Page 25 - Ipsos

IPSOS STAT FZ LLC

Attached to and forming part of the Policy No: - TBA

(Policy Period: - September 28th, 2016 To December 31st, 2017)

BENEFIT SCHEDULE – CLASSIC PLAN – CATEGORY A – Non Abu Dhabi

21 Chronic and pre-existing disease/illness Covered up to the Annual Benefit Level.

22 Type of Network Of Providers General Network.

23 ➢ Covered on reimbursement basis
Vaccination Covered as per MOH schedule ➢ Reimbursements claims are settled at 100% of actual
(For Children up to 6 years) covered cost subject to not exceeding 100% of
Applicable Network rates.
24 Diabetic Screening:
Fasting Blood Sugar and HBA1C tests are covered once a
Preventive services covered for members over 18 policy year for eligible members
years of age Reimbursements claims are settled at 100% of actual covered
cost subject to not exceeding 100% of Applicable Network
rates
*Free Access facility is available only within Aster Group.
25 • Covered for 30 days from birth
• Coverage includes BCG, Hepatitis B and neo- natal
screening tests (Phenylketonuria (PKU), Congenital
New born cover
Hypothyroidism, sickle cell screening, congenital
adrenal hyperplasia)
• The cover is provided under the mother’s policy.
26 The cost of accommodation of a person
accompanying an in-patient in the same room in
cases of medical necessity at the
recommendation of the treating doctor and after Maximum 100 AED per night
the prior approval of the insurance company
providing coverage

27 Hearing and vision aids, and vision correction by Covered only in cases of medical emergencies
surgeries and laser
28 Congenital Diseases Covered if it is life threatening

Note: All Full Refunds are subject to not exceeding the Maximum Aggregate
Annual Benefit Level. Further the rates, benefits and terms stated in this quotation
are not applicable for Abu Dhabi and Al Ain based members