Understanding Your Insurance Benefits

Annual Limit

The maximum amount your insurance will pay for medical expenses in one policy year.

• Example: If your annual limit is AED 500,000, this is the total coverage available
• Resets on your policy anniversary date
• Includes all medical expenses except excluded services
• Check remaining balance anytime via app

Deductible

The fixed amount you pay per visit before insurance coverage begins.

• Example: AED 50 deductible means you pay first AED 50 of each visit
• Applies per visit, not per year
• Some plans have zero deductible
• Emergency visits may have different deductibles

Co-payment (Co-insurance)

Your percentage share of costs after the deductible.

• Example: 20% co-pay means you pay 20% of remaining bill
• Usually has a maximum cap per claim
• Premium plans often have 0% co-payment

1. Coverage Summary

• Plan name and type
• Policy effective dates
• Network category
• Geographic coverage area

2. Benefit Details

• In-patient benefits (hospitalization)
• Out-patient benefits (clinic visits)
• Additional benefits (dental, optical, etc.)
• Exclusions and waiting periods

3. Financial Limits

• Overall annual limit
• Sub-limits for specific services
• Deductibles by service type
• Co-payment percentages and caps

Essential/Basic Network

• Access to quality healthcare providers
• Covers fundamental medical needs
• Lower premium cost
• May require referrals for specialists

Enhanced/Standard Network

• Wider selection of providers
• Direct access to specialists
• Premium hospitals included
• Additional service locations

Comprehensive/Premium Network

• Access to all network providers
• VIP hospitals and clinics
• International coverage options
• Minimal or no restrictions

Scenario 1: Doctor Visit

Your Plan: AED 50 deductible, 20% co-pay

Doctor Fee: AED 300

Scenario 2: Hospital Admission

Your Plan: No deductible, 10% co-pay (max AED 1,000)

Hospital Bill: AED 15,000

Maternity Coverage

• Check if included in your plan
• Waiting period typically 10-12 months
• Covers prenatal, delivery, postnatal
• May have separate sub-limit

Dental Coverage

• Basic: Emergency pain relief only
• Enhanced: Routine care included
• Annual limits typically AED 2,000-10,000
• Some procedures require pre-approval

Optical Benefits

• Eye exams and vision tests
• Frames and lenses allowance
• Contact lenses may be covered
• Usually once per year

1. Use Network Providers

• Direct billing available
• Negotiated rates apply
• No claim forms needed
• Guaranteed coverage

2. Understand Pre-Approvals

• Required for expensive procedures
• Ensures coverage before treatment
• Avoids claim rejections
• Provider can request on your behalf

3. Track Your Usage

• Monitor remaining annual limit
• Check sub-limit balances
• Plan major treatments accordingly
• Use app for real-time updates

4. Preventive Care

• Annual check-ups often covered
• Vaccinations included
• Early detection saves money
• Wellness programs available