SCHEDULE OF BENEFITS

Any benefit mentioned in the table of benefits supersede any general condition or exclusion
that will contradict with the said benefit
STANDARD BENEFITS

AGGREGATE LIMIT AED 250,000 per person per annum

ENROLMENT FORM Required for members above 65 yrs. And the late enrollment, to be submitted together with the
passport & visa copy (in addition to the EID, continuity certificate & Labor card or contract copy
in case AUH law applies)

LOCAL NETWORK Worker Network + SEHA Western Region only

(Abu Dhabi National Takaful reserves the right to add or remove any medical provider to the
applicable network without prior notice. When Takaful applies any changes to the existing
network, The updated network list of medical providers will be sent accordingly to the policy
holder.)

OUTPATIENT LIMIT ➢ Within the aggregate Limit.

In compliance with HAAD Circular no ➢ Pharmaceuticals are covered 70% covered up to AED 1,500/- with 30% copayment. as per
(DG/32/17) dated 13/08/2017 DOH circular US/27/18- New mechanism of dispensing Generic medicines.
Patients seeking a second or ➢ Physician Consultation (GP):100% Covered – With Patient deductible of AED 50 per
subsequent outpatient appointment
physician consultation (not applicable for follow up within 7 days)
for the same specialty within 21
days, without doctor referral, will ➢ Specialty Consultation (Specialist / Consultant):100% Covered – upon referral from
only be covered if the patient obtains GP with additional Patient deductible of AED 20 per physician consultation (not applicable for
pre-approval by calling the follow up within 7 days)
“Company” claims’ centre. This ➢ Diagnostics Services: 100% Covered for Laboratory & Imaging Services with deductible
process excludes the following: of AED 10/-
Patient’s first visit for a specific ➢ Imaging Services to cover:
symptom, children (under the age of ➢ X-rays
18), patients aged 60 years and
➢ MRI
above, health screening visits,
vaccination visits, and emergencies.
➢ CT-scan,
➢ Ultra Sound
➢ Laboratory Services to cover:
➢ Biochemistry
➢ Hematology
➢ Virology
➢ Bacteriology
➢ Pathology

OUTPATIENT APPROVAL ➢ CT and MRI scans

REQUIREMENTS ➢ Endoscopies
➢ All additional therapies e.g. Physiotherapy, Chiropractic, etc.
➢ Any additional benefits to HAAD Basic Product such as Optical and Dental treatment,
Psychiatry, vaccination, etc.

INPATIENT LIMIT PER ➢ Within the aggregate Limit (100% Covered Except for Exclusions)
CLAIM ➢ Hospital Accommodation, Inpatient Services & Inpatient Medications (Medical, Surgical &
ICU).

SETTLEMENT BASIS INSIDE

Direct Billing
NETWORK IN UAE

BASIC TERRITORY UAE

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P.O. Box 35335, Abu Dhabi, U.A.E. – Telephone No. (+971) 2 4107700 – Telefax No. (+971) 2 4107800
STANDARD BENEFITS

OUT-OF-NETWORK INSIDE
UAE. Outpatient Treatment:
Claims to be submitted ➢ Physician Consultation (GP) covered with 20% Co-payment and applicable deductible
within 30 days inside UAE ➢ Specialist Consultation (SP) covered with 20% Co-payment and applicable deductible
and within 60 days outside ➢ Pharmaceutical: are subject providing proper documentation.
UAE ➢ Lab and Imaging Services: are subject providing proper documentation.
➢ Reimbursement At 80% of the incurred cost, subject to maximum of The Applicable
Network Tariff (Reasonable & Customary charges) on reimbursement basis only.
➢ Any treatment initiated outside the network will be settled as an out of Network.
Inpatient Treatment:
Treatment taken outside the Network is covered At 80% of incurred cost, subject to
maximum of The Applicable Network Tariff (Reasonable & Customary charges) on
reimbursement basis only.

