Adamjee Individual Health Insurance

Q: Q1. What is the significance of Maternity Cover in health insurance?

Ans: Maternity cover in health insurance provides coverage for pregnancy-related medical expenses. Typically including both outpatient and inpatient maternity services, this cover offers financial support for normal deliveries, C-sections, complications, and termination (if considered medically necessary).

Q: Q2. How does the waiting period affect maternity coverage?

Ans: With Adamjee individual health insurance plans, the maternity waiting period is usually 40 calendar days from the inception of the policy. In this period, pregnancy-related expenses are not covered. It's essential to understand this waiting period to plan for maternity-related costs effectively.

Q: Q3. What is the copayment and coinsurance in health insurance?

Ans: Co-payment and coinsurance are cost-sharing mechanisms in health insurance. Co-payment is a fixed amount that the policyholder pays for a specific service like a doctor's visit. Coinsurance, on the other hand, is a percentage of the medical costs shared by the insured — the rest is covered by the insurance provider.

Q: Q4. Can I get coverage for my newborn under my health insurance policy?

Ans: Yes, many health insurance policies offer coverage for newborns for a limited duration (typically 30 days) as per the DHA (Dubai Health Authority) guidelines. It's essential to check your policy terms and conditions for specific details.

Q: Q5. How does prior approval work in health insurance?

Ans: Prior approval or pre-authorisation is a process where the insurance company reviews and approves certain medical treatments or procedures before they are conducted. This process helps the provider ensure that the treatment is medically necessary and covered by the policy.

Adamjee Insurance Company Limited (AICL), founded in 1960 in Pakistan, has firmly established itself as a prominent player in the UAE insurance market as well. Boasting a rich history of providing coverage for various industries — from Oil & Gas to Textile and Sugar sectors — the company continues to demonstrate its versatility and commitment to excellence in insurance services.read more

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Adamjee Insurance presents a great choice if you are looking for comprehensive individual health insurance plans. With Adamjee individual health insurance plans, you can easily get access to quality medical care and peace of mind in times of illness or injury. These policies of Adamjee are known for their reliability, extensive coverage, and a variety of features that ensure the availability of swift assistance.

Let’s find out more about the individual health insurance plans of Adamjee through which individuals in the UAE can enjoy the benefits of personalised healthcare protection.

Adamjee Individual Health Insurance Plans

With Adamjee individual health insurance plans, you can enjoy medical coverage of up to AED 1,000,000 and a host of other features. Let’s take a look at those key coverage inclusions of the different variants under this plan -

