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ALL YOU NEED TO KNOW

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The Insurance product detailed in this leaflet is a product established, maintained and controlled by National General Insurance PJSC (“NGI”), in its capacity as an approved insurance provider, in collaboration with Prime Healthcare Group LLC. Customers should be aware that, upon participation in such a scheme, they will be contracting with NGI and not the Dubai Chamber, or any subsidiary thereof.

The insurance product detailed in this leaflet is subject to general and specific terms and conditions including limits to benefits, liability and exclusions and customers are strongly advised to familiarize themselves with the product and policy terms & conditions prior to making a decision.

IMPORTANT NOTICE

توضيح

الوطنية الشركة قبل من فيه التحكم و إدارته و استحداثه تم منتج هو الورقة هذه في المبين التأمين منتج إن للتأمينات العامة )ش م ع(، بالتعاون مع مجموعة برايم للرعاية الصحية و ذلك وفقًا لصالحيتها كشركة تأمين. و على العمالء أن يدركوا بأنهم يقوموا من خالل مشاركتهم في هذا المنتج، بالتعاقد مع الشركة الوطنية للتأمينات العامة ال

مع غرفة دبي أو مع أي من الشركات التابعة لها.

و يخضع هذا المنتج لألحكام و الشروط العامة و الخاصة بما في ذلك حدود اإلمتيازات و اإللتزامات المترتبة و اإلستثناءات. و يجب على العمالء أن يطلعوا على أحكام و شروط المنتج و ذلك قبل القيام بأي قرار.

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INTRODUCTION

In consideration of the Application of the Policyholder and the payment of Premium, WE agree to pay the Benefits concerning Treatment expense of all Medically Necessary conditions if not specifically excluded, which incur within the Geographical Area during the Policy Year as specified in the Schedule of Benefits.

The Certificate of Insurance, an evidence of our acceptance of your Application, is issued following completion of Application Form and payment of Premium. Any new Certificate of Insurance replaces any other certificate previously issued to cover the same insurance.

The following documents including any Endorsement are hereby made a part of the Policy and constitute the entire contract, must necessarily be read together:

i. The Application Form And any associated Declaration

ii. The Schedule Of Benefits ( of the applicable Benefit Plan)

iii. The Policy Conditions

iv. The Certificate of Insurance

v. The Endorsements To The Policy (If Any)

vi. The Details of Premium

HEALTHNET HEALTHCARE INSURANCE POLICY

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STANDARD BENEFITS: PULSE PLUS PLAN

BENEFIT DESCRIPTION BENEFIT LEVEL

Annual Limit Dhs. 150,000 per person

Eligibility

All individuals/members of Dubai Chamber of Commerce either on payroll of a registered company or sponsoring their eligible legal dependents who are:1. Aged less than 65 years2. Holding valid residence visa of UAE

Geographical Limit / Area of CoverageInpatient: UAE, Middle East & Sub Asian CountriesOutpatient: UAE Only

INPATIENT SERVICES

Access to Inpatient Services

Restricted to Healthnet Network Only, excluding Al Zahra Group, Mediclinic Group & Saudi German Hospital and their affiliated group hospitals.

Elective Admission Pre-authorization

Room & Board Covered (Single Room)

Consultation / Specialist’s fee during hospitalization Covered

Hospital Services Covered at Network Providers

Emergency Ward Services Covered if followed by inpatient hospitalization requiring not less than 12 hours stay in hospital

Intensive Care Unit Covered

Laboratory and Radiology services during hospitalization Covered

Prescribed Drugs / Pharmaceuticals during hospitalization Covered

Pre-existing Conditions & its consequences

Group of 05 Employees or lessDhs. 15,000 per person for first 6 month of first scheme membership and thereafter up to annual limitAbove 05 EmployeesCovered up to annual limit

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Maternity Benefit- CHILD BIRTH ONLYSubject to 6 month waiting period

In-patient maternity servicesNormal Delivery = Dhs. 7,000Medically necessary C-Section, Complications & medically necessary Termination = Dhs. 10,000

• 10% co-insurance payable by the insured (all limit include co-insurance)

• Requires prior approval from the insurance company or within 24 hours of emergency treatment.

