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Individual Health Insurance FAQ

What are the main amendments to the Abu Dhabi Basic insurance plan?

  1. Premiums: Minor increases to the premiums. The amount will vary based on the member’s category and age group.
  2. Benefits: Minor amendments to the benefits as follows:
    • Inpatient and Daycare: Out-of-pocket amount of AED 200 per admission with an annual cap of AED 500.
    • Medicines: Covering 70% of the costs of medicines, equivalent to AED 1,500, with a deductible of 30%.
    • Diagnostic and lab services: 20% co-pay, max AED 50 per visit.

Why are these changes being made?

The changes are being made in line with the ongoing efforts to ensure that all community members receive continued access to the highest quality of care. The changes will also enhance efficiency in the delivery of healthcare services within the emirate, in accordance with best practices and international standards.

What changes are being made to the coverage for inpatient and daycare treatments?

Out-of-pocket expense is now AED 200 per encounter with an annual aggregate Out-of-pocket limit of AED 500.

What changes are being made to medications and pharmaceutical product coverage?

The coverage for medicines and pharmaceutical products remains the same, equal to 70% coverage within the policy’s network providers list, a deductible value of 30%, and a total coverage value of AED 1,500.

What changes are being made to diagnostics and laboratory services?

Previously, there was a deductible of AED 10 for lab tests and AED 10 for diagnostics. Now, there will be a 20% co-pay with a maximum amount of AED 50, including radiology.

When will these changes take effect?

The changes will take effect on the 1st of July 2024.

How do these changes benefit policyholders?

These changes aim to ensure the sustainability of the programme and the continuity of the coverage for all the eligible categories and age groups, while maintaining access to quality care, which aligns with the evolving needs of individuals and families living in Abu Dhabi.

Will there be any changes to the network of healthcare providers?

There is no changes in the current Basic Network. Policyholders can continue to access services from the existing network providers which comprises over 1,250 providers offering outpatient, inpatient, and emergency services in the various regions of the emirate of Abu Dhabi.

 

Access to quality healthcare providers remains unchanged through this update; however, Daman and the Department of Health constantly update the network as part of their regular network review.

What changes are being made to medications and pharmaceutical product coverage?

The coverage for medicines and pharmaceutical products remains the same equaling a 70% coverage within the network providers list of the policy with a deductible value of 30%, and a total coverage value of AED 1,500.

What documents do I need to submit to buy a Thiqa Top-Up plan?

For a new application, you will need to submit the following documents:

  • Individual enhanced application form
  • Valid Passport copy
  • Valid Emirates ID copy
  • Valid Thiqa card
  • Medical examination form (for 61 years old and above & 6 months old and below, declared conditions) as and when required.
  • Signed quotation

How can I buy a Thiqa Top-Up plan?

Buying a Thiqa Top-Up plan is easy. Simply visit the Daman website to log your request to buy a Thiqa Top-Up plan here:

Select Enhanced Plan as the type of request, provide the required information in the form and submit it. One of our sales representatives will get in touch with you to complete your application.

How much are Thiqa Top-Up plans?

Thiqa Top-Up plan prices vary according to your age and the type of product you choose. A member of our sales team will provide you with a number of plans and their prices so you can choose one that is best suited to needs.

Are Maternity, Dental and Optical benefits offered under Thiqa Top-Up plans?

In order to offer cost-effective Health insurance solutions, Maternity, Dental and Optical benefits are not offered under Thiqa Top-Up plans.

Does the Thiqa Top-Up plan offer coverage outside the UAE?

Yes, various territorial coverage options are offered under Thiqa Top-Up plans, which you can opt for depending on your needs.

What happens to my old Thiqa Top-Up plan if my Thiqa category changes? Do I get a refund for the period I didn’t use it?

If your eligibility in your current Thiqa Top-Up plan has changed, you will get a refund as per policy terms and conditions.

My Thiqa category has changed. Can I continue to be covered under my existing Thiqa Top-Up plan?

Your Top-Up plan should complement your Thiqa coverage. Hence, if your Thiqa category has been changed, you should buy a new Thiqa Top-Up plan that is applicable to your new category. Please note that additional premium may be applicable.

Is my non-network coverage under the Thiqa Top-Up plan modified because of Thiqa changes?

No, there is no change in your Thiqa Top-Up plan non-network coverage. You will continue to be covered as per your plan terms and conditions on a reimbursement basis.

I already have an existing Thiqa Top-Up plan. Do I need to buy a new plan to enjoy the benefit changes being offered by Daman?

If you already have a Thiqa Top-Up plan, you do not need to buy a new one. The benefits will be offered automatically until your Thiqa Top-Up policy expires. You will only need to buy a new Thiqa Top-Up plan upon renewing your policy.