Plan	Details
MEDNET Silk Road	Maternity Cover with inpatient and outpatient services - 10% co-insurance Hospital Access with direct specialist access Dental and Gum Treatment with 20% co-payment Hearing and Vision Aids (valid only for emergencies) with 20% co-payment Out-Patient Services with 20% co-payment In-Patient Services Ambulance Service for medical emergencies Companion Accommodation coverage Worldwide Territorial Scope Of Coverage (for UAE visa holders) - Excludes Abu Dhabi (AUH) and Al Ain (AAN) Laboratory Tests and Radiology diagnostic with 20% co-payment Physiotherapy Treatment with 20% co-payment and prior approval - Up to 15 sessions in a year Test, diagnosis, and treatments concerning surgeries with prior approval Emergency Treatment with prior approval within 24 hours Medication with 20% co-payment and annual limit Essential Vaccines and Preventive Services covered Policybazaar.ae Exclusive Offer (Pakistani Nationality): Family Size = 1: Spouse has per person benefit limit of AED 400,000 and a room limit of AED 12,000 Family Size > 1: Parents have AED 300,000 coverage with a room limit of AED 6,500
MEDNET Pearl	Maternity Cover - Maternity-related medical emergencies covered Dental and Gum Treatment - Covered with AED 3,500 sub-limit; 20% Coinsurance Hearing and Vision Aids - Covered for medical emergencies Out-Patient Services New Born Cover - As per DHA guidelines Laboratory Tests - Covered with 20% co-payment for each invoice Physiotherapy Treatment - Covered with 20% Co-payment In-Patient Services Ambulance Services Pre-existing conditions - covered Parent Accommodation for Child Repatriation of Mortal Remains - Covered up to AED 7,500 Essential Vaccines and Preventive Services - Covered Alternative Medicine - Covered up to AED 1,600/year per member
MEDNET Emerald	Maternity Cover Out-patient Maternity Services with 10% co-payment In-patient Maternity Services with sub-limits Medical Emergency Maternity expenses up to AED 150,000 Dental and Gum Treatment Covered with 20% co-payment Dental consultation covered Hearing and Vision Aids - Covered for medical emergencies Out-Patient Services with 20% copay In-Patient Services - Includes ambulance services (subject to conditions), organ transplant, ICU, and more Pre-Existing and Chronic Conditions All conditions that are declared are covered with AED 150,000 sub-limit Undeclared conditions underwritten at renewal Network Mednet - Emerald for both IP and OP Other Services New Born Cover for first 30 days Physiotherapy covered with 20% co-pay Cancer Treatment for enrolled members of the ‘Patient Support Program’ Preventive services for members over 18 Daycare Treatment, Out-Patient Surgery, Emergency Mental Health Treatments, and Work Related Injuries covered MedNet’s Global Emergency Assistance services Medication Alternative Medicine covered up to AED 1,600/year (reimbursement) Essential Vaccines and Preventive Services - Covered Policybazaar.ae Exclusive Offer (Pakistani Nationality): Family Size = 1: Spouse has per person benefit limit of AED 350,000 and a room limit of AED 12,000 Family Size > 1: Parents have AED 250,000 coverage with a room limit of AED 6,500
MEDNET Green	Maternity Cover with Out-patient and In-patient services covered by 10% copay New Born Cover: Covered for 30 days as per DHA guidelines Waiting Period: Maternity Waiting Period: No coverage for pregnancy for the first 40 calendar days PED & Chronic Condition Waiting Period: None for medical underwritten conditions — undeclared pre-existing conditions not covered during the policy period Hospital - Direct access Dental and Gum Treatment: 20% co-payment up to AED 3,500 Hearing and Vision Aids: Covered for emergencies (subject to 20% co-payment) Out-Patient Services: 20% co-payment In-Patient Services Ambulance Service: Covered for medical emergencies Companion Accommodation: Covered for children under 16 years - up to AED 100 per night Territorial Scope Of Coverage: Worldwide (for UAE visa holders, except AUH/AAN) Other Services Laboratory Tests: 20% co-payment Radiology Diagnostic: 20% co-payment Physiotherapy Treatment: 20% co-payment, up to 15 sessions per year Test, diagnosis, and treatments related to surgeries: Subject to prior approval Emergency Treatment: Approval required within 24 hours Medication: 20% co-payment and limited to formulary products — up to the policy’s annual limit Essential Vaccines and Preventive Services: Covered with co-payment Policybazaar.ae Exclusive Offer (Pakistani Nationality): Family Size = 1: Spouse has per person benefit limit of AED 400,000 and a room limit of AED 12,000 Family Size > 1: Parents have AED 300,000 coverage with a room limit of AED 6,500
