EXHIBIT E- 19TC1023R0001 -Amendment 0001- Supporting Document.pdf

PART 1 Health insurance claims record summary

1 Name of scheme / employer

2 Policy Number

3 Policy Period

3a Policy effective date

3b Policy Expiry date

3c Initial policy effective date (date from which you have provided continuous cover for this client

Report period (must be a minimum 9 months, less at discretion of insurer) 4a Report period start date

4b Report period end date

4c Report production date

5 Total values (AED)

5a Value of Claims paid during report period only

5b Value of Claims incurred, reported but not paid up to end of reporting period

5c Value of Claims incurred but not reported up to end of reporting period

6 Population census (at beginning of reporting period) 0-15 16-25 26-35 36-50 51-65 Over 65

6a Male 144 92 12 161 106 5

6b Single females 119 78 6 13 3

6c Married females 42 171 58 3

7 Population census (at end of reporting period) 0-15 16-25 26-35 36-50 51-65 Over 65

7a Male 156 89 10 171 107 3

7b Single females 130 78 3 13 1

7c Married females 1 44 178 53

PART II Claims data

8 Claims data by Member Type (Value AED) IP OP Pharmacy Dental Optical Totals

8a Employee 591,275 1,902,168 1,044,446 1,859,083 65,288 5,462,260

8b Spouse 607,409 1,114,414 443,205 1,136,688 33,694 3,335,410

8c Dependents 280,408 913,386 213,492 600,002 37,342 2,044,630

8d Totals 1,479,091 3,929,969 1,701,143 3,595,774 136,324 10,842,301

9 Claims data by Member Type (number) IP OP Pharmacy Dental Optical Totals

9a Employee 32 3588 2238 1008 113 6979

9b Spouse 55 2378 1344 680 55 4512

9c Dependents 30 2112 1846 713 73 4774

9d Totals 117 8078 5428 2401 241 16265

10 Claims data by diagnosis grouping (top 10 by value) IP OP Pharmacy Totals

10a

DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION

TYPE II OR UNSPECIFIED TYPE NOT STATED AS UNCONTROLLED

49,202 43,034 126,536 218,771

10b HYPERLIPIDEMIA/DISPLIPIDEMIA 35,470 82,281 70,728 188,479

10c HYPERTENSION 4,008 84,233 90,804 179,044

10d CYTOMEGALOVIRAL DISEASE 75,202 82,050 157,252

10e

C/S DELIVERY ADMISSION (MEDICALLY NECESSARY)

(MATERNITY)

130,111 130,111

10f UNSPECIFIED HEMORRHOIDS WITH OTHER COMPLICATION 111,495 8,194 4,841 124,530

10g ENCOUNTER FOR ANTINEOPLASTIC CHEMOTHERAPY 104,694 3,608 108,303

10h UPPER RESPIRATORY INFECTION (URTI / URI) 60,037 43,243 103,280

10i LARGE CELL LYMPHOMA INTRA-ABDOMINAL LYMPH NODES 20,405 40,066 41,106 101,576

10j UNSPECIFIED REHABILITATION PROCEDURE 101,191 101,191

Number of Claims by diagnosis grouping (corresponds to list in 10 by value) IP OP Pharmacy Totals

11a UPPER RESPIRATORY INFECTION (URTI / URI) 264 358 622

11b HYPERTENSION 1 197 166 364

11c HYPERLIPIDEMIA/DISPLIPIDEMIA 2 177 113 292

11d

DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION

TYPE II OR UNSPECIFIED TYPE NOT STATED AS UNCONTROLLED

1 94 126 221

11e LARGE CELL LYMPHOMA INTRA-ABDOMINAL LYMPH NODES 1 27 17 45

11f UNSPECIFIED HEMORRHOIDS WITH OTHER COMPLICATION 3 16 11 30

11g

C/S DELIVERY ADMISSION (MEDICALLY NECESSARY)

(MATERNITY)

9 9

11h ENCOUNTER FOR ANTINEOPLASTIC CHEMOTHERAPY 6 1 7

11i UNSPECIFIED REHABILITATION PROCEDURE 3 3

11j CYTOMEGALOVIRAL DISEASE 1 1 2

DHA CLAIMS REPORT

10,842,301

AMERICAN EMBASSY

4512200000 / 4512210000 / 4512220000 / 4512230000

1 Year

6,724

01-01-2020

31-12-2020

01-07-2009

01-01-2019

31-12-2019

17-08-2023

45122 DHA REPORT

2019-01-01-2019-12-31

12 Claims data by provider (top 10 by AED value) IP OP Totals

12a Al Noor Hospital-Airport Road 30,705 346,378 377,082

12b Mediclinic City Hospital 207,899 138,328 346,227

12c Mediclinic Welcare Hospital 109,422 193,793 303,215

12d Burjeel Hospital 85,605 215,954 301,559

12e NMC Specialty Hospital -Abu Dhabi 28,296 260,408 288,704

12f Al Noor Hospital - Khalifa Abu Dhabi 86,012 199,399 285,411

12g Al Zahra Hospital Sharjah - VIP and Gold 172,525 97,223 269,748

12h American Hospital 18,411 143,827 162,238

12i Zulekha Hospital - Dubai 90,848 55,764 146,612

12j NMC Royal Hospital LLC 36,256 109,265 145,521

Number of claims by provider (corresponding to top 10 by number) IP OP Totals

13a NMC Specialty Hospital -Abu Dhabi 4 613 617

13b Al Noor Hospital-Airport Road 2 481 483

13c Burjeel Hospital 5 399 404

13d Al Noor Hospital - Khalifa Abu Dhabi 4 386 390

13e NMC Royal Hospital LLC 3 204 207

13f American Hospital 2 190 192

13g Al Zahra Hospital Sharjah - VIP and Gold 10 173 183

13h Mediclinic City Hospital 8 152 160

13i Mediclinic Welcare Hospital 4 149 153

13j Zulekha Hospital - Dubai 9 113 122

14 Claims data by network (UAE only by AED value) IP OP Pharmacy Dental Optical Totals

14a In Network 1,431,776 3,757,529 1,673,388 3,096,098 10,719 9,969,511

14b Out Of Network 47,314 172,440 27,755 499,675 125,605 872,790

15 Claims data by network (UAE only by number) IP OP Pharmacy Dental Optical Totals

15a In Network 105 7882 5363 2091 15480

15b Out Of Network 12 196 65 310 785

16 Non-UAE claims data IP OP Totals

16a By value (AED) 33,732 21,824 55,556

16b By number 9 10 19

17 Total claims paid per service month (by AED value) Month ending date Year

17a Jan-2019 2019

17b Feb-2019 2019

17c Mar-2019 2019

17d Apr-2019 2019

17e May-2019 2019

17f Jun-2019 2019

17g Jul-2019 2019

17h Aug-2019 2019

17i Sep-2019 2019

17j Oct-2019 2019

17k Nov-2019 2019

17l Dec-2019 2019

18 Patient Support Programs

Number of Member enrolled in BASMAH initiative -

Number of Member screened for BASMAH initiative -

Number of Member enrolled in HCV initiative -

Number of Members Screened for HCV -a) b) c) d) f) g) h) i) j) k) l) m)

