Who Can Apply for Flexi Health Insurance Option?
The Flexi Health Insurance Plan is available for Abu Dhabi visa holders who meet the Department of Health’s eligibility guidelines. It’s for people who are not already covered under an employer’s health insurance policy, whether government or private.
You can apply if you fall into one of these categories —
- Private sector expatriates living in Abu Dhabi with a monthly income of more than AED 5,000
- Investors and free enterprise license holders, along with their families and employees
- Family members of a resident expat: such as spouse, children, or parents — who are not covered by the sponsor’s employer insurance
- Specific cases like —
- Investor or partner in a business
- Freelancer or free enterprise visa holder
- Golden Visa holder (under investor status)
- Fourth child in the family
- Dependent children over 18
- Full-time university students
- Dependent parents
One important note: retirement visa holders are not eligible for this plan. Also, to enroll dependents, the sponsor’s salary must be above AED 5,000.
Network Coverage and How It Works
With the Flexi Health Insurance Plan, your choice of where you get treated matters. The plan works with a specific network of healthcare providers. Let’s understand how it’s set up to help you avoid unexpected costs.
- Network Clinics and Primary Healthcare Centres (PHC)
These are your first point of contact for outpatient care and general medical needs. You can see a general practitioner (GP) here without any special steps.
- Specialists and Consultants
You can only visit a specialist if a GP refers you from a network clinic or PHC. The GP will make the referral through Daman’s electronic system, including the reason for the referral. Without this step, specialist treatment won’t be covered.
- Network Hospitals
Hospitals in the network mainly handle inpatient and emergency cases. Outpatient services at hospitals are not covered unless your GP refers you there for services not available in clinics or PHCs.
- Non-Network Providers
These are not part of Daman’s Flexi network. Treatment here is not covered unless it’s an emergency. In emergencies, you can be treated anywhere in the UAE and claim reimbursement afterwards.
Inclusions of Flexi Health Insurance
Some of the key coverages provided by Flexi Health