EMERGENCY & TREATMENT

NOT AVAILABLE WITHIN Covered 100% within UAE (Subject to policy terms, conditions & exclusions and applicable
NETWORK COVERED 100% deductible/co-payment if any)
WITHIN UAE

ROOM TYPE Semi Private Room (2 beds)

PARENT ACCOMMODATION Daily benefit for one parent accompanying an insured child under 18 years of age, (up to a
maximum of Dhs. 150/- per night)

ACCOMPANYING PERSON Accommodation of an accompanying person in the same room in case of critical conditions and
as per recommendation of attending physician, subject to prior approval (up to a maximum of
AED 150/- per night)

LOCAL AMBULANCE Transportation services for medical emergencies inside the UAE by an authorized party is 100%
covered

PHYSIOTHERAPY 100% Covered, subject to prior approval

MATERNITY / Obstetrical & 1. Deductible:

Follow up (IP & OP) FOR AED 500/- per Delivery & same conditions of OP consultations will apply.
MARRIED FEMALES ONLY 2. Inside Abu Dhabi:
✓ Waiting period of 180 days Covered up to aggregate.
on In-Patient cases only 3. Out Side Abu Dhabi:
(unless there is proof of Covered up to AED 10,000/- with copayment of AED 500/-
continuity of health The antenatal care (visits, ultra sounds, etc…) is inclusive of the above limits.
insurance coverage). Emergency inside UAE covered 100% up to the policy limit
✓ Subject to Prior Approval. Treatment not available within the network is covered 100% up to policy limit.

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P.O. Box 35335, Abu Dhabi, U.A.E. – Telephone No. (+971) 2 4107700 – Telefax No. (+971) 2 4107800
STANDARD BENEFITS

PRE-EXISTING AND Outpatient treatment:

CHRONIC CONDITIONS ➢ Covered with no waiting period.
Inpatient treatment:
➢ Existing Members: Covered with no waiting period.
➢ New Joiners: covered with no waiting period if there is continuity of health insurance
coverage i.e. proof of existing and continuous cover up to the enrollment date. Otherwise,
waiting period of 6 months is applicable for the following high cost medical conditions only
(as defined by Health Authority of Abu Dhabi in Circular no. 11): Diabetes mellitus, Arterial
diseases, Chronic Obstructive Pulmonary disease, all cancers cases, Neurosurgery, Cerebro
Vascular diseases & all Delivery cases (Maternity). All other conditions are covered from day
one.
All known major Pre-existing / Chronic cases (Chemotherapy, radiotherapy, Arterial diseases and
heart operations, Neurosurgery, renal dialysis, Rheumatoid Arthritis treatment, osteoarthritis
treatment, treatment above 2500/- per month) to be mentioned to ADNTC before submitting
the final documents to issue the contract. These cases will be subject to specific underwriting if
needed. Failing to declare such cases, will cause a Contribution increase to be decided upon by
ADNTC.

WORK RELATED ACCIDENTS Covered inside Abu Dhabi only.

As per Federal Law No. 8 of
1980 concerning the
regulation of work relation
as amended and applicable
laws in this regard.

OTHER BENEFITS Diagnostic and treatment services for dental and gum treatments emergency cases only.
Hearing and vision aids, and vision correction by surgeries & ophthalmology, and laser are
covered for emergency cases only.