Name: Apostolos Ailamakis

1,027,759

947,108

824,880

31-Oct-2019

30-Nov-2019

31-Dec-2019

Value

1,026,495

858,700

952,347

869,467

776,847

30-Jun-2019

31-Jul-2019

31-Aug-2019

1,036,449

901,229

31-Jan-2019

28-Feb-2019

31-Mar-2019

30-Apr-2019

31-May-2019

789,566

831,45230-Sep-2019

Notes All monetary values to be entered as AED and rounded to nearest dirham

Claims amounts should be the net invoice value after application of any network discounts and excluding any patient share

Pharmacy values to be reported separately unless associated with IP treatment in which case they should be included within IP column

Where requested and in the case of schemes of 500+ lives at the time of request month by month population census data must be supplied

e) Reports must be provided (where requested) for up to 3 policy years where cover has been provided with the same insurer for multiple years

This applies in respect of reporting periods after the introduction of this reporting format only

The report is obligatory for group sizes of 10+ members. For smaller schemes provision of the report is at the discretion of the current insurer

The report can be generated as hard copy on the insurer's notepaper with signature or electronically with digital signature

The report must be issued only to the employer or the employer's authorised representative

I certify that the information contained within this report is true and accurate as at the date of its production in so far as it reflects the complete claims history for the reporting period held in our records.

Designation: Head of Employee Benefits, Bancassurance & Direct to ConsumerSignature:

An updated report must be provided (where requested) showing detail at end of scheme months 10 and 11 if not previously provided

Target turnaround time is 5 working days (10 working days during October to January inclusive)

Non-UAE claims data should be identified by continent where possible

Claims data must be restricted to claims made in respect of UAE based members only

The existing Table of Benefits and exclusions list must be provided with this report

Authentication statement

2 Policy Number

3 Policy Period

3a Policy effective date

3b Policy Expiry date

3c Initial policy effective date (date from which you have provided continuous cover for this client

Report period (must be a minimum 9 months, less at discretion of insurer) 4a Report period start date

4b Report period end date

4c Report production date

5 Total values (AED)

5a Value of Claims paid during report period only

5b Value of Claims incurred, reported but not paid up to end of reporting period

5c Value of Claims incurred but not reported up to end of reporting period

6 Population census (at beginning of reporting period) 0-15 16-25 26-35 36-50 51-65 Over 65

6a Male 156 89 10 171 109 3

6b Single females 132 79 3 14 2

6c Married females 1 45 179 55 2

7 Population census (at end of reporting period) 0-15 16-25 26-35 36-50 51-65 Over 65

7a Male

7b Single females

7c Married females

PART II Claims data

8 Claims data by Member Type (Value AED) IP OP Pharmacy Dental Optical Totals

8a Employee 634,792 1,777,947 905,100 1,806,987 74,306 5,199,132

8b Spouse 710,561 1,381,204 452,704 1,079,630 38,707 3,662,805

8c Dependents 96,853 609,564 126,126 612,372 36,821 1,481,736

8d Totals 1,442,206 3,768,715 1,483,931 3,498,988 149,834 10,343,674

9 Claims data by Member Type (number) IP OP Pharmacy Dental Optical Totals

9a Employee 29 3305 1985 999 128 6446

9b Spouse 58 2565 1183 665 68 4539

9c Dependents 11 1507 966 709 78 3271

9d Totals 98 7377 4134 2373 274 14256

10 Claims data by diagnosis grouping (top 10 by value) IP OP Pharmacy Totals

10a

DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION

TYPE II OR UNSPECIFIED TYPE NOT STATED AS UNCONTROLLED

48,606 109,408 158,014

10b HYPERTENSION 62,023 93,572 155,595

10c HYPERLIPIDEMIA/DISPLIPIDEMIA 64,331 81,090 145,421

10d

C/S DELIVERY ADMISSION (MEDICALLY NECESSARY)

(MATERNITY)

126,950 12,707 139,657

10e SUPERVISION OF OTHER NORMAL PREGNANCY 26,707 81,781 108,487

10f NORMAL DELIVERY ADMISSION (MATERNITY) 97,498 97,498

10g LACK OF COORDINATION 58,895 29,812 88,706

10h COVID-19 85,305 3,139 34 88,478

10i

SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF

INTRAPELVIC LYMPH NODES

17,118 70,074 87,192

10j BRACHIAL NEURITIS OR RADICULITIS NOS 73,658 7,970 3,352 84,981

Number of Claims by diagnosis grouping (corresponds to list in 10 by value) IP OP Pharmacy Totals

11a HYPERTENSION 163 169 332

11b HYPERLIPIDEMIA/DISPLIPIDEMIA 152 128 280

11c

DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION

TYPE II OR UNSPECIFIED TYPE NOT STATED AS UNCONTROLLED

124 131 255

11d SUPERVISION OF OTHER NORMAL PREGNANCY 2 167 169

11e BRACHIAL NEURITIS OR RADICULITIS NOS 2 35 17 54

11f COVID-19 3 7 1 11

11g NORMAL DELIVERY ADMISSION (MATERNITY) 11 11

11h

C/S DELIVERY ADMISSION (MEDICALLY NECESSARY)

(MATERNITY)

