Takaful Emarat
Flexi Plan
The short version
NEXTCARE — PCP AUHWhat Flexi Plan does and does not do, before you read the insurer's own Table of Benefits.
Annual limit
AED 150,000
Medical network
NEXTCARE — PCP AUH
Consultation
Covered
Pharmacy
AED 1,500 with 30% co-pay
What is good
Good to know
- Network Restriction: Outpatient treatment is exclusive to clinics only; GP referral is required for access to Specialist.
Get your price to download this plan's Table of Benefits and your quote.
Everything in the policy
Medical Network
NEXTCARE — PCP AUHOutpatient treatment is exclusive to clinics only. GP referral is required for access to Specialist.
Annual Limit per Person
AED 150,000
Area of Coverage
Emirate of Abu Dhabi (elective treatment); UAE (emergency cases)
In-patient Services
Covered. Copayment: 20% payable by the insured, maximally AED 500 paid for each new service; total annual copayment limit AED 1,000 (in case of exceeding the limits, the insurance company shall cover 100% of the treatment cost). Non-emergency (elective) cases need pre-authorization.
Out-patient Services
Covered: copayment of 20% payable by the insured for each visit (not applicable in case of a follow-up visit within 7 days). Outpatient treatment is exclusive to clinics only; GP referral is required for access to specialists.
Hospital Accommodation
A room of 2 or more beds
Consultation Deductible (Co-Pay)
Covered with 20% copay for GP; covered with nil copay for specialist (GP referral is required); coinsurance not applicable for follow up within 7 days
Diagnostics & Laboratory Services
Copayment of 20% payable by the insured for each visit; in non-emergency medical cases, preauthorization is required for MRI, CT and endoscopy
Medicine Limit
30% copayment payable by the insured for each prescription. Cost of drugs and medicines are covered up to an annual limit of AED 1,500 (including copayment). Copayment is restricted to products listed in the medical prescriptions where available.
Maternity
In-patient: 10% copayment payable by the insured; AED 7,000 for normal delivery or AED 10,000 for medically necessitated C-section, complications and medically necessary termination of pregnancy; requires preauthorization from the insurance company or notification within 24 hours of the emergency case treatment. Out-patient: 10% copayment payable by the insured; 8 visits to PHC centers including reviews, checks and tests in accordance with the Antenatal Care Protocols; requires preauthorization from the insurance company. Where any condition develops to be an emergency case, the necessary medical expenses will be covered up to the annual aggregate limit.
Abu Dhabi law excludes pregnancy and delivery cover for women enrolled as unmarried (Law 23/2005, Art. 13(5)).
Women and maternity on this plan
Men and women pay the same premium on this plan.
Get a quote to see the amount for your family.
Physiotherapy
20% copayment payable by the insured per session; covered up to 6 sessions per member yearly (subject to pre-approval)
Pre-existing / Chronic Conditions
Covered up to annual limit. No waiting period applies if evidence of continuity of coverage is provided; otherwise a waiting period of 6 months applies to the first scheme membership.
Emergency Road Ambulance Services
Ground transportation services in UAE provided by a medical emergency licensed entity (ground ambulance): covered
Vaccination for Children (as per MOH, UAE)
Essential vaccinations for newborns and children as stipulated in MOHAP's policies and any updates thereto. Claims are covered on reimbursement basis (refund of expenses due) as per the coverage specified in the Medical Claims Settlement Terms.
Specialist access
GP referral is required for access to specialists: the GP must refer the insured with justifications via the electronic system for the claim to be considered by the insurance company
Within the Network (Direct Billing)
Elective treatment within the healthcare providers network: 100% of actual covered costs
Outside the Network (Reimbursement)
Elective treatment outside the network: no coverage outside the network within UAE, except at Government Hospitals in UAE, refunded at 80% of actual covered cost subject to a maximum of 100% of the applicable network rates. In UAE except Government Hospitals: not covered.
Emergency Treatment
Emergency treatment within the geographical territory of coverage: within the healthcare providers network, 100% of actual covered cost; refund of expenses at non-network healthcare providers within UAE, 100% of actual covered costs
Follow-up consultation co-pay (within 7 days)
Coinsurance not applicable for follow up within 7 days (same treatment, same doctor)
Day care Treatment
One day treatment: covered
Dental, hearing & vision aids, vision correction
Diagnostic and therapeutic services for dental and gum treatments: covered only in medical emergency cases, subject to 20% copayment payable by the insured
Hearing Emergencies
Hearing aids: covered only in cases of medical emergencies, subject to 20% copayment payable by the insured
Intensive care & coronary artery disease
ICU and coronary artery diseases treatment: covered
New Born baby coverage
First 30 days after the newborn's date of birth are covered under the mother's annual benefit maximum limit / AED 150,000. BCG, Hepatitis B and neo-natal screening tests are covered for the first 30 days from date of birth.
Out Patient Surgery
Outpatient surgery: covered
Accompanying person accommodation
A patient's companion stay in the same room in cases of medical necessity, on the treating physician's recommendation and after pre-authorization from the insurance company: covered, maximum up to AED 100 per night
Vision Emergencies
Vision aids, and vision correction by surgeries and laser: covered only in cases of medical emergencies, subject to 20% copayment payable by the insured
Only on this plan
Benefits this plan adds beyond the rows compared above.
Everyday care
Out-patient care you are likely to use in a normal year- Dental, hearing & vision aids, vision correction
- Diagnostic and therapeutic services for dental and gum treatments: covered only in medical emergency cases, subject to 20% copayment payable by the insured
- Hearing Emergencies
- Hearing aids: covered only in cases of medical emergencies, subject to 20% copayment payable by the insured
- Out Patient Surgery
- Outpatient surgery: covered
- Vision Emergencies
- Vision aids, and vision correction by surgeries and laser: covered only in cases of medical emergencies, subject to 20% copayment payable by the insured
Cash back and waived fees
Money paid back to you, and charges this plan does not make- Follow-up consultation co-pay (within 7 days)
- Coinsurance not applicable for follow up within 7 days (same treatment, same doctor)
Hospital and recovery
What the plan does around a hospital stay- Emergency Treatment
- Emergency treatment within the geographical territory of coverage: within the healthcare providers network, 100% of actual covered cost; refund of expenses at…
- Day care Treatment
- One day treatment: covered
- Intensive care & coronary artery disease
- ICU and coronary artery diseases treatment: covered
- New Born baby coverage
- First 30 days after the newborn's date of birth are covered under the mother's annual benefit maximum limit / AED 150,000.
- Accompanying person accommodation
- A patient's companion stay in the same room in cases of medical necessity, on the treating physician's recommendation and after pre-authorization from the insurance…
- Accommodation for a beneficiary below 16 years of age
- Companion stay to accompany an insured child up to the age of 16: covered, maximum up to AED 100 per night
- Doctor, Surgeon, Anesthetist Fees
- Consultant, surgeon and anesthetist's fees: covered
- Inpatient coverage of high-cost medical conditions (6-month waiting period)
- Inpatient treatment services for main high cost diseases as per the DoH list: coverage is subject to a 6 month waiting period from the starting date of the first…
Other benefits
Named in this plan's document and not easily grouped- Network Restriction
- Outpatient treatment is exclusive to clinics only; GP referral is required for access to Specialist