New Born Cover

Cover for 30 days from birthBCG, Hepatitis B and neo-natal screening tests (Phenylketonuria ( PKU ), Congenital Hypothyroidism, sickle cell screening, congenital adrenal hyperplasia)

24 Hours Hotline Service Available

Death due to Any Cause Dhs. 50,000

Accidental Death Benefit Covered up to Dhs. 50,000 (Additional Complementary Benefit Limit)

REIMBURSEMENT TERMS FOR INPATIENT TREATMENT

Reimbursement of Eligible Inpatient Treatment requiring not less than 24 hours stay in Hospital

3. UAE within Network4. Within area of coverage outside UAE as per

Territorial Scope5. Within UAE Out of Network

100% (Direct Billing)

100% of the usual common costs as per UAE network tariffs for same or similar treatment.

Not Covered

Reimbursement in Emergency Cases For Eligible Treatment

1. UAE2. Inside Territorial Scope3. Outside Territorial Scope

100% of incurred cost

100% of incurred cost

Not Covered

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OUTPATIENT SERVICES

Annual Limit Dhs. 150,000 per person

Access to Outpatient Services Restricted to Prime Econocare Network Only

General Outpatient Consultations Covered

Specialist Outpatient Consultations Covered

Deductible Dhs. 50 per visit

Pre-existing & Chronic conditions

Covered

30% Co-insurance for every prescription & no coverage for drugs & medicines in excess of the annual limit of Dhs. 1,500 (inclusive of co-insurance on medication)

Maternity services Out-patient ante-natal services

10% Co-insurance payable by the insured

8 consultation, Initial investigation to include FBC and Platelets Blood Group, Rhesus Status and antibodies, VDRL, MSU & Urinalysis, Rubela Serolgoy, HIV, Hep C offered to high risk patient, GTT If high risk, FBS, Random or A1c for all due to high prevalence of diabetes in UAE, 3 ante-natal ultrasound scans.

Examination, diagnostic and treatment services by authorized general practitioners, specialists and consultants

Deductible Dhs. 50 per visit for Consultation

Laboratory test services carried out in the authorized facility assigned to treat the insured person

Radiology diagnostic services carried out in the authorized facility assigned to treat the insured person.

20% Co-insurance payable by the insured

In cases of non-medical emergencies, the insurance company’s prior approval is required for MRI, CT scans and endoscopies

Physiotherapy treatment services Maximum 6 sessions per year

20% Co-insurance payable by the insured Prior approval of the insurance company is required

Drugs and other medicines up to annual limit of Dh, 1,500; restricted to a list of formulary products to be published by DHA.

30% coinsurance payable by the insured.Prior approval of the insurance company is required for above Dhs. 500/-

Excluded healthcare services except in cases of medical emergencies

• Diagnostic and treatment services for dental and gum treatments

• Hearing and vision aids, and vision

20% Co-insurance payable by the insured Prior approval of the insurance company is required

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Outpatient Surgical Procedure (Restricted to Prime Econocare Network clinics only)

Covered subject to deductible and coinsurance as per above

REIMBURSEMENT TERMS FOR OUTPATIENT TREATMENT

Reimbursement of Non-Emergency Outpatient Treatment

1. UAE Within Network2. Within UAE Out of Network3. Outside UAE

Direct Billing (co-insurance & deductible apply)

Not Covered

Not Covered

Reimbursement in Emergency Cases For Eligible Outpatient Treatment

1. UAE Within Network2. Within UAE Out of Network at Government

Facilities only (after working hours where network clinics cannot be accessed)

Direct Billing (co-insurance & deductible apply)

Up to 100% of usually, customary & reasonable cost after deductible & co-insurance subject to pre-approval

Premium Dhs. 1,665 per person per annum (inclusive of premium for inpatient services)

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Whenever the following words are used in this Policy, they shall have the meanings, which are given to them below, wherever they occur and the terms denominated in the singular shall include the plural, and masculine terms shall include the feminine, when the context requires. However, the section is not intended to describe Covered or Uncovered services:

“Accident” means an unforeseen event, which resulted in an injury, caused solely and directly from unexpected, external, violent and visible means beyond anyone’s control.