7 1 8

11i

SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF

INTRAPELVIC LYMPH NODES

1 1 2

11j LACK OF COORDINATION 1 1 2

DHA CLAIMS REPORT

10,343,674

AMERICAN EMBASSY

4512200000 / 4512210000 / 4512220000 / 4512230000

1 Year

7,826

01-01-2020

31-12-2020

01-07-2009

01-01-2020

31-12-2020

17-08-2023

45122 DHA REPORT 2020-01-01- 2020-12-31

12a Mediclinic Welcare Hospital 283,255 194,997 478,251

12b American Hospital 145,543 218,326 363,869

12c Al Noor Hospital-Airport Road 106,566 221,492 328,059

12d Mediclinic City Hospital 63,655 220,644 284,299

12e Burjeel Hospital 59,171 214,017 273,188

12f Al Zahra Hospital Sharjah - VIP and Gold 155,951 84,918 240,869

12g NMC Specialty Hospital -Abu Dhabi 26,707 190,746 217,453

12h Al Zahra Private Hospital - Dubai LLC 141,539 36,872 178,411

12i NMC Royal Hospital LLC 156,994 156,994

12j Al Noor Hospital - Khalifa Abu Dhabi 32,930 119,794 152,724

Number of claims by provider (corresponding to top 10 by number) IP OP Totals

13a NMC Specialty Hospital -Abu Dhabi 2 425 427

13b Burjeel Hospital 4 402 406

13c Al Noor Hospital-Airport Road 6 340 346

13d American Hospital 6 262 268

13e Al Noor Hospital - Khalifa Abu Dhabi 3 244 247

13f Mediclinic Welcare Hospital 12 190 202

13g Mediclinic City Hospital 4 187 191

13h NMC Royal Hospital LLC 178 178

13i Al Zahra Hospital Sharjah - VIP and Gold 8 164 172

13j Al Zahra Private Hospital - Dubai LLC 6 85 91

14 Claims data by network (UAE only by AED value) IP OP Pharmacy Dental Optical Totals

14a In Network 1,437,553 3,637,897 1,477,861 3,132,582 12,461 9,698,354

14b Out Of Network 4,653 130,818 6,070 366,407 137,373 645,319

15 Claims data by network (UAE only by number) IP OP Pharmacy Dental Optical Totals

15a In Network 94 7198 4107 2114 13573

15b Out Of Network 4 179 27 259 683

16 Non-UAE claims data IP OP Totals

16a By value (AED) 2,903 1,276 4,179

16b By number 1 4 5

17 Total claims paid per service month (by AED value) Month ending date Year

17a Jan-2020 2020

17b Feb-2020 2020

17c Mar-2020 2020

17d Apr-2020 2020

17e May-2020 2020

17f Jun-2020 2020

17g Jul-2020 2020

17h Aug-2020 2020

17i Sep-2020 2020

17j Oct-2020 2020

17k Nov-2020 2020

17l Dec-2020 2020

18 Patient Support Programs

Number of Member enrolled in BASMAH initiative -

Number of Member screened for BASMAH initiative -

Number of Member enrolled in HCV initiative -

Number of Members Screened for HCV -a) b) c) d) f) g) h) i) j) k) l) m)

Name: Apostolos Ailamakis

957,259

1,175,149

1,656,490

31-Oct-2020

30-Nov-2020

31-Dec-2020

Value

880,895

1,013,105

680,676

329,027

432,854

30-Jun-2020

31-Jul-2020

31-Aug-2020

884,791

755,439

31-Jan-2020

29-Feb-2020

31-Mar-2020

30-Apr-2020

31-May-2020

727,493

850,49630-Sep-2020

Notes All monetary values to be entered as AED and rounded to nearest dirham

Claims amounts should be the net invoice value after application of any network discounts and excluding any patient share

Pharmacy values to be reported separately unless associated with IP treatment in which case they should be included within IP column

Where requested and in the case of schemes of 500+ lives at the time of request month by month population census data must be supplied

e) Reports must be provided (where requested) for up to 3 policy years where cover has been provided with the same insurer for multiple years

This applies in respect of reporting periods after the introduction of this reporting format only

The report is obligatory for group sizes of 10+ members. For smaller schemes provision of the report is at the discretion of the current insurer

The report can be generated as hard copy on the insurer's notepaper with signature or electronically with digital signature

The report must be issued only to the employer or the employer's authorised representative

I certify that the information contained within this report is true and accurate as at the date of its production in so far as it reflects the complete claims history for the reporting period held in our records.

Designation: Head of Employee Benefits, Bancassurance & Direct to ConsumerSignature:

An updated report must be provided (where requested) showing detail at end of scheme months 10 and 11 if not previously provided

Target turnaround time is 5 working days (10 working days during October to January inclusive)

Non-UAE claims data should be identified by continent where possible

Claims data must be restricted to claims made in respect of UAE based members only

The existing Table of Benefits and exclusions list must be provided with this report

Authentication statement

2 Policy Number

3 Policy Period

3a Policy effective date

3b Policy Expiry date

3c Initial policy effective date (date from which you have provided continuous cover for this client

Report period (must be a minimum 9 months, less at discretion of insurer) 4a Report period start date

4b Report period end date

4c Report production date

5 Total values (AED)

5a Value of Claims paid during report period only

5b Value of Claims incurred, reported but not paid up to end of reporting period

5c Value of Claims incurred but not reported up to end of reporting period

6 Population census (at beginning of reporting period) 0-15 16-25 26-35 36-50 51-65 Over 65

6a Male 214 80 25 195 100 2

6b Single females 188 74 4 16

6c Married females 3 63 203 42 1

7 Population census (at end of reporting period) 0-15 16-25 26-35 36-50 51-65 Over 65

7a Male 222 84 25 201 102 2

7b Single females 197 73 4 16

7c Married females 3 65 204 43 1

PART II Claims data

8 Claims data by Member Type (Value AED) IP OP Pharmacy Dental Optical Totals

8a Employee 275,984 1,403,221 482,664 185,722 105,359 2,452,951

8b Spouse 373,242 1,152,938 330,846 126,978 67,542 2,051,547

8c Dependents 219,347 828,819 275,381 285,844 77,926 1,687,316

8d Totals 868,573 3,384,978 1,088,891 598,544 250,826 6,191,814

9 Claims data by Member Type (number) IP OP Pharmacy Dental Optical Totals

9a Employee 19 2642 1495 280 115 4551

9b Spouse 39 2105 1044 177 68 3433

9c Dependents 26 1998 1425 401 95 3945

9d Totals 84 6745 3964 858 278 11929

10 Claims data by diagnosis grouping (top 10 by value) IP OP Pharmacy Totals

10a HYPERTENSION 78,204 74,572 152,776

10b BRONCHITIS ACUTE 11,502 57,117 40,196 108,814

10c

DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION

TYPE II OR UNSPECIFIED TYPE NOT STATED AS

UNCONTROLLED

46,616 57,801 104,416

10d HYPERLIPIDEMIA/DISPLIPIDEMIA 57,798 41,156 98,954

10e

C/S DELIVERY ADMISSION (MEDICALLY NECESSARY)