MEDNET Silver Classic	Maternity Cover Out-patient Maternity: 10% coinsurance, prior approval required In-patient Maternity: 10% coinsurance Benefits AED 10,000 for normal delivery AED 10,000 for C-section, AED 150,000 for complications and termination deemed medically necessary (all with 10% coinsurance) New Born Cover: Covered for 30 days as per DHA guidelines Waiting Period Maternity Waiting Period: No coverage within 40 calendar days PED and Chronic Condition Waiting Period: None for medical underwritten conditions — undeclared pre-existing conditions not covered during the policy period Hospital Access: Direct access to hospital Dental and Gum Treatment: 20% co-payment up to AED 3,500 — covered with pre-authorisation Hearing and Vision Aids: Covered for emergencies, 20% co-payment Out-Patient Services: 20% co-payment In-Patient Services Ambulance Service: Ground transportation for medical emergencies Companion Accommodation: Covered for children under 16 Territorial Scope Of Coverage: Worldwide (for UAE visa holders) - Except AUH and AAN Other Services Laboratory Tests: 20% co-payment Radiology Diagnostic: 20% co-payment Physiotherapy Treatment: 20% co-payment, up to 15 sessions in a year Test, treatments, and diagnosis related to surgeries: Prior approval is necessary Emergency Treatment: Approval required within 24 hours Healthcare services for emergency cases: Prior approval required Medication: 20% co-payment, up to the policy annual limit (limited to formulary products) Essential Vaccines and Preventive Services: Covered with co-payment Policybazaar.ae Exclusive Offer (Pakistani Nationality): Family Size = 1: Spouse has per person benefit limit of AED 400,000 and a room limit of AED 21,500 Family size > 1: Parents have AED 300,000 coverage with a room limit of AED 12,000
MEDNET Silver Premium	Maternity Cover Out-patient Maternity: 10% coinsurance applicable and prior approval is necessary In-patient Maternity: 10% coinsurance Benefits up to: AED 10,000 for normal delivery AED 10,000 for C-section AED 150,000 for complications and termination deemed medically necessary (all with 10% coinsurance) New Born Cover: Covered for 30 days following the DHA guidelines Waiting Period Maternity Waiting Period: No coverage if pregnancy conceived within 40 calendar days from policy inception PED and Chronic Condition Waiting Period: No waiting period for medical underwritten conditions Undeclared pre-existing conditions not covered during the policy period and underwritten at renewal Hospital Access: Direct access Dental and Gum Treatment: Up to AED 3,500, subject to 20% co-payment and pre-authorisation Hearing and Vision Aids: Covered for emergencies, 20% co-payment Out-Patient Services: 20% co-payment In-Patient Services Ambulance Service: Ground transportation for medical emergencies Companion Accommodation: Covered for children under 16 Territorial Scope Of Coverage: Worldwide (for UAE visa holders) Except AUH and AAN Other Services Laboratory Tests: 20% co-payment Radiology Diagnostics: 20% co-payment Physiotherapy Treatment: 20% co-payment, up to 15 sessions in a year Diagnosis, tests, and treatments related to surgeries: Prior approval necessary Emergency Treatment: Approval required within 24 hours Healthcare services for emergency cases: Prior approval required Medication: Up to policy annual limit, subject to 20% co-payment and only for formulary products Essential Vaccines and Preventive Services: Covered with co-payment Policybazaar.ae Exclusive Offer (Pakistani Nationality): Family Size = 1: Spouse has per-person benefit limit of AED 450,000 with a room limit of AED 21,500 Family size > 1: Parents have AED 300,000 coverage with a room limit of AED 12,000
MEDNET Gold	Maternity Cover Out-patient Maternity: 10% coinsurance and co-payment, with prior approval necessary In-patient Maternity: 10% coinsurance and includes benefits as follows - AED 10,000 for normal delivery AED 10,000 for C-section AED 150,000 for complications and medically-necessary termination (all with 10% co-payment) New Born Cover: Covered for 30 days as per DHA guidelines Waiting Period Maternity Waiting Period: No coverage within 40 calendar days from application PED and Chronic Condition Waiting Period: No waiting period for medical underwritten conditions Undeclared pre-existing conditions not covered during the policy period and underwritten at renewal Hospital Access: Direct access to hospital Dental and Gum Treatment: Up to AED 3,500, subject to 20% co-payment and necessary pre-authorisation Hearing and Vision Aids: Covered for emergencies only (20% co-payment) Out-Patient Services: 20% co-payment In-Patient Services Ambulance Service: Ground transportation for medical emergencies Companion Accommodation for children up to 16 years Territorial Scope Of Coverage: Worldwide (for UAE visa holders) except AUH/AAN Other Services Laboratory Tests: 20% co-payment Radiology Diagnostic: 20% co-payment Physiotherapy Treatment: 20% co-payment — up to 15 sessions per year Test, treatments, and diagnosis related to surgeries: Prior approval necessary Emergency Treatment: Approval required within 24 hours Healthcare services for emergency cases: Prior approval required Medication: Up to the policy annual limit and limited to formulary products - subject to 20% co-payment Essential Vaccines and Preventive Services: Covered with co-payment Policybazaar UAE Exclusive Offer (Pakistani Nationality): Family Size = 1: Spouse has per person benefit limit of AED 500,000 and a room limit of AED 21,500 Family size > 1: Parents have AED 300,000 coverage and a room limit of AED 21,500