“Annual Limit” means the total aggregate Benefits that the Insured Person/ Policyholder may Claim in any Policy-Year, as shown in the Schedule of Benefits.

“Application” means the Company’s standard Form for applying insurance.

“Benefits” mean the amount of money that may be payable in respect of any Claim of medical expenseconcerning Disease or Disorder covered under the Policy.

“Certificate of Insurance” means a certificate evidencing our acceptance of your Application, which isissued following completion of Application Form and payment of Premium.

“Chronic Conditions” means a medical condition which does not have any specific cure. Such conditions are characterized by recurrent consultation and treatment for an indefinite period.

“Claim” means the Benefits that the Insured Person/ Policyholder ask the Company or the Outpatient Service Provider to pay in respect of medical expense concerning Disease or Disorder covered under the Policy.

“Claim Form” means the Company’s standard Claim Form.

“Co-Insurance” means the proportion of the cost of each Claim of medical expense that is not coveredunder the Policy and for which the Insured Person/ Policyholder must contribute at point of service. The Co-Insurance proportion, if any, is stated on the Schedule of Benefits.

“Commencement Date” means the Date of Commencement of Cover as shown on the Certificate ofInsurance.

“Day-Patient (a patient who occupies a HOSPITAL bed or is charged for HOSPITAL accomodation in the course of MEDICAL TREATMENT but does not remain overnight) Treatment” Treatment, which for medical reasons requires a period of clinically -supervised recovery however, it does not require an overnight stay in the Hospital. Expenses incurred for Treatment at the Outpatient or emergency ward of the Hospital are not considered “Day-patient Treatment”.

“Deductible” means the first part of the cost of a Claim or series of Claims expressed in terms of afixed amount that is not covered under the Policy and for which the Insured Person/ Policyholder mustcontribute. The Deductible amount if any is stated in Schedule of Benefits.

“Dependant” The spouse of the INSURED PERSON (but excluding those legally separated), and/or unmarried children, step-children, foster children and legally adopted children, who are dependent on the INSURED PERSON for support provided it can be proved that the child is dependent upon the parents for financial support, and in full time education within the United Arab Emirates. The DEPENDANTS of the INSURED PERSON must be recognized as such in the records of the EMPLOYER.

“Disease” means any Illness or Injury.

GENERAL DEFINITIONS-TERMS USED IN POLICY DOCUMENT

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“Disorder” means any Illness or Injury.

“Due Date” The date of commencement or renewal of cover as shown on the Certificate of Insurance, or the date on which any subsequent payment of premium falls due.

“Econocare Network” designated clinics/ providers maintaining direct contract/agreement with Prime Medical Center/ Prime Healthcare Group for the purpose of providing outpatient services “Eligible Expenses” means those charges for Treatment that are payable by the Company and are:

i. Reasonable and Customary;

ii. Medically Necessary;

iii. Within Policy coverage and Limits; and

iv. Not excluded under any of the terms and conditions of the Policy.

“Emergency” means a health condition resulting from sudden Illness or injury raising a professional concern that there may be a significant medical problem jeopardizing the Insured Person/ Policyholder’s life and necessitating Treatment, which must be given through emergency ward services without any delay.

“Emergency Ward Services following Accident” Services performed in a HOSPITAL casualty ward oremergency room immediately following an ACCIDENT.