(MATERNITY)

94,057 94,057

10f SORE THROAT / PHARYNGITIS ACUTE 11,573 52,835 22,589 86,997

10g UPPER RESPIRATORY INFECTION (URTI / URI) 6,715 43,745 26,656 77,117

10h NONTOXIC MULTINODULAR GOITER 64,657 10,774 226 75,656

10i GASTROESOPHAGAL REFLUX DISEASE (GERD/GORD) 50,512 17,806 68,318

10j LUMBAGO / LOW BACK PAIN 48,932 12,438 61,370

Number of Claims by diagnosis grouping (corresponds to list in 10 by value) IP OP Pharmacy Totals

11a BRONCHITIS ACUTE 2 255 250 507

11b UPPER RESPIRATORY INFECTION (URTI / URI) 2 198 241 441

11c SORE THROAT / PHARYNGITIS ACUTE 2 205 203 410

11d HYPERTENSION 184 127 311

11e HYPERLIPIDEMIA/DISPLIPIDEMIA 121 72 193

11f

DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION

TYPE II OR UNSPECIFIED TYPE NOT STATED AS

UNCONTROLLED

118 72 190

11g LUMBAGO / LOW BACK PAIN 142 45 187

11h GASTROESOPHAGAL REFLUX DISEASE (GERD/GORD) 84 53 137

11i NONTOXIC MULTINODULAR GOITER 2 14 2 18

11j

C/S DELIVERY ADMISSION (MEDICALLY NECESSARY)

(MATERNITY)

4 4

01-01-2023

31-12-2023

01-01-2023

01-01-2023

31-07-2023

17-08-2023

DHA CLAIMS REPORT

6,191,814

AMERICAN EMBASSY

6261800000 / 6261810000 / 6261820000 / 6261830000

1 Year

2,246,640

19,259

61618 DHA REPORT 2023-01-01 2023-07-31

7MONTHS

12a Mediclinic City Hospital 151,441 231,162 382,602

12b Burjeel Hospital 58,456 220,094 278,550

12c Al Noor Hospital-Airport Road 85,670 188,161 273,831

12d Mediclinic Welcare Hospital 130,230 133,169 263,399

12e American Hospital 19,465 231,256 250,721

12f NMC Specialty Hospital -Abu Dhabi 58,407 189,923 248,330

12g NMC Royal Hospital LLC 13,740 83,229 96,969

12h Burjeel Medical City LLC 90,973 90,973

12i Medeor 24X7 Hospital LLC - Abu Dhabi 18,427 70,571 88,998

12j Al Noor Hospital - Khalifa Abu Dhabi 16,927 71,302 88,229

Number of claims by provider (corresponding to top 10 by number) IP OP Totals

13a American Hospital 3 365 368

13b NMC Specialty Hospital -Abu Dhabi 11 343 354

13c Burjeel Hospital 6 342 348

13d Al Noor Hospital-Airport Road 8 265 273

13e Mediclinic City Hospital 6 236 242

13f Medeor 24X7 Hospital LLC - Abu Dhabi 3 165 168

13g Burjeel Medical City LLC 164 164

13h Mediclinic Welcare Hospital 8 147 155

13i NMC Royal Hospital LLC 1 148 149

13j Al Noor Hospital - Khalifa Abu Dhabi 2 135 137

14 Claims data by network (UAE only by AED value) IP OP Pharmacy Dental Optical Totals

14a In Network 851,045 3,268,859 1,069,387 425,879 34,183 5,649,354

14b Out Of Network 17,529 116,119 19,504 172,665 216,643 542,460

15 Claims data by network (UAE only by number) IP OP Pharmacy Dental Optical Totals

15a In Network 82 6557 3904 695 11289

15b Out Of Network 2 188 60 163 640

16 Non-UAE claims data IP OP Totals

16a By value (AED) 64,301 17,264 81,565

16b By number 10 29 39

17 Total claims paid per service month (by AED value) Month ending date Year

17a Jan-2023 2023

17b Feb-2023 2023

17c Mar-2023 2023

17d Apr-2023 2023

17e May-2023 2023

17f Jun-2023 2023

17g Jul-2023 2023

17h

17i

17j

17k

17l

18 Patient Support Programs

Number of Member enrolled in BASMAH initiative -

Number of Member screened for BASMAH initiative -

Number of Member enrolled in HCV initiative -

Number of Members Screened for HCV -a) b) c) d) f) g) h) i) j) k) l) m)

Name: Apostolos Ailamakis

I certify that the information contained within this report is true and accurate as at the date of its production in so far as it reflects the complete claims history for the reporting period held in our records.

Designation: Head of Employee Benefits, Bancassurance & Direct to ConsumerSignature:

An updated report must be provided (where requested) showing detail at end of scheme months 10 and 11 if not previously provided

Target turnaround time is 5 working days (10 working days during October to January inclusive)

Non-UAE claims data should be identified by continent where possible

Claims data must be restricted to claims made in respect of UAE based members only

The existing Table of Benefits and exclusions list must be provided with this report

Authentication statement

e) Reports must be provided (where requested) for up to 3 policy years where cover has been provided with the same insurer for multiple years

This applies in respect of reporting periods after the introduction of this reporting format only

The report is obligatory for group sizes of 10+ members. For smaller schemes provision of the report is at the discretion of the current insurer

The report can be generated as hard copy on the insurer's notepaper with signature or electronically with digital signature

The report must be issued only to the employer or the employer's authorised representative

Notes All monetary values to be entered as AED and rounded to nearest dirham

Claims amounts should be the net invoice value after application of any network discounts and excluding any patient share

Pharmacy values to be reported separately unless associated with IP treatment in which case they should be included within IP column