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P.O. Box 35335, Abu Dhabi, U.A.E. – Telephone No. (+971) 2 4107700 – Telefax No. (+971) 2 4107800
 GROUP MEDICAL TAKAFUL QUOTATION
GENERAL CONDITIONS
POLICYHOLDER : M/S CLEANHOUSE CLEANING SERVICES
COVER : As per Abu Dhabi National Takaful Company’s standard Group Medical Takaful policy wording to
(As Per AUH Law 23/2005 cover the benefits as per the attached schedule of benefits
for Abu Dhabi Groups
only)
BENEFICIARIES : All UAE permanent residents, actively at work, full time & permanent employees of the policy
holder and their dependents (Spouse & children).
PERIOD OF TAKAFUL : 12 months from the date to be advised and agreed
AGE LIMIT : From 0 to 65 years (65 yrs and above subject to individual underwriting)
POLICY HOLDER The Policy Holder hereby confirms that members working or residing inside the Emirate of Dubai
DISCLAIMER who are having salaries below AED 4,000/- will not be included under this policy. Dubai
Members who are having salaries above AED 4,000/- have to be included under separate
policy/contract. The Company (ADNTC) bears no responsibility in case any member as specified
above is included as it will be the sole liability upon the Policy Holder.
OTHER CONDITIONS : ➢ Contribution is payable annually and in advance (in case of renewal, the renewal will be
confirmed subject to previous outstanding is paid). In case payment is not received on the
agreed dates, the issued policy will be considered as Null and Void. 15% of the policy
applicable premium will be deducted as administration fees from the refunded premium in
case the policy is cancelled for Non- payment of premium. ADNTC reserves the right to
recover the due premium in all possible means.
➢ All additions and deletions are on pro-rata basis. The deletion of members is only subject to
date of visa cancellation (documentation of proof required). The effective date of any
transaction shall be the receiving date of the request by ADNTC subject to full compliance with
local regulations (Dubai visa holders shall be cancelled effective 30 days from request date,
assuming request date is same visa cancellation date).
➢ Any existing employee or dependants not covered on joining date, TAKAFUL reserve the right
to accept such addition or to apply individual underwriting.
➢ The policy holder has the obligation of declaring the place of work/stay of the insured
members; ADNTC is not responsible for any penalties related to this issue in the absence of
declaration.
➢ All new members are subject to appropriate underwriting. Enrollment form, visa copy with
entry stamp, passport copy & Emirates ID are required for all members (Labor contract &
certificate of insurance continuity are required in case AUH law applies).
➢ Coverage under the proposed Policy, if secured is compulsory for all Employees. There is no
voluntary option exercised by any employee. In case of dependents (Wife & Children only) to
be covered (compulsory enrollment for dependents in AUH in line with HAAD regulations,
ADNTC is not liable for any penalties related to non declaration of dependents), it has to be on
compulsory basis for all employees' dependents residing in UAE without exception (children
dependents are not less than 14 days subject to compliance with AUH law when applicable and
not more than 18 years old at the date of enrollment to the plan. However, coverage shall be
extended up to 23rd birthday subject to full time student in an accredited college or university).
The non-compliance by the Policyholder to these rules shall give to the Company the right to
terminate the proposed Policy immediately without Contribution refund.
➢ The Policyholder shall be liable to reimburse the Company all Claims amounts paid by the latter
to any of its Providers in respect of the following:
➢ Treatment availed by any Beneficiary in excess of the limits of benefits provided in the Policy
➢ Treatment availed by any Beneficiary for an Excluded or uncovered conditions
➢ Treatment availed by any Beneficiary after his deletion date
➢ Treatment availed by any Beneficiary during any period when Contribution was in arrears
➢ Treatment availed through fraudulent us of the Access Card
The same will be debited to the client account on monthly to be recovered from the insured
member.
Notwithstanding to anything contained herewith to the contrary, it is agreed that the quoted
rates are based on the provided census list. At any time during the policy period, “TAKAFUL”
reserve the right to review the rates to the adequate level required as a result of reduction of
the number of members (i.e. more than 10% of the number of beneficiaries). “TAKAFUL”
reserve the right to review the rates to the adequate level required as a result of Redistribution
of census amongst various classes.
VALUE ADDED TAX “VAT” CLAUSE: The quote provided above is exclusive of any Value Added
Tax ('VAT') or any similar tax, as applicable on the Medical Takaful. It is hereby declared and
agreed that the Value Added Tax (VAT) is applicable on the insurance contribution and other
charges payable/ paid in relation to this insurance policy, the Company reserves its right to
collect the same from the insured / Policy Holder in line with impending VAT laws and
regulations as implemented in the UAE.
QUOTATION VALIDITY : 30 days from the above date, subject to no material change in data, i.e. persons covered

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P.O. Box 35335, Abu Dhabi, U.A.E. – Telephone No. (+971) 2 4107700 – Telefax No. (+971) 2 4107800
Requirements Needed in order to Issue the Policy:
1.Client Confirmation Letter
2.Updated members List in excel format with Emirates ID Number for each staff.
3.Enrollment form, passport copy, visa copy, continuity certificate & labor contract or labor card
copy.
4. Scanned Photograph of each member (in JPEG format, one photo one file)
5. The current Municipality Trade License.
6. Chamber of Commerce Certificate.
7. Copy of power of Attorney or letter of authority of person designated to act in owner’s behalf.
8. List of employees issued from the ministry of labors.
9. Broker Appointment Letter (If business is through a broker).
N.B. Account opening requirements will be conveyed upon receiving the firm order.