“Employee” An INSURED PERSON who is in ACTIVE SERVICE on a full-time basis with the EMPLOYERunder a written contract of employment. Persons in casual employment with the EMPLOYER are notincluded. Sole Proprietors, Partners or Directors of the EMPLOYER can be included.

“Employer” The EMPLOYER of the INSURED PERSON or, in the case of non employee groups acceptedby US, the Sponsoring organization through which the plan is offered, effected or administered and towhom the MASTER POLICY is issued.

“Endorsement” means any variation to this Policy or any of its attached terms, including a replacementof any term.

“Exclusion” means any expense or medical condition the Treatment of which although Medically Necessary but is not covered under the terms of Policy.

“Geographical Area” means the geographical Limitation as stated in the Schedule of Benefits.

“Group” means a group of EMPLOYEES employed by an EMPLOYER or Members of a Trade Union orMembers of any Association and their Dependants or Members of any other Institution accepted by US and considered to be a group for the purposes of this contract.

“Hospital” means any institution that is:

i. Licensed in accordance with the applicable laws of the jurisdiction in which it is located,

ii. Is primarily engaged in providing, for compensation from its patients, diagnostic, medical and surgical facilities for the care and Treatment of injured or sick persons,

iii. Has 24 hours-a-Day nursing service by registered graduate nurses under the permanent

supervision of the Physician in charge,

iv. Maintains In-patient facilities, and

v. Maintains a daily medical record for each of its patients, which is accessible to the Company.

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A Hospital, despite any similarities with the above description, does not include any institution, which isprimarily a rest or convalescent facility, a place of custodial care, a facility for the aged, alcoholics or drug addicts or for the Treatment of mental Disorders, or a nursing home.

“Hospital Services” Accommodation, nursing, operating theatres, drugs, dressings, diagnostic procedures and any other necessary services rendered by the HOSPITAL for MEDICAL TREATMENT as an IN-PATIENT.

“Illness” means any physical condition marked by a pathological deviation from the normal state of health.

“In-patient” means an Insured Person/ Policyholder who for medical reasons requires an overnight orlonger stay (more than 24 hours) in the Hospital to receive Treatment.

“Insured Person/ Policyholder” means any Person and/or Dependant who has fulfilled all of the eligibility conditions and is included under the Policy and is listed on the Certificate of Insurance.

“Laboratory and X-ray Services” Laboratory testing, radiographic and nuclear medicine procedures used to diagnose and treat MEDICAL CONDITIONS. Laboratory and X-ray Services must be provided by or ordered by a PHYSICIAN.

“Local Ambulance Services” Transportation of the Insured Person/ Policyholder for medical reasons, by road using an Ambulance service to a local Hospital or from Hospital To Hospital

“Maternity” Pregnancy related expenses are in lieu of all other Benefits under this Policy and is subject to the Benefit Limits Specified for Delivery- Child Birth. This Benefit applies only to pregnancies beginning at least 10 calendar months after the Date of inception of your insurance coverage, the Benefit Limit applies to one pregnancy, including all complications. In the event of a pregnancy requiring an abdominal cutting operation such as caesarian section or extra –uterine pregnancy, then such expenses are payable up to the Benefit Sub Limit. Exclusion: Treatment given to the newborn is not covered.

“Medically Necessary” means Treatment, services or supplies, as provided by a Hospital, Physician, registered Nurse or other provider required to identify or treat an Insured Person/ Policyholder’s Disease or Disorder, which are:

i. Consistent with customary allopathic medical Treatment for the Insured Person/ Policyholder’s symptoms, diagnosis Disease or Disorder;

ii. Appropriate with regard to the standards of good medical practice;

iii. Not solely for the convenience or Benefit of the Insured Person/ Policyholder, the Physician, the Hospital or any other provider of Health Care; and

iv. iv. Performed in the most “Reasonable and Customary” manner and setting that can safely be provided to the Insured Person/ Policyholder.

“Network Hospital/Clinic - INPATIENT” means a Hospital approved and identified as such by the Company for the purposes of providing Treatment, subject to the terms of the Policy, to the Insured Person/Policyholders.