Where requested and in the case of schemes of 500+ lives at the time of request month by month population census data must be supplied

30-Jun-2023

31-Jul-2023 514,845

942,674

31-Jan-2023

28-Feb-2023

31-Mar-2023

30-Apr-2023

31-May-2023

Value

1,136,137

913,924

972,753

819,246

892,236

14, Dec 2020 FILE NAME: ADNIC NAS TOB -2021 Reference: 11375-3-2

Group Medical Insurance Quotation- Minimum Acceptable Coverage Level

Insured : M/s. US Embassy

Period : Twelve months at date to be agreed

Contributory : The employer shall pay the annual premium

Persons Covered : All Employees and their eligible family members who are under the payroll or contract employment with M/s. US Embassy and identified in the attached Annexure-A & Subject to Abu Dhabi Law No.23/2005 / Dubai Health Authority

SCHEDULE OF BENEFITS – SOB

ALL BENEFITS MENTIONED BELOW IS TO BE READ IN CONJUNCTION WITH “ADNIC’s GENERAL TERMS & CONDITIONS”- SOB supersedes the requirements/definitions/limitations outlined in the General Terms & Conditions

Plan Customized

Class Cat - AUH & DXB

Product Standard Annual Limit1 AED 400,000/-

Geographical Limit Elective & Emergency: Worldwide subject to UAE Reasonable & Customary Rates

Outside UAE Cover

Cover shall be on Member Reimbursement / Pay and Claim Model and will be up to a maximum of reasonable and customary (R&C) charges made at the same percentage rate and subject to the same annual maximum limits as for expenses incurred in country.

Out-of-Country Medical Treatment Medical expenses incurred out-of-country will be covered at the same benefit levels up to a maximum of reasonable and customary (R&C) charges and subject to the same total maximum annual limit as for medical expenses incurred in-country.

Out-of-Country Medical Travel

80% Reimbursement. Transportation for out-of-country medical treatment will be a covered expense for covered employees and eligible family members. To be considered a covered expense, the attending certified health care provider must certify in advance that the treatment is medically necessary and unavailable locally.

80% of covered individual’s transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be covered. 80% of the transportation expenses of an attendant will also be covered, but only if the covered individual's attending certified health care provider certifies that an attendant for the patient is necessary, (e.g., a parent in the case of a patient who is a minor, or a family member to make medical decisions in the case of a patient who is unwell or unconscious). All coverage for transportation for out-of-country medical treatment is subject to the total maximum annual limit.

Transportation to a neighboring country without the attending certified health care provider certifying that the treatment is medically necessary and unavailable locally will not be covered.

180 Day Coverage for Dependents After Employee’s Death

At the time of a covered employee’s death, his/her eligible dependents covered under post’s medical plan are eligible to continue receiving the same level of medical coverage for up to 180 days. This optional benefit is subject to availability of funds at post and no extensions are permitted.

Pre-existing and Chronic conditions Covered

Emergency Services 100% Covered within UAE

Inpatient Benefits

Inpatient Benefits Covered 100% with Nil Copay. Subject to Prior Approval

Services and supplies provided during hospitalization including services provided by a licensed healthcare provider, bed and board operating room, recovery room, intensive care, imaging and diagnostic testing, and general hospital nursing care, physical therapy, as well as drugs and medicines administered while in-patient

Covered 100%

Accommodation (Upgrading up on patient request or in case of non-availability of covered Room Type is at the expenses of insured member)

Covered 100% Semi Private Room Up to AED 600 outside ADNIC network

100% Govt. Hospitals (outside the network) within UAE

Accommodation Costs for one parent staying with a child aged less than 16 years (Excluding

Up to AED 100 per day

14, Dec 2020 Reference: 11375-3-2 telephone and any extra expenses other than included in Accommodation rates)

Accommodation Costs for one accompanying family member in case of critical medical conditions subject to treating doctor recommendation (Excluding telephone and any extra expenses other than included in Accommodation rates)

Up to AED 200 per day

Ambulance: Professional ground transport to move a patient from the place where s/he is injured or becomes ill to the nearest hospital able to provide treatment or to move a patient from one medical facility to another.

Covered 100% for land ambulances

Healthcare services for illness and injuries as per Federal Law No. 8 of 1980 concerning the Regulation of Work Relations, as amended and applicable laws in respect.

Covered

Outpatient Benefits

Out-Patient Services

Services provided by a certified healthcare provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon’s fees and other medical services provided at a hospital, clinic, doctor’s office, medical facility, etc.

Examples include, but are not limited to:

- Annual physical examinations

- Specialist consultations and treatment, including second surgical opinion

- Minor surgical interventions

- Chemotherapy and radiation treatments

- Immunizations recommended by local authorities and/or the World Health Organization

- Diagnostic tests and diagnostic imaging

Outpatient Doctor Consultations and Treatment

Covered 100%. Subject to applicable copayment / deductible.

Examination, diagnosis and treatment services of clinics and health centers by GPs and Specialists provided that the Insured person is referred to a specialist and/or consultant by a GP.

Outpatient surgery Covered 100%

Diagnostic Imaging & Labs In case of non-medical emergencies, the insurance company’s prior approval is required for MRI, CT scans and endoscopies.

Covered 100%

Chemotherapy and radiation treatments Covered 100%

Physiotherapy Treatments (Subject to Prior Approval)

Covered 100%

Cost of medicine, subject to insurance company’s prior approval prescription which exceeds AED 500.

Covered 80%

Out-patient Co-Insurance / Deductibles

Within Network

Direct Billing

Outside Network & Outside UAE (If Applicable)

Reimbursement on R & C

Consultation Deductible (For any services other than Maternity & Dental).

(Access to outpatient specialists only upon referral by a General Practitioner)

AUH Visa Holders:

AED 50/- Deductible DXB Visa Holders:

20% Co-insurance up to AED 50 deductible

Nil Co-Insurance (On top of applied deductible inside Network

Consultation Deductible For Maternity.