Note: All the given rates and premiums are indicative and may change as per the applicant’s medical background, coverage requirements, chosen plan, and so on.

Other Adamjee Health Insurance Plans

Adamjee - Emerald

Adamjee - Emerald (AUH)

Adamjee - Gold

Adamjee - Gold - (AUH)

Adamjee - Green

Adamjee - Green (AUH)

Adamjee - Pearl

Adamjee - Pearl (AUH)

Adamjee - Silk Road

Adamjee - Silk Road (AUH)

Adamjee - Silver Classic

Adamjee - Silver Classic (AUH)

Adamjee - Silver Premium

Adamjee - Silver Premium (AUH)

Key Features and Benefits of Adamjee Individual Health Insurance

Let’s take a look at the major features of Adamjee individual health insurance -

24/7 Customer Care: Adamjee’s customer care service is available around the clock, which ensures that you can easily get assistance or solutions to your queries in an instant.
Swift Claim Settlement: The company ensures timely settlement of claims, which means quicker access to financial assistance when facing any unfortunate circumstances.
Comprehensive Coverage: Adamjee individual health insurance plans, as we saw above, offer coverage for a wide range of conditions.
Customisable Plans: Depending on your specific requirements, you can always customise your plan to suit your individual needs.
High Coverage Limits: With Adamjee individual health insurance plans having high coverage limits and sub-limits, you can focus on getting the necessary treatment without worrying about the financial burden of health issues.

Eligibility Criteria for Adamjee Individual Health Insurance

Listed below are the general eligibility criteria for health insurance plans in the UAE -

Category	Eligibility Criteria
Age Limit	18 to 60+ years
Renewability	As per the provider

Adamjee Individual Health Insurance Inclusions

Let’s take a look at the general inclusions of Adamjee individual health insurance -

In-patient services — ambulance services, ICU, hospital accommodation, and more
Out-patient services
Hospital accommodation
Tests and diagnostics
Transportation services for medical emergency
Cost of medications
Pre-existing and chronic conditions (only if declared)

Exclusions of Adamjee Individual Health Insurance

The general exclusions of Adamjee Individual Health Insurance (may vary on plan basis):

Cosmetic procedures
Self-harm or suicide-related injuries.
Injuries or illnesses resulting from illegal activities
Undeclared pre-existing conditions
Injuries due to wars
Hazardous sport activities

Have a look at some frequently asked questions regarding Adamjee individual health insurance -

FAQ's

Ans: Maternity cover in health insurance provides coverage for pregnancy-related medical expenses. Typically including both outpatient and inpatient maternity services, this cover offers financial support for normal deliveries, C-sections, complications, and termination (if considered medically necessary).

Ans: With Adamjee individual health insurance plans, the maternity waiting period is usually 40 calendar days from the inception of the policy. In this period, pregnancy-related expenses are not covered. It's essential to understand this waiting period to plan for maternity-related costs effectively.

Ans: Co-payment and coinsurance are cost-sharing mechanisms in health insurance. Co-payment is a fixed amount that the policyholder pays for a specific service like a doctor's visit. Coinsurance, on the other hand, is a percentage of the medical costs shared by the insured — the rest is covered by the insurance provider.

Ans: Yes, many health insurance policies offer coverage for newborns for a limited duration (typically 30 days) as per the DHA (Dubai Health Authority) guidelines. It's essential to check your policy terms and conditions for specific details.

Ans: Prior approval or pre-authorisation is a process where the insurance company reviews and approves certain medical treatments or procedures before they are conducted. This process helps the provider ensure that the treatment is medically necessary and covered by the policy.