“Network Hospital/Clinic - OUTPATIENT” means a Hospital/ Clinic approved and identified as such byOutpatient Service Providers/ Prime Medical Center for the purposes of providing Outpatient Treatment,subject to the terms of the Policy, to the Insured Person/ Policyholders.

“Non-Network Hospital” means any Hospital/ Clinic other than a Network Hospital/ Clinic.

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“Organ Transplantation” MEDICAL TREATMENT costs incurred in respect of kidney, heart and liver transplants. This BENEFIT does not cover the cost of acquiring the organ or any expenses whatsoeverincurred by the donor.

“Out-patient” means an Insured Person/ Policyholder who receives Treatment at Physician’s consultingrooms, outpatient clinic or the residence of the Insured Person/ Policyholder, where the Insured Person/Policyholder does not go in for a Day patient or In-patient Treatment. Any consultation either from A General Practitioner or a Specialist Doctor as an Outpatient is not covered

“Out-patient Service Provider/ Administrator: Prime Medical Center/ Prime Healthcare Group throughEconocare Network

“Parent Accompanying Child” Charges made by a HOSPITAL for one parent to accompany a child aged 15 years or under when treated as an IN-PATIENT. Such expenses are not covered.

“Pharmaceuticals/ Prescribed Drugs” Drugs prescribed by a Physician, which are Medically Necessaryfor the Treatment of a medical condition.

“Physician” is an individual legally licensed to operate in the Geographical Area of his/her practice, is qualified by a degree acceptable to and recognized by the Government of United Arab Emirates and isother than the Insured Person/ Policyholder, who:

i. In the case of a Surgeon, Specialist, or Anesthetist, is recognized as qualified to treat the type of injury or Illness for which the Claim is made and for which Treatment is being provided;

ii. Is practicing within the scope of his/her licensing and training;

iii. Is not related by blood or marriage to the Insured Person/ Policyholder, to whom Treatment is being provided; and

iv. Is not a Policyholder of or connected in any way to the Policy Holder.

“Plan,” means any one of the medical insurance schemes provided by the Company.

“Policy” means this agreement including its Schedules / terms / any Endorsement and Claims procedure, along with the Application and any Claim Form.

“Policy-Year” means twelve (12) calendar months from the Commencement Date of this Policy or fromthe Renewal Date.

“Pre-Authorization” means approval of treatment expense of a medical condition prior to receiving anyscheduled/ elective inpatient treatment. Such approvals are accorded by the insurer directly to the hospital or insured person.

“Pre-Existing Condition” means any Disease, Illness or injury for which a person receives Treatment or experience symptoms, incurs expense, receives diagnosis from a physician (even if no Treatment isprovided) or was aware of at any time prior to applying for insurance.

“Premium” means the amount of money payable to the Company by the Insured Person/ Policyholder/Policyholder to join the Policy.

“Reasonable and Customary Charges” means charges for medical Treatment to the extent that they do not exceed the general level of charges being made by other facilities, or Physicians of similar training and standing for like or comparable Treatment to Insured Person/ Policyholder for a similar Disorder. An independent third party, being a practicing Surgeon/Specialist or Government Health Department, may substantiate such charges.

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“Renewal Date” means the anniversary or when the Policy began, unless the Company has agreed anyother Date in writing.

“Resident of United Arab Emirates” means a person that is normally living in United Arab Emirates andwho spends a total of at least nine (9) months of the Policy-Year in United Arab Emirates.

“Schedule” means any of the Schedules attached to the Policy.

“Schedule of Benefits” means a list stipulating the Annual Limit and the Limits available for each Benefit offered under this Policy as attached.

“Specialist” means Physician, Surgeon or Gynecologist specialized in area of own speciality like medicine, surgery or Gynecology & Obstetrics.