AUH Visa Holders:

AED 50/- Deductible DXB Visa Holders:

10% Co-insurance up to AED 50 deductible

Nil Co-Insurance (On top of applied deductible inside Network

Lab and Scan / X-Ray Deductible Nil Deductible Nil Co-Insurance (On top of applied deductible inside Network)

Pharmaceuticals Co-Insurance (Applicable on Maternity and any other services requires Pharmaceuticals)

20% Co-insurance

Nil Co-Insurance (On top of applied deductible inside Network)

In AUH: As per DOH Circular UA/27/18, if Regulations warrants – All Pharmaceuticals shall be subject to Generic Medications

Medical Providers Network

Inside UAE & GCC (Excluding The Kingdom of Saudi Arabia)

NAS Comprehensive Network

Outside GCC & The Kingdom of Saudi Arabia On Reimbursement Basis

Additional Benefits

Maternity Includes: Care and services that women receive during pregnancy (prenatal care), throughout labor, delivery and post-delivery, and outpatient care for newborn babies.

Hospitalization during pregnancy and/or delivery will be reimbursed as Hospitalization (treatment in the hospital for inpatient care). All other treatments will be considered outpatient services

Within Network: Covered up to Annual limit.

Outside Network: Covered up to Annual Limit subject to a maximum of within network Reasonable & Customary charges.

Cover:

Inpatient: 100% Covered Outpatient: AUH visa Holders: AED 50 Employee Co-Payment | DXB Visa Holders: 10% Co-insurance up to AED 50 Co-Payment.

New Born Cover Cover for 30 days from Birth. Hepatitis B and neonatal screening tests

(Phenylketonuria, Congenital hypothyroidism, Sickle cell screening, Congenital Adrenal hyperplasia).

Pediatric Services Including: Primary and preventive routine care services for covered dependent children, including, but not limited to:

physical examinations, developmental assessments, laboratory tests, and immunizations recommended by local authorities and/or the World Health Organization.

Inpatient: 100% Covered Outpatient: AUH visa Holders: AED 50 Employee Co-Payment | DXB Visa Holders: 10% Co-insurance up to AED 50 Co-Payment.

Diabetic Screening Test Covered every 3 years from age of 30. High risk individuals annually from age 18.

DHA mandated Vaccinations & Immunizations (For Dubai Visa Holders)

Covered – Essential vaccinations and inoculations for new-born’s and children up to age 6 years as stipulated in the DHA’s policies and its updates..

Hepatitis C Virus Screening and treatment (For Dubai Visa Holders)

Covered as per the guidelines laid out in the DHA’s Hepatitis C support program

Cancer Screening and treatment (For Dubai Visa Holders)

Covered as per the guidelines laid out in the DHA’s Cancer support program

Birth Defects and Congenital Conditions Covered as per DOH guidelines (Only if medically necessary)

Medical Expenses related to Work related Accidents, Injuries and Illness Covered 100%

Vitamins & Supplements Covered 100% only if medically necessary & prescribed by the treating physician

Treatment Related to sports injuries other than those specified below will be covered:

Participation in any kind of power-vehicle race, rally or competition

Climbing activities (mountaineering, rock climbing, pot holing, abseiling)

Any professional sports activities.

Covered 100%

Growth hormone therapy Covered 100% if medically necessary

Nasal septum deviation; Nasal concha resection Covered 100% if it is non-cosmetic, medically necessary or post traumatic

Hepatitis A Covered 100%

Ophthalmology: Limited to eye consultation and any medical condition related to it (Illness/Injury) excluding vision, sight test & refraction error.

Covered 100%

Cover is extended to include the following only in emergency cases:

Diagnostic and treatment services for dental and gum treatments.

Hearing and vision aids, and vision correction by surgeries and laser.

Covered 100%

Circumcision is covered for new Muslims subject to the following:

The member is insured with ADNIC.

The member declared his Islam in the Emirate of Abu Dhabi in line with all the legal formalities in this aspect along with

Covered 100% a letter from Judicial Department in Emirate of Abu Dhabi.

Global Assistance Program (Outside UAE)

- Emergency Medical Evacuation

- Medical Repatriation

- Repatriation of Mortal Remains Please contact Assist America directly to avail the service and no claims to be submitted to ADNIC for reimbursement. Cover will be limited to Geographical area specified only. Refer ADNIC's General Terms & Conditions / Assist America cover for more details.

Covered through Assist America

Second medical Opinion Covered through Assist America

Air fare for outside UAE treatment (Limited to Geographical area specified)

Cost if treatment outside UAE for the required medical procedures is less than 70% of UAE Customary rates with a minimum difference of AED 3,000/-; covered up to a maximum of AED 2,000/- on reimbursement basis.

Covered only for in-patient treatment for economy class round trip ticket only for patients.

Visiting Doctor (Subject to agreed network tariff) Covered 100%

Dietician Covered 100% only if medically necessary

Rehabilitation (Non-excluded medical conditions) Including: Rehabilitative services (e.g., recovering skills, such as speech therapy after a stroke or physical therapy after an accident) and habilitative services (e.g., developing skills, such as speech therapy for children, etc.) that help develop skills needed for everyday life. Devices to help gain or recover mental or physical skills lost due to injury, disability or a chronic condition, and devices needed for habilitative reasons

Covered 100% only if medically necessary

Hearing Aids

Examinations and Treatment: 80% Minimum Coverage Hearing Aid Apparatus: Limited to one apparatus per ear up to a maximum of AED 5,520 per covered individual per three-year period. 80% Minimum Coverage: with annual cap.

All chronic conditions requiring hemodialysis or peritoneal dialysis and related test/treatment or procedure

Covered 100% subject to pre-approval

Treatment and services related to viral hepatitis (B&C) and associated complications

Covered 100% subject to pre-approval

Health services and associated expenses for organ and tissue transplants, when the insured person is a recipient.

Covered 100% subject to pre-approval

Vaccination/Inoculation / Immunizations Will be covered 100% as per DHA / DOH/ MoH inoculation schedule

HIV/Aids Treatment

Covered up to a limit of AED 36,730 per policy year applicable to all insured members.

Medications to suppress opportunistic infections (such as tuberculosis or toxoplasmosis for covered individuals who have HIV/AIDS). Brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV/AIDS to the child.

