Health Products
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Features
- A comprehensive Healthcare Benefits Plan for both groups and individuals
- Provides Medical Reimbursement for hospitalization expenses and out-patient treatments
- Cashless treatments through the direct billing facility in more than one thousand designated network providers worldwide (NEXTCARE)
- Customizable: many options to chose from, including a number of additional benefits
- No limits for consultations within designated providers. No sublimit for out-patient treatments
3.2.1 Plan and Class Options
| Platinum | Diamond | Gold 1 | Gold 2 | |
|---|---|---|---|---|
| Territorial Scope of Coverage | Worldwide | Worldwide excluding USA and Canada | Bahrain, Arab Countries and Sub -Asia Countries, Philippines, Korea, Sri-Lanka | Bahrain only |
| Aggregate Benefit Limit per Participant per year | BD250,000 |
VIP: BD100,000 A: BD50,000 B: BD25,000 |
VIP: BD30,000 A: BD15,000 B: BD7,500 |
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| Network Options | General Network (GN) | General (GN) / Restricted Network (RN) | ||
| Hospital Room Accommodation | Suite | VIP: Suite A: Private Room B: Semi-Private Room |
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| Deductible Options | BD7.5 / BD10 / BD15 / BD20 | BD5 / BD7.5 / BD10 / BD15 / BD20 | ||
3.2.2 Healthcare Benefits
| a. Consultation Charges • Physician's Fees • Pathology, X-ray and diagnostic procedures, MRI and CT Scans, Radiotherapy, Chemotherapy • Illness or Injury that requires consultations, diagnostic procedures, physiotherapies, prescribed drugs or other covered healthcare services |
• Within the network: 100% of consultation fees • Outside the network: Fees up to BD25 per consultation |
| b. Hospitalization • Room and board charges, based on Plan's Room Accommodation • Physician fees including theatre charges for the treatment of an illness or injury • ICU Charges |
• Within Scope & Network: 100% coverage • Within Scope, Outside Network, Pre-Authorized: 80% • Within Scope, Outside Network, Not Pre-Authorized: 80% but up to a maximum of 80% of UCR Charges |
| c. Prescribed Drugs / Pharmaceuticals | Covered, but up to BD200 per Participant per year for individual contracts |
| d. Emergency Treatment | • Within Bahrain: 100% • Within Scope other than Bahrain: 100% but up to maximum of 100% of UCR Charges • Outside Scope: 80% but up to maximum of 80% of UCR Charges |
| e. Emergency Local Ambulance Charges, including transport costs to and from the Hospital by the most appropriate transport method, only when considered medically necessary by a Physician | Covered |
| f. Cash Indemnity for In-Patient Treatments for Hospitalizations within the Designated Network Providers that are not submitted to the Company for claim | BD20 per night up to 180 days per Participant per year |
| g. Physiotherapy Treatment which is referred by a specialist Physician and deemed to be medically necessary for recovery from an Illness or Injury | • In-Patient: No limit in number of sessions • Out-Patient: Up to 15 sessions per Participant per year |
| h. Chiropractic Treatment and Osteopathy | Up to BD160 per Participant per year |
| i. Organ Transplant but as recipient of heart, liver and kidneys only, excluding all costs associated with the acquisition of the required organ to be transplanted including administrative and transportation costs | Covered |
| j. Accidental damage to teeth provided Treatment is received in a Hospital's Emergency room within 48 hours following the accident, and provided that the damage is caused to sound, natural teeth and for the initial relief of pain and any Treatment necessary to preserve the dental structure | Covered |
| k. Baiti Nursing Care (if medically necessary) | Up to 13 weeks per Participant per year |
| l. Parent Accommodation - Charges for one parent staying with a child Participant who is less than 16 years old | BD30 per night, up to a maximum of BD300 per Participant per year |
| m. International Medical Emergency Assistance | Covered for Platinum and Diamond Plans |
3.2.3 Reimbursement for Treatments
| In-Patient | Amount of Reimbursement |
| Within Scope & Network | 100% of Actual Costs |
| Within Scope, Outside Network, Pre-Authorized | 80% of Actual Costs |
| Within Scope, Outside Network, Not Pre-Authorized | 80% of Actual Costs, but up to maximum of 80% of UCR Charges |
| Out-Patient | Amount of Reimbursement |
| Within Scope & Network | 100% of Actual Costs, minus deductible |
| Within Scope, Outside Network, Pre-Authorized | 80% of Actual Costs but up to a maximum of 80% of UCR Charges, minus deductible |
UCR Charges refers to charges or expenses for necessary healthcare which, in our sole opinion and based on our or our claim administrator's experience, does not exceed the general level of charges being made by other healthcare providers of similar standing in the Kingdom of Bahrain, when providing like or comparable treatments or healthcare services.
3.2.4 International Medical Emergency Assistance
- Emergency Evacuation
- Emergency Message Transmission
- Emergency Family Member Visit
- Medically Supervised Repatriation
- Care and Transportation (1-way economy) of unattended Minor Children
- Repatriation of Mortal Remains of a deceased Participant to his country of residence or employment, or costs for local burial at place of death
- Legal Assistance and Emergency Cash Advance
3.2.5 Optional Benefits
| COBRA EXTENSION | If treatment is not available at the country of residence or employment: • Free Access for such treatment at an international Designated Network Provider • Air Transportation for the Participant and accompanying relative (spouse, child or parent) • Accommodation for the accompanying relative |
| ROUTINE DENTAL BENEFIT |
Medically necessary dental treatments such as root canal treatment, teeth extractions and routine filings (amalgam, resin, plastic and temporary); excluding braces, dentures, crowns or treatments for cosmetic reasons |
| OPTICAL BENEFIT
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Optical examinations conducted for the purpose of obtaining eye glasses or upgrading existing lenses, excluding the cost of frames or contact lenses |
| MATERNITY BENEFIT (for female Participants only)
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Treatments related to or caused by pregnancy, childbirth, puerperium (i.e. 4 weeks following childbirth), conditions or illnesses, miscarriage or abortions when the life of the mother would be medically endangered |