“Standard Exclusion” means any Treatment expense of a medical condition, which although MedicallyNecessary but is not covered under the terms of Policy and applicable to all Policy Holders unless it isspecifically and mutually agreed to cover under the Policy by a separate Endorsement.

“Surgeon” means an individual legally licensed to conduct surgical operations.

“Treatment” means a medical or surgical intervention including any Medically Necessary investigation to cure a Disease or Disorder.

“The Company” means NATIONAL GENERAL INSURANCE CO. (P.S.C.)

“The Insurer” means NATIONAL GENERAL INSURANCE CO. (P.S.C.)

“Usual Country of Residence” means United Arab Emirates.

“Waiting Period,” means a specific period from the Commencement Date where the Insured Person/ Policyholder is not entitled to certain Benefits included in the Policy.

Additions/DeletionsAdditions/ Deletions will be on a pro-rata premium basis. For new additions passport copies showing stamped visa page, photograph and duly filled in application forms if applicable should be submitted.

ApplicationAll policies are subject to the completion of the appropriate application form. WE retain the right to decline any application.

ArbitrationAny differences in respect of medical opinion will be settled between two medical experts one appointedby each of the two parties to the dispute in writing. Any differences of opinion between the two medicalexperts shall be referred to an umpire who shall have been appointed in writing at the outset by the twomedical experts.

POLICY ADMINISTRATION- GENERAL TERMS & CONDITIONS

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CancellationWE may cancel this POLICY if:

• The premium has not been paid.

• The EMPLOYER fails to observe the terms of the POLICY or fails to act with utmost good faith.

Cancellation of the POLICY will automatically cancel all cover for all persons insured under the POLICY.

Cessation of CoverageCover will cease automatically at the first DUE DATE following the 65th birthday of any INSURED PERSON covered hereunder or if any INSURED PERSON ceases to fulfill the requirements for ELIGIBILITY.

ClaimsIn the event of a claim under the policy BENEFIT is payable if:

1. YOU have contacted US and received PRE-AUTHORISATION of any costs to be incurred as an IN-PATIENT or Outpatient Service Provider where it is deemed necessary. In an emergency when WE cannot be contacted in advance then the admission to HOSPITAL must be reported as soon as possible and in any event not later than 2 working days after admission and.

2. Premiums have been paid for the POLICY YEAR and MEDICAL TREATMENT is received during the POLICY YEAR and

3. WE can ask for medical information including pre-admission certification and concurrent review reports, from any PHYSICIAN as often as WE require and if necessary examine YOU and

4. WE are told of any circumstances that may lead to a claim against a third party or any other insurance and

5. MEDICAL TREATMENT is carried out within the “HEALTHNET” NETWORK and.

6. Where MEDICAL TREATMENT is carried out outside of the “HEALTHNET” NETWORK written details of the claim have been sent to US as soon as possible and in any event not later than 90 days from the start of MEDICAL TREATMENT. All documentation relating to the claim must be originals and not copies.

7. IN-PATIENT Treatment received outside of the “HEALTHNET” NETWORK will be on a reimbursement basis and reasonable and customary charges will prevail and.

8. PRE- AUTHORIZATION is mandatory for Emergency Outpatient Treatment at NON- NETWORK

EligibilityThis Insurance is available only to United Arab Emirates Nationals and persons holding a valid current full residence status visa for the United Arab Emirates and who are ordinarily resident in Emirates other than Abu Dhabi.

EMPLOYEES aged under 65 currently in ACTIVE SERVICE of the EMPLOYER and their DEPENDANTSaged under 65 at the date of entry into the coverage are eligible.

Newly born children shall be eligible for insurance from day 01 after discharge from the HOSPITAL where the birth took place.

FraudIf any claim shall in any respect be false or fraudulent or if fraudulent means or devices are used by theINSURED PERSON or anyone acting on his behalf to obtain BENEFIT hereunder then the coverage inrespect of such person and insured dependants shall be cancelled immediately and all BENEFITS andpremium forfeited.