Generally, excludes medication for the long-term suppression of HIV/AIDS through the combination of anti-retroviral drugs in locations with inadequate local healthcare infrastructures. Reimbursement under this benefit is excluded from the annual maximum limit

Routine Annual Physical Examination

100% covered for routine physical examination (the coverage is limited to a General consultation, ECG, Chest X-Rays, CBC, FBS, Urea, Creatinine, ESR, Cholesterol, Tryglycerides, HDL/LDL, Routine Urinalysis, Stool Analysis, Peripheral Smear/Pap Smear). Prior approval may be required within Network

Optical Care

Examinations and Treatment: 80% Minimum Coverage Prescription lenses and frames or contact lenses: Covered up to a maximum of AED 1,104 per covered individual every two years. 80% Minimum Coverage; with annual cap.

Dental Care

Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of AED 11,776 per covered individual per contract year. 80% Coverage: with annual cap.

Orthodontia: Treatment is covered only if treatment begins before age 18, or if required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per covered individual up to a maximum of AED 8,808 lifetime limit. 80% Coverage; with contract lifetime cap.

Reproductive Health

80% Coverage. Includes: Prescribed contraceptive devices, preventive care and routine examinations, voluntary sterilization, and diagnosis and treatment of conditions which may cause infertility.

Assisted reproductive technology (ART), fertility treatments, and reversal of sterilization are not covered (see Exclusions to Coverage).

Mental Health and Substance Abuse Care

50% Coverage Inpatient and outpatient care provided to evaluate, diagnose and treat a mental health condition or substance abuse disorder. This includes behavioral health treatment, counseling, and psychotherapy. Services must be provided by a licensed psychiatrist, psychoanalyst, psychologist, or psychiatric social worker. Inpatient care for alcohol and substance abuse must be carried out at a facility licensed for detoxification and rehabilitation.

Preventive and Wellness Services and Chronic Disease Management Services for stable chronic Patients

Covered via;

1. the NAS Chronic Care Management Program (CMP) through the mynas App:

Enrolling in CMP allows the member to refill the required chronic medication without having you visit the doctor regularly, as long as the member’s condition is stable. If a follow up with the doctor is needed NAS team will book the appointment for the member.

2. Trudoc 24x7 Chronic Care Management Programs Through this program, members can consult doctors over voice/ video call/ live chat, get medicines delivered to your doorsteps and have lab services arranged at your convenience (where available). Members also get personalized Wellness Coaching and Mental Health Support to better manage the chronic condition.

Teleconsultation Benefit through TruDoc 24X7

24X7 access to highly trained and licensed Doctor’s & wellness experts.

Medication delivery, wherever applicable and within the regulatory framework.

Support for Healthy Life style and support for Acute and Chronic Conditions Appointment booking, on your behalf, within your network.

Chronic Care Management Programs

Mental Health Services by TruDoc 24x7 (Voluntary program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services to members who have personal and/or work-related problems).

Access to trained and licensed mental health experts.

Convenient Access through mobile application Medication delivery, wherever applicable and within the regulatory framework.

Catastrophic Coverage

Additional coverage equal to AED 298,000 per covered individual per contract year.

Catastrophic conditions shall be defined as major medical conditions occurring as a result of a single/illness/accident or closely related set of major illnesses (or conditions relating to a single accident) that exceed the standard maximum coverage limit.

1Annual Maximum Limit herein is defined as the maximum annual reimbursement per covered individual per contract year, not including expenses defined under Exclusions and Limitations and Catastrophic Coverage, or those covered under HIV/AIDS, and Excess Coverage is equivalent to AED 298,000.

Exclusions and Limitations There is no coverage for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long-term rehabilitative therapy; non-medical hospital charges (e.g., telephone, television, etc.); home help, family help, or similar household assistance; fees of persons who are not certified health care providers; advanced reproductive technology (e.g., in-vitro fertilization, intra-cellular sperm injection, artificial insemination, microsurgical epididymal sperm aspiration, testicular sperm extraction, cryopreservation, etc.); or services or supplies which have not been prescribed or approved by a certified health care provider. Removal of any exclusions require prior authorization.

There is no coverage for expenses that will be reimbursed or paid directly under a host country medical program or workers' compensation program, the U.S. workers’ compensation program, or post’s LE Staff workers’ compensation program.

The exclusions listed in the ADNIC General Terms and Conditions shall be applicable as mandated by HAAD/DoH and or the DHA. The Table of Benefits shall supersede the exclusions listed in the ADNIC General Terms and Conditions.

Note:

Our offer is subject to ADNIC’s General Terms & Conditions.

Approval of this quotation will be the basis of the agreement between insurer and insured and the premium payment has to be done based on this agreement. Printed policy document will be send within agreed time.

ADNIC reserves the right to change the participation status of Providers from time to time and the Network providers status will be updated regularly according to the changed status.

Errors & omissions are excluded.

This quote is valid for a period of 30 days from date of submission.

https://mynas.ntouch.cloud/mynas/Login/Login.aspx https://forms.office.com/Pages/ResponsePage.aspx?id=TChl82B34ky1t-CwUu0FFRAs7FsTBmFIhHbK6x6nreJUMDFJSUNQSlJHV1dZRkNMRjFGUU80Wk5EMC4u https://trudoc24x7.com/ https://forms.office.com/Pages/ResponsePage.aspx?id=TChl82B34ky1t-CwUu0FFRAs7FsTBmFIhHbK6x6nreJUMDFJSUNQSlJHV1dZRkNMRjFGUU80Wk5EMC4u

Annexure-A (Eligibile Persons) C.1.4 Eligible Participants

C.1.4.1 Identification of Eligible Employees and Dependents:

Eligible Employees: To be eligible to participate in the medical plan, LE Staff must be:

- Paid under the terms of the Local Compensation Plan (LCP); and –

- Under a non-temporary direct hire appointment, personal services agreement (PSA), or personal services contract (PSC); or

- Under a temporary direct hire appointment or PSA Fixed Term of one year or more.

Not eligible are those working under temporary appointments; those working under a PSC or PSA that is time limited to less than one year; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in UAE who provides services to other local organizations as well as to the U.S. Mission; employees working on an intermittent or When Actually Employed (WAE) schedule; employees of USAID institutional contractors; Peace Corps personal services contractors as indicated in MS 743; and Recreation Association employees.

Official Residence Expense (ORE) and Employee Association (EA) employees may be covered under a rider to the contract. The employing officer/EA, not the USG, is responsible for the employer’s share of the premium costs for an ORE employee.

U.S. Mission United Arab Emirates will provide a list of all eligible employees and dependents with relationship to employee (self/spouse/child) and DOB for each. Updates will be provided to add or remove individuals on an as needed basis.

