Table of Benefits

Effective date: 01 September 2021

Group renewal date: 01 September 2022
Treatment Guarantee (pre-authorisation) may be required for some benefits as indicated by a '1' or a '2' in the
table(s) below. Please refer to the "Notes" section for further details.

All benefit and deductible amounts are per person, per year of cover, unless otherwise indicated.

Benefit limit

Select DPlus Direct Core Plan Maximum Plan Benefit US$

1,060,000

Hospital accommodation - Private room Full Refund 1

Intensive care Full Refund 1

Prescription drugs and materials (in-patient and day-care Full Refund 1

treatment only) (Prescription drugs are those which legally can
only be purchased when you have a doctor’s prescription)

Surgical fees, including anaesthesia and theatre charges Full Refund 1

Physician and therapist fees (in-patient and day-care treatment Full Refund 1
only)

Surgical appliances and materials Full Refund 1

Diagnostic tests (in-patient and day-care treatment only) Full Refund 1

Organ transplant US$ 71,000 1

Psychiatry and psychotherapy (in-patient and day-care US$ 14,000 1

treatment only)

Accommodation costs for one parent staying in hospital with an Full Refund 1
insured child under 18

Accommodation costs for one person accompanying an insured Full Refund 1

person in cases of medical necessity

Emergency in-patient dental treatment Full Refund

Day-care treatment Full Refund 2

Kidney dialysis Full Refund 2

Policy number: P002467443 Page 1 of 7

Orient Insurance PJSC, 02a Orient Building, Al Badia Business Park, Dubai Festival City, P.O. Box 27966, Dubai, United Arab Emirates.
 Select DPlus Direct Core Plan Maximum Plan Benefit US$
1,060,000

Out-patient surgery Full Refund 2

Nursing at home or in a convalescent home (immediately after US$ 3,550 2

or instead of hospitalisation)

Rehabilitation treatment (in-patient, day-care and out-patient US$ 2,800 2

treatment; must commence within 14 days of discharge after the
acute medical and/or surgical treatment ceases)

Local ambulance Full Refund

Emergency treatment outside area of cover (for trips of a US$ 14,000

maximum period of six weeks) 42 day limit

Medical evacuation: * Where necessary treatment is not Full Refund 2

available locally, we will evacuate the insured person to the
nearest appropriate medical centre, * Where ongoing treatment
is required, we will cover hotel accommodation costs, *
Evacuation in the event of unavailability of adequately screened
blood

- If medical necessity prevents an immediate return trip following 7 day limit

discharge from an in-patient episode of care, we will cover hotel
accommodation costs

Expenses for one person accompanying an evacuated person US$ 4,250 2

Travel costs of insured family members in the event of an US$ 2,800 2

evacuation (per event)

Repatriation of mortal remains US$ 14,000 2

Travel costs of insured family members in the event of the US$ 2,800 2
repatriation of mortal remains (per event)

CT scans (in-patient and out-patient treatment) Full Refund

MRI, PET and CT-PET scans (in-patient and out-patient Full Refund 2
treatment)

Oncology (in-patient, day-care and out-patient treatment): Full Refund

- Chemotherapy (in-patient/daycare) 2
- Hospital accommodation 2
- Oncology diagnostic tests (in-patient) 2
- Oncology professional fees (in-patient) 2
- Purchase of a wig, prosthetic bra or other external prosthetic device for US$ 270 per member lifetime
cosmetic purposes
- Radiotherapy (in-patient/day case) 2

Routine maternity (in-patient and out-patient treatment): US$ 5,650 per pregnancy

Policy number: P002467443 Page 2 of 7

Orient Insurance PJSC, 02a Orient Building, Al Badia Business Park, Dubai Festival City, P.O. Box 27966, Dubai, United Arab Emirates.
 Select DPlus Direct Core Plan Maximum Plan Benefit US$
1,060,000

- Newborn care 2
- Other diagnostic tests (in-patient) 2
- Package 2
- Prescription drugs and materials 2
- Private room 2
- Professional fees 2
- X-rays (in-patient) 2

Complications of pregnancy and childbirth: US$ 43,000

- In the event of emergency treatment US$ 43,000

- In the event of non emergency treatment US$ 11,300 2

Antenatal care (within the limits outlined by the Dubai Health Full Refund
Authority protocols)

Newborn care (in-patient and out-patient treatment) 30 day limit 2

In-patient cash benefit (per night) (where treatment has been 25 day limit
received free of charge) US$ 210 per day

Emergency out-patient treatment Full Refund

Emergency out-patient dental treatment Full Refund

Palliative care Full Refund 2

Long term care 90 day limit per member lifetime 2

MyHealth Digital Services: Manage your cover online with our Full Refund
app or portal anytime, anywhere; Submit and track progress of
claims; Access your policy documents, health services, payment
details and more