How will the changes on the Thiqa program coverage impact my existing Thiqa Top-Up plan coverage?

Due to the recent changes to your Thiqa plan coverage, there are certain benefits which are no longer covered. That’s why we have extended your Thiqa Top-Up coverage so you can continue to enjoy the best healthcare services through our broad network of partners, including hospitals, health centres, clinics and pharmacies.

Previously, Thiqa used to offer 90% coverage in Dubai and the Northern Emirates, while 10% was under your Thiqa Top-Up plan. However, since Thiqa does not cover these networks anymore, the full 100% will be covered under your Top-Up plan.

Can I reimburse my medical claim if treatment is availed in non-network providers?

Non-network treatment is not covered under Flexi Health Insurance except in case of Emergency
treatment.

Is maternity covered under ‘Flexi Health Insurance’ Plan?

Yes, maternity is covered under Flexi Health Insurance plan:

Maximum Annual benefit limit per delivery (inclusive of co-insurance):

  • Normal delivery: AED 7,000
  • Caesarian section, complications, and medically necessary termination: AED 10,000

Outpatient maternity includes:

  • 8 visits to Primary Health Centre (PHC) reviews, checks and tests in accordance with the Antenatal Care Protocols
  • All care provided by PHC obstetrician for low risk or specialist obstetrician for high-risk referrals.

Do my ‘Flexi Health Insurance’ Plan offers coverage for inpatient and outpatient treatment?

Yes, Flexi Health Insurance plan offers coverage for inpatient and outpatient treatment. Network
Hospitals offers coverage for inpatient and emergency treatment only. Outpatient treatment and GP
consultations are covered at network Clinics/Primary Healthcare Centres (PHC) only.

Is premium refund allowed under ‘Flexi Health Insurance’ plan, if a member is deleted or entire policy is cancelled?

No premium refund will be allowed for member deletion or policy cancellation.

Is premium of AED 750 applicable for all age, gender?

Flexi Health Insurance plan is offered at AED 750 across all age bands and gender for standard risks.
Sub-standard risks will be medically underwritten, and premium will shared accordingly by Daman.

Is a medical report required for members during plan enrollment?

Yes, medical reports are required in below mentioned scenarios, such as:

  • For member’s 61 years and above
  • For Newborn’s age up to 6 months
  • As and when requested by Daman

Is medical declaration required for enrolling under ‘Flexi Health Insurance’ plan?

Yes, medical declaration is required to enrol under Flexi Health Insurance plan. Member must fill
individual application form irrespective of the group size.

Are pre-existing conditions covered under the ‘Flexi Health Insurance’ plan?

Pre-existing conditions are covered only if declared on the application form.
Below listed pre-existing conditions are covered with 6 months waiting period. The waiting period
applies to Inpatient treatment only for the following medical conditions:

  • Diabetes mellitus
  • Arterial diseases
  • COPD (Chronic Obstructive Pulmonary Disease)
  • All cancers cases
  • Neurosurgery
  • Cerebro Vascular diseases
  • All delivery cases

No waiting period applicable if pre-requisition of uninterrupted (pre-) coverage is fulfilled.

How can I enroll for the ‘Flexi Health Insurance’ plan?

You can submit your quote request on Daman website, our customer representative will be contact
and guide you with the next steps.

Can a UAE resident who holds a Retirement Visa enroll in the ‘Flexi Health Insurance’ plan?

No, reference to eligibility guidelines set by Department of Health (DoH), ‘Flexi health insurance’ plan
is not offered for Retirement visa holders.

If I am an existing Daman member, can I opt for ‘Flexi Health Insurance’ plan?

Yes, subject to eligibility guidelines, you can opt for ‘Flexi Health Insurance’ plan at the time of
renewal. Please note your application will be subject to medical underwriting.

Who is eligible for ‘Flexi Health Insurance’ plan

Abu Dhabi Visa Holders under following categories:

  • An expatriate residing in the Emirate who works in the private sector, provided that his/her
    monthly income exceeds 5,000 dirhams.
  • Investors and holders of free enterprises licenses, who desire to have this policy, and their families
    and employees.
  • The family of the resident expatriate and his/her workers who are not covered by employer’s
    health insurance policy (government or private).

Few Examples:

  • Investor/Partner
  • Freelancer/Holder of free enterprise visa
  • Members with Golden visa under investor status
  • Fourth Child
  • Above 18 Years Dependent Child
  • Spouse not covered under Employer Insurance
  • Full time Students under University
  • Dependent Parents

Note: Sponsor Salary should be above AED 5,000 to enrol their dependents under Flexi Health
Insurance Plan.

