 5 years for women aged 50-65 years
12
Benefits includes psychology services is covered, subject to referral of psychiatric physician excluding Autism, Development Delay and
Learning Disabilities.
13
Alternative Medicine is limited to Herbal Medicine, Homeopathy medicine, Acupuncture, Osteopathy, Chinese Medicine and
Ayurvedic treatment only.

SOB REF NO: SOB US-11018-R0-201223| DOH Approval NO: 55646

C Package no: 38166 & 38167

National Health Insurance Company – Daman (PJSC) (P.O. Box 128888, Abu Dhabi, U.A.E. Tel No. +97126149555 Fax No. +97126149550)
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