Employee Assistance Programme offers access to a range Full Refund

of 24/7 multilingual support services as follows: Confidential,
professional counselling (in-person, phone, video and chat);
Legal and financial support services; Critical incident support;
Wellness website access

Travel Security Services offers 24/7 access to personal security Full Refund
information and advice for all your travel safety queries. This
includes: Emergency Security Assistance Hotline (not a free
phone number); Country intelligence and security advice; Daily
security news updates and travel safety alerts

Policy number: P002467443 Page 3 of 7

Orient Insurance PJSC, 02a Orient Building, Al Badia Business Park, Dubai Festival City, P.O. Box 27966, Dubai, United Arab Emirates.
 Silver DPlus Direct Out-patient Plan Maximum Plan Benefit US$ 61,700

Medical practitioner fees Full Refund

Video consultation services Full Refund

Prescription drugs (Prescription drugs are those which legally Full Refund
can only be purchased when you have a doctor’s prescription)

Specialist fees Full Refund

Diagnostic tests Full Refund

Vaccinations Full Refund

Chiropractic treatment, osteopathy, homeopathy, Chinese herbal Full Refund

medicine, acupuncture and podiatry (max. 12 sessions per
condition for chiropractic treatment and max. 12 sessions per
condition for osteopathic treatment, subject to the benefit limit)

- Chiropractic treatment Max. 12 per claim (diagnosis) per year

- Osteopathy Max. 12 per claim (diagnosis) per year

Prescribed physiotherapy (initially limited to 12 sessions per Full Refund

condition; limit also applies to prescribed and non-prescribed
physiotherapy sessions, where combined)

- Non-prescribed physiotherapy (visits) Max. 5

Prescribed speech therapy, oculomotor therapy and Full Refund

occupational therapy:

- Occupational therapy 2

Health and wellbeing checks including screening for the early US$ 850
detection of illness or disease. Checks are limited to: * Physical
examination * Blood tests (full blood count, biochemistry, lipid
profile, thyroid function test, liver function test, kidney function
test) * Cardiovascular examination (physical examination,
electrocardiogram, blood pressure) * Neurological examination
(physical examination) * Cancer screening

- Annual faecal occult blood test Max. 1

- Annual prostate screening (yearly for men aged 50+, or younger where Max. 1
a family history exists)
- Bone densitometry (every five years for women aged 50+) Max. 1 for a period of 5 years
- Colonoscopy (every five years for members aged 50+, or 40+ where a Max. 1 for a period of 5 years
family history exists)
- Mammogram (every two years for women aged 45+, or younger where Max. 1 for a period of 2 years
a family history exists)
- Well child test (for children up to the age of six years, up to a maximum Max. 15 per member lifetime
of 15 visits per lifetime)

Preventive services. Checks are limited to Full Refund

- Annual pap smear Max. 1

Policy number: P002467443 Page 4 of 7

Orient Insurance PJSC, 02a Orient Building, Al Badia Business Park, Dubai Festival City, P.O. Box 27966, Dubai, United Arab Emirates.
 Silver DPlus Direct Out-patient Plan Maximum Plan Benefit US$ 61,700

- Diabetes tests (every three years for members aged 30+) Max. 1 for a period of 3 years
- Diabetes tests (yearly for members aged 18+ if there is a high risk of Max. 1
diabetes developing)

Infertility treatment US$ 17,000 per member lifetime

Psychiatry and psychotherapy (visits) Max. 20

Prescribed medical aids US$ 3,550

Prescribed glasses and contact lenses including eye US$ 280

examination

Ayurvedic treatment US$ 850

M.E. DPlus Dental 2 Dental Plan Maximum Plan Benefit US$ 2,875

Dental treatment 80% refund

Dental surgery 80% refund

Periodontics 80% refund

Orthodontic treatment and dental prostheses 50% refund

NOTES
.
Hospital network
.
.
The name of the provider network applicable to your cover is indicated on your personal Access Card and a list
of the medical providers included in your network was issued with your membership pack.
.
.
Your provider network includes a large number of clinics/hospitals and pharmacies that have contractual
arrangements in place with us. Upon presentation of your Access Card (plus a Pharmacy Services Claim
Form, in the case of pharmacies) each of these clinics/hospitals and pharmacies will provide their services and
products without seeking immediate payment from you, unless the prescribed treatment is specifically excluded
under your policy.
.
.
Please note that under some benefits, cover may be available on a reimbursement basis only, i.e. you will have
to pay for eligible treatments and then complete and submit a Claim Form. For further details please refer to
“Getting treatment” section of the “Quick start guide” which is attached to the end of your Employee Benefit
Guide.
.
.
Pre-authorization
.