I live abroad, and my golden visa application is still under process, am I required to buy a Golden Visa Insurance plan at this stage?

A six-month visit visa insurance plan – “Ziyarah,” is also available for golden visa applicants living abroad who have applied for a six-month visa to visit United Arab Emirates to complete their golden visa application documentation and processing.

My Visa is valid for 5/10 years. Can I obtain a Golden Visa Insurance plan for the same period as my Visa?

Your policy duration is 1 year (annual contract) and can be renewed on a yearly basis.

Where can I buy a Golden Visa Insurance plan?

You can buy a Golden Visa Insurance plan at Daman branches or online through the website. You can also reach us through our call centers 24/7 and we will ask one of our sales representatives to contact you.

How much does Golden Visa Insurance cost?

Your premium will vary according to your age and the plan option you have chosen. Our Daman sales representatives will guide you accordingly to find a reasonable coverage and premium that meet your needs.

What are the requirements to apply for Golden Visa Insurance?

Primary applicants are requested to submit the following documents:

Individual Enhanced Application Form
Additional medical reports, if required

Who can apply for Golden Visa Insurance?

The Golden Visa Insurance is available for United Arab Emirates Golden Visa applicants and their dependents who do not have an existing health insurance coverage.

What is Golden Visa Insurance?

The Golden Visa Insurance is a selection of comprehensive health insurance plans available for golden visa applicants to fulfill the health insurance required under the “Thrive in Abu Dhabi Programme.” For more information about the United Arab Emirates Golden Visa, click here

Can a UAE resident who isn’t a holder of a Retirement Visa enrol in the Madeed plan?

No, the Madeed plan is available only for Retirement Visa holders issued by the GDRFA-Dubai.

My Retirement Visa is valid for 5 years. Can I obtain a Madeed plan for the same period as my Visa?

Your policy duration is 1 year (annual contract) and can be renewed on an annual basis.

Does my Madeed Plan offer any screening benefits?Is there any limit for medications under my plan?

Yes, to encourage wellbeing your Madeed plan offers a screening benefit for:

  • Annual Breast Cancer Screening
  • Annual Prostate Cancer Screening
  • Colorectal Cancer Screening
  • Cervical Cancer Screening
  • Hepatitis C Virus Screening

Is COVID-19 treatment covered under the Madeed Plan?

Pandemics/epidemics are excluded under the Madeed plan. However, as directed by the Dubai Health Authority (DHA), treatment for COVID-19 is covered under the Madeed plan till further notice.

Is the medical check-up benefit covered under this plan?

Yes, the Medical check-up benefit is covered under the Madeed Silver and Madeed Gold plans.

Is there any limit for medications under my plan?

The Madeed plan is offered with 3 different pharmacy option limits as follows:

  • AED 3,000 (Madeed Bronze)
  • AED 5,000 (Madeed Silver)
  • AED 10,000 (Madeed Gold)

Are pre-existing conditions covered under the Madeed Plan?

Yes, pre-existing conditions declared in the Individual Application Form (IAF) are covered up to a maximum of AED 150,000.

What is the premium for each of the Madeed plan options?

Your premium will vary according to your age and the plan option you have chosen.  Our Daman sales representative will guide you accordingly to find a reasonable coverage and premium that meet your needs.

Can I request for additional benefits on my Madeed plan?

At the time of application, you can request to add dental and optical benefits under your Madeed plan.

Is Non-Network treatment covered under Madeed plans?

Yes, Non-Network coverage is offered under Madeed Plans, as specified in the plan Schedule of Benefits (SOB) on a reasonable and customary basis

What is the geographical coverage I can choose from for Madeed plans?

Depending on the plan option, there are 3 geographical coverage options to choose from:

  • UAE (Madeed Bronze)
  • UAE and home country (HC) (Madeed Silver)
  • Worldwide (WW) (Madeed Gold)

How many plan options are offered under Madeed?

You can choose from 3 plan options under Madeed. Plans vary in terms of network, geographical coverage and other benefits:

  • Madeed Bronze
  • Madeed Silver
  • Madeed Gold

Where can I buy a Madeed plan?

You can buy a Madeed plan at Daman branches, online through the website and with the help of insurance brokers. You can also reach us through our call centers 24/7 and we will ask one of our sales representatives to contact you.

Are dependents eligible to be enrolled in the Madeed plan?

Yes, dependents sponsored by Retirement Visa holders are eligible to be enrolled in this plan.

How can I be eligible for the Madeed plan?

To be eligible for the Madeed plan, you must fall under the following criteria:

  • Be a holder of a Retirement Visa issued by the General Directorate of Residency and Foreigners Affairs (GDRFA-Dubai)
  • Be at least 55 years old if you are the principal member of the policy.

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