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Legal ProceedingsNo Legal proceedings shall be commenced until 60 days after a claim has been correctly submitted with all documentation required by US and no such action shall be brought unless commenced within 6 years from the first date of treatment.

This POLICY is governed by the Law of the United Arab Emirates and any dispute arising out this POLICY shall be settled in the Courts of Dubai.

Lost CardFor Lost or stolen cards a cost of Dhs. 25 will be levied. Lost cards if subsequently found shall be returned to us.

Material ChangesWE must be advised as soon as possible of any material change affecting any INSURED PERSONS. WE retain the right to alter the terms of the POLICY or cancel the POLICY in the event of material change.

Other InsuranceWE will not pay for MEDICAL TREATMENT CHARGES if there is any other insurance or indemnity thatmay cover those charges. If the other insurance or indemnity does not cover all MEDICAL TREATMENTCHARGES, WE will pay the balance subject to the limitations of this policy.

WE have full rights of Subrogation.

Payment of BenefitsWe will make payment directly to a provider of MEDICAL TREATMENT which is a member of the HEALTHNET NETWORK subject to receiving satisfactory proof of the MEDICAL TREATMENT provided.WE will make payment to YOU for MEDICAL TREATMENT received outside the HEALTHNET NETWORKsubject to receiving satisfactory proof of the MEDICAL TREATMENT received.

Payment of PremiumPremiums are payable in advance of the DUE DATE. If payment is not made on or before the DUE DATEthe insurance will be cancelled from the DUE DATE.

RenewalThis plan is an annual contract and YOUR cover ends on the last day of the POLICY YEAR. It may berenewed if renewal is invited by us and the premium has been paid.

The Company shall not pay any expense or consequential expenses of a Treatment of any condition arising from event, activity and Disease or Disorder as mentioned hereunder:

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 including

• 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.

GENERAL POLICY EXCLUSIONS(FOR ALL EMIRATES OTHER THAN THE EMIRATE OF ABU DHABI)

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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. 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 and investigations and pharmacological weight reduction regimens.

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

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. Non-medically necessary Amniocentesis

14. Treatment, services and surgeries for sex transformation, sterility and sterilization with the exception of corrective surgery.

15. Treatment and services for contraception

16. Treatment and services related to sterility (varicocele / polycystic ovary / ovarian cyst / hormonal disturbances / sexual Dysfunction).

17. Prosthetic devices and medical equipment, 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, both out-patient and in-patient treatments, unless it is an emergency condition.

22. 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.

23. 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.

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

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

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

27. Healthcare services and treatments by acupuncture; acupressure, hypnotism, massage therapy, aromatherapy, ozone therapy, homeopathic treatments, and all forms of treatment by alternative medicine.

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

29. Elective diagnostic services and medical treatment for correction of vision

30. Nasal septum deviation and nasal concha resection.

31. All chronic conditions requiring hemodialysis or peritoneal dialysis, and related investigations, treatments or procedures.

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

33. Birth defects, congenital diseases for newborn and deformities unless life threatening.

34. Healthcare services for senile dementia and Alzheimer’s disease.

35. Air or terrestrial medical evacuation (except for emergency cases); and unauthorized transportation services.

36. Healthcare services related to circumcision.

37. 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.

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

39. Any investigations or health services conducted for non-medical purposes such as investigations related to 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, exercise equipment and sanitary supplies.

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

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

43. Services and educational programs for handicaps.

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If you are unsure of any matter concerning Pre-authorization or you need assistance in finding a Physician or Network Hospital you can contact us.

Inpatient: Outpatient:

Tel: + 971 4 211 5800 (Intimations & pre-approvals) Tel: + 971 4 272 0720 (Network information)

Fax: + 971 4 250 2895 Mob: + 971 55 725 5732 (Medical Emergency)

Email: dccs@ngiuae.com Email: econocare@primehealth.ae

MEDICAL HELPLINES & ASSISTANCE