Policy number: P002467443 Page 5 of 7

Orient Insurance PJSC, 02a Orient Building, Al Badia Business Park, Dubai Festival City, P.O. Box 27966, Dubai, United Arab Emirates.
For certain benefits listed in your Table of Benefits, you are required to submit a completed Pre-authorization
Form in advance of receiving your treatment. Following approval by us, cover can then be guaranteed. In the
Table of Benefits, benefits which require pre-approval through submission of a Pre-authorization Form are
indicated by either a 1 or a 2.
.
.
If you choose to be treated within your provider network, then your medical provider will automatically deal with
us directly for Pre-authorization, where necessary.
.
.
However, where you choose to be treated outside of the provider network, you will need to ensure that you
contact us for the necessary Pre-authorization. Full details of our Pre-authorization process are provided in the
Employee Benefit Guide issued at policy inception. Please note that:
.
.
•If Pre-authorization is not obtained for the benefits listed with a 1, we reserve the right to decline a claim. If
the respective treatment is subsequently proven to be medically necessary, we will pay only 80% of the eligible
benefits.
.
•If Pre-authorization is not obtained for the benefits listed with a 2, we reserve the right to decline a claim. If
the respective treatment is subsequently proven to be medically necessary, we will pay only 50% of the eligible
benefits.
.
•In the case of an emergency, you don’t need to submit the Pre-authorization Form in advance but we should be
informed within 48 hours of the event to ensure that no Pre-authorization penalty apply to your claim.
.
.
For further details please refer to our Benefit Guide, or simply contact our Helpline.
.
.
Chronic conditions
.
Chronic conditions are covered within the limits of the selected plan during the Insurance Year.
.
.
Pre-existing conditions
.
Pre-existing conditions are covered within the limits of the selected plan during the Insurance Year.
.
.
Benefit limits
.
There are two kinds of benefit limits shown in the Table of Benefits. The maximum plan benefit , which applies
to certain plans, is the maximum we will pay for all benefits in total, per member, per Insurance Year, under that
particular plan. Some benefits also have a specific benefit limit , which may be provided on a "per Insurance
Year" basis, a "per lifetime" basis or on a "per event" basis, such as per trip, per visit or per pregnancy. Where
a specific benefit limit applies or where the term "Full refund" appears next to certain benefits, the refund is
subject to the maximum plan benefit, if one applies to your plan(s). All limits are per member, per Insurance
Year, unless otherwise stated in your Table of Benefits.
.
.
Policy terms and conditions
.
Your Table of Benefits provides an outline of the cover we provide under each plan. Cover is subject to our
policy terms and conditions, as detailed in our Employee Benefit Guide which is issued to members upon policy
inception.
.

Policy number: P002467443 Page 6 of 7

Orient Insurance PJSC, 02a Orient Building, Al Badia Business Park, Dubai Festival City, P.O. Box 27966, Dubai, United Arab Emirates.
.
If you are based in Dubai, please note that your policy terms and conditions are also subject to the Dubai Health
Authority requirements that may be changed from time to time.
.
.
Policy endorsement(s)
.
If there are any policy terms and conditions unique to your policy they will be listed below. Please read carefully
in conjunction with our Employee Benefit Guide.
.

LiveDoc is provided by Health at Hand DMCC, address 4207 BB1 Tower, Mazaya Business Avenue, JLT,
Dubai, United Arab Emirates and the consultation costs are covered by us, subject to the terms of your
insurance cover. Orient Insurance PJSC, its administrators and reinsurers are not responsible or liable for any
claim, loss or damage directly or indirectly resulting from the use of the Live Doc services or any other Health at
Hand service.
.
.
The Employee Assistance Programme Services are made available by Morneau Shepell Limited, subject to
your acceptance of our terms and conditions. You understand and agree that Orient Insurance PJSC and its
appointed reinsurers and administrators are not responsible or liable for any claim, loss or damage directly or
indirectly resulting from your use of the Employee Assistance Programme Services.
.
.
The Travel Security Services are made available by WorldAware LTD, subject to your acceptance of our
terms and conditions. You understand and agree that Orient Insurance PJSC, its appointed reinsurers and
administrators are not responsible or liable for any claim, loss or damage directly or indirectly resulting from your
use of the Travel Security Services.

Contact details

If you have any questions or need any help, please email us at: AZChelpline@nextcarehealth.com. Or you can
call our Helpline: 800 6334 (toll-free from the UAE) or on: + 971 56 681 9977 (from inside or outside the UAE).

Policy number: P002467443 Page 7 of 7

Orient Insurance PJSC, 02a Orient Building, Al Badia Business Park, Dubai Festival City, P.O. Box 27966, Dubai, United Arab Emirates.