C.1.4.1.1 Definition of Dependents LE Staff who are eligible to participate in the medical plan automatically confer coverage to eligible family members who meet the following criteria:

C1.4.1.1.1 Legal Spouse: a limit of one legal spouse as defined by local law per employee will be covered. LE Staff with more than one legal spouse must select only one spouse for coverage.

In cases where LE Staff and their legal spouse both work for the mission and both are eligible to participate in the medical plan, one will be designated as the lead for purpose of the medical plan, and the other will be considered a legal spouse.

C.1.4.1.1.2 Children: a child is defined as the LE Staff’s natural, adopted, stepchild, or foster child. The child must be unmarried and financially dependent upon the LE Staff. A child will be covered until the end of the contract year in which s/he reaches age 26. An unmarried child determined to be incapable of self-support due to a physical or mental condition will continue to be eligible to participate in the medical plan as long as the condition persists, the child remains unmarried, and the LE Staff maintains coverage.

C.1.4.2 Location of Employment:

The eligible employees covered by C.1.4.1 must be employed within the geographic boundaries of the United Arab Emirates as defined by: Department of State, Department of Defense, Department of Justice, Department of the Treasury, Department of Transportation, Department of the Navy, Department of Homeland Security, Department of Commerce, Department of the Army, Department of Agriculture, etc.

C.1.4.3 Participants Covered Under a Rider

a. All current active ORE Staff, including their eligible dependents, personally employed by the Chief of Mission, the Deputy Chief of Mission and the Principle Officer and assigned to their respective official Government residences are paid under an ORE account. All costs for coverage of ORE Staff and their eligible dependents, are the responsibility of the Chief of Mission, the Deputy Chief of Mission, and Principal Officer, not the U.S. Government.

b. All current active employees and their eligible dependents of the Employee Association at Embassy Abu Dhabi or Consulate General Dubai. All costs for coverage of American Embassy Employees Association (AEEA) employees and their dependents are the responsibility of the AEEA, not the U.S. Government.

c. All current active employees and their eligible dependents of the Marine Security Guard (MSG) Detachment at Embassy Abu Dhabi or Consulate Dubai. All costs for MSG Detachment employees and their dependents are the responsibility of the MSG Detachment, not the U.S. Government.

C.1.5 Eligibility

C.1.5.1 Term of Eligibility and Effective Date Each current active eligible employee and their eligible dependents are enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee and eligible dependents will be enrolled upon entering on duty with the United States Government. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid

06, Dec 2021 FILE NAME : ADNIC - TOB -2022

Reference: 11375-3-2/Ren-1

Group Medical Insurance Quotation- Minimum Acceptable Coverage Level

Insured : M/s. US Embassy (11440 & 11439)

Period : Twelve months at date to be agreed

Contributory : The employer shall pay the annual premium

Persons Covered : All Employees and their eligible family members who are under the payroll or contract employment with M/s. US Embassy and identified in the attached Annexure-A & Subject to Abu Dhabi Law No.23/2005 / Dubai Health Authority

SCHEDULE OF BENEFITS – SOB

ALL BENEFITS MENTIONED BELOW IS TO BE READ IN CONJUNCTION WITH “ADNIC’s GENERAL TERMS & CONDITIONS”- SOB supersedes the requirements/definitions/limitations outlined in the General Terms & Conditions

Plan Customized

Class Cat - AUH & DXB

Product Standard Annual Limit1 AED 400,000/-

Geographical Limit Elective & Emergency: Worldwide subject to UAE Reasonable & Customary Rates

Outside UAE Cover

Cover shall be on Member Reimbursement / Pay and Claim Model and will be up to a maximum of reasonable and customary (R&C) charges made at the same percentage rate and subject to the same annual maximum limits as for expenses incurred in country.

Out-of-Country Medical Treatment Medical expenses incurred out-of-country will be covered at the same benefit levels up to a maximum of reasonable and customary (R&C) charges and subject to the same total maximum annual limit as for medical expenses incurred in-country.

Out-of-Country Medical Travel

80% Reimbursement. Transportation for out-of-country medical treatment will be a covered expense for covered employees and eligible family members. To be considered a covered expense, the attending certified health care provider must certify in advance that the treatment is medically necessary and unavailable locally.

80% of covered individual’s transportation expenses by the least expensive, appropriate means of transportation to the nearest city with adequate medical facilities will be covered. 80% of the transportation expenses of an attendant will also be covered, but only if the covered individual's attending certified health care provider certifies that an attendant for the patient is necessary, (e.g., a parent in the case of a patient who is a minor, or a family member to make medical decisions in the case of a patient who is unwell or unconscious). All coverage for transportation for out-of-country medical treatment is subject to the total maximum annual limit.

Transportation to a neighboring country without the attending certified health care provider certifying that the treatment is medically necessary and unavailable locally will not be covered.

180 Day Coverage for Dependents After Employee’s Death

At the time of a covered employee’s death, his/her eligible dependents covered under post’s medical plan are eligible to continue receiving the same level of medical coverage for up to 180 days. This optional benefit is subject to availability of funds at post and no extensions are permitted.

Pre-existing and Chronic conditions Covered

Emergency Services 100% Covered within UAE

Inpatient Benefits

Inpatient Benefits Covered 100% with Nil Copay. Subject to Prior Approval

Services and supplies provided during hospitalization including services provided by a licensed healthcare provider, bed and board operating room, recovery room, intensive care, imaging and diagnostic testing, and general hospital nursing care, physical therapy, as well as drugs and medicines administered while in-patient

Covered 100%

Accommodation (Upgrading up on patient request or in case of non-availability of covered Room Type is at the expenses of insured member)

Covered 100% Semi Private Room Up to AED 600 outside ADNIC network

100% Govt. Hospitals (outside the network) within UAE

Accommodation Costs for one parent staying with a child aged less than 16 years (Excluding

Up to AED 100 per day

06, Dec 2021 Reference: 11375-3-2/Ren-1 telephone and any extra expenses other than included in Accommodation rates)

Accommodation Costs for one accompanying family member in case of critical medical conditions subject to treating doctor recommendation (Excluding telephone and any extra expenses other than included in Accommodation rates)

Up to AED 200 per day

Ambulance: Professional ground transport to move a patient from the place where…