Abu Dhabi National Takaful Standard Exclusions (Abu Dhabi Plans):

Except as may be specifically provided in the Health Insurance Law and the Regulations, cover for the costs
of Healthcare Services and associated expenses in respect of the following events or causes, medical
conditions, items, supplies, procedures and all their related or consequential expenses shall be excluded
from the requirements to obtain health insurance cover under the Health Insurance Scheme:

1. Healthcare Services, which are not medically necessary.

2. All expenses relating to dental treatment, dental prostheses, and orthodontic treatments.

3. Domiciliary care; private nursing care; care for the sake of travelling.

4. Custodial care includes (1) Non medical treatment services; or (2) Health related services
which do not seek to improve or which do not result in a change in the medical condition of
the patient.

5. Services which do not require continuous administration by specialized medical personnel.

6. Personal comfort and convenience items (television, barber or beauty service, guest service
and similar incidental services and supplies).

7. Healthcare Services and associated expenses for replacement of an existing breast implant.
Cosmetic operations which improve physical appearance and which are related to an Injury,
sickness or congenital anomaly when the primary purpose is to improve physiological
functioning of the involved part of the body. Breast reconstruction following a mastectomy for
cancer is covered.

8. Surgical and non-surgical treatment for obesity (including morbid obesity), and any other
weight control programs, services, or supplies.

9. Medically non-approved experimental, research, investigational healthcare services,

treatments, devices and pharmacological regimens.

10. Healthcare Services that are not performed by Authorized Healthcare Service Providers, apart
from Healthcare Services rendered in a Medical Emergency.

11. Healthcare services, treatments & associated expenses for alopecia, baldness, hair falling,
dandruff or wigs.

12. Supplies, Treatment and services for smoking cessation programs and the treatment of
nicotine addiction.

13. Non-medically necessary Amniocentesis.

14. Treatment, services and surgeries for sex transformation, sterility and sterilization

15. Treatment and services for contraception

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P.O. Box 35335, Abu Dhabi, U.A.E. – Telephone No. (+971) 2 4107700 – Telefax No. (+971) 2 4107800
16. Treatment and services related to fertility / sterility (treatment including varicocele / polycystic
ovary / ovarian cyst / hormonal disturbances / sexual dysfunction).

17. Prosthetic devices and consumed medical equipments, unless approved by the insurance
company

18. Treatments and services arising as a result of hazardous activities, including but not limited to,
any form of aerial flight, any kind of power-vehicle race, water sports, horse riding activities,
mountaineering activities, violent sports such as judo, boxing, and wrestling, bungee jumping
and any professional sports activities

19. Growth hormone therapy

20. Costs associated with hearing tests, vision corrections, prosthetic devices or hearing and vision
aids.

21. Mental Health diseases, in-patient and out-patient treatments, unless the condition is a
transient mental disorder or an acute reaction to stress.

22. Patient treatment supplies (including elastic stockings, ace bandages, gauze, syringes, diabetic
test strips, and like products; non-prescription drugs and treatments, excluding such supplies
required as a result of Healthcare Services rendered during a Medical Emergency).

23. Preventive services, including vaccinations, immunizations, allergy testing and desensitization;
any physical, psychiatric or psychological examinations or testing during these examinations.

24. Services rendered by any medical provider relevant of a patient for example the Insured
person and the Insured member’s family, including spouse, brother, sister, parent or child.

25. Enteral feedings (via a tube) and other nutritional and electrolyte supplements, unless
medically necessary during treatment.

26. Healthcare services for adjustment of spinal subluxation, diagnosis and treatment by
manipulation of the skeletal structure, by any means, except treatment of fractures and
dislocations of the extremities.

27. Healthcare services and treatments) by acupuncture; acupressure, hypnotism, rolfing, massage
therapy, aromatherapy, homeopathic treatments, and all forms of treatment by alternative
medicine.

28. All Healthcare services & Treatments for in-vitro fertilization (IVF), embryo transport; ovum
and male sperms transport

29. Elective diagnostic services and medical treatment for correction of vision.

30. Nasal septum deviation and nasal concha resection.

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

32. Treatments and services related to viral hepatitis and associated complications, except for
treatment and services related to Hepatitis A.

33. Birth defects, Congenital diseases for newborn &/or Deformities unless life-threatening.

34. Healthcare services for Senile dementia and Alzheimer’s disease.

35. Air or Terrestrial Medical evacuation except for Emergency cases or unauthorized
transportation services.

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P.O. Box 35335, Abu Dhabi, U.A.E. – Telephone No. (+971) 2 4107700 – Telefax No. (+971) 2 4107800
36. Circumcision healthcare services except for new Muslims who raised their Islam in the emirate
of Abu Dhabi as per the agreed legal procedures.

37. Inpatient treatment received without prior approval from the insurance company including
cases of Medical Emergency which were not notified within 24 hours from the date of
admission.

38. Any inpatient treatment, tests and other procedures, which can be carried out on outpatient
basis without jeopardizing the Insured Person’s health.

39. Any test or treatment, for purpose other than medical such as tests related for employment,
travel, licensing or insurance purposes.

40. All supplies which are not considered as medical treatments including but not limited to:
mouthwash, toothpaste, lozenges, antiseptics, milk formulas, food supplements, skin care
products, shampoos and multivitamins (unless prescribed as replacement therapy for known
vitamin deficiency conditions) and all equipment not primarily intended to improve a medical
condition or injury, including but not limited to air conditioners or air purifying systems, arch
supports, convenience items / options, exercise equipment and sanitary supplies.

41. More than one consultation or follow up with a medical specialist in a single day unless
referred by a physician.

42. Health services and associated expenses for organ and tissue transplants, irrespective of
whether the Insured Person is a donor or recipient.

43. Services and educational program for handicaps.

Healthcare Services outside the Scope of Health Insurance

1. Injuries or illnesses suffered by the Insured Person as a result of military operations of

whatever type.

2. Injuries or illnesses suffered by the Insured Person as a result of wars or acts of terror of
whatever type.

3. Healthcare services for injuries and accidents arising from nuclear or chemical contamination.

4. Injuries resulting from natural disasters (including but not limited to) earthquakes, tornados
and any other type of natural disaster.

5. Injuries resulting from criminal acts or resisting authority by the Insured Person.

6. Healthcare services for patients suffering from AIDS and its complications.

7. All cases resulting from the use of alcohol, drugs and hallucinatory substances.

8. Any test or treatment not prescribed by a doctor.

9. Injuries resulting from attempted suicide or self-inflicted injuries.

10. Diagnosis and treatment services for complications of exempted illnesses.

11. All healthcare services for internationally and locally recognized epidemics.

12. Venereal sexually transmitted diseases. A list with respect thereto will be set out by the
General Authority of Health Services.

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P.O. Box 35335, Abu Dhabi, U.A.E. – Telephone No. (+971) 2 4107700 – Telefax No. (+971) 2 4107800
DENTAL (APPLICABLE ONLY FOR DENTAL COVER)

1. Normal check-up and examinations

2. Any preventive treatment
3. All kinds of bridgework and false teeth
4. Tooth adjustment
5. General anesthesia
6. All surgeries, Treatment of gingivitis
7. Orthodontics and cosmetic services

TERRITORY DEFINITION:

Arab Countries :UAE, Algeria, Bahrain, Djibouti, Egypt, Iraq, Jordan, KSA, Kuwait, Lebanon, Libya,
Mauritania, Morocco, Oman, Palestine, Qatar, Somalia, Sudan, Syria, Tunisia, Yemen, Comoros.
Sub Asia Countries: Bangladesh, Bhutan, Burma, India, Indonesia, Malaysia, Nepal, Pakistan,
Philippines, Sri Lanka, Thailand, Vietnam, Laos, Myanmar, Afghanistan, Iran, Maldives.
Indian Subcontinent Countries: Bangladesh, Bhutan, India, Nepal, Pakistan, Sri Lanka, Maldives.
South East Asia Countries: Burma, Indonesia, Malaysia, Philippines, Thailand, Vietnam, Laos, Myanmar.
Middle East Countries: Egypt, Iran, Turkey, Iraq, Saudi Arabia, Yemen, Syria, United Arab Emirates,
Jordan, Palestine, Lebanon, Oman, Kuwait, Qatar, Bahrain, Cyprus, Afghanistan, Iran.
GCC Countries
Bahrain, KSA, Kuwait, Oman, Qatar, Yemen.
Other Countries
All countries other than Australia, Canada, France, Germany, Japan, United Kingdom, United States

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P.O. Box 35335, Abu Dhabi, U.A.E. – Telephone No. (+971) 2 4107700 – Telefax No. (+971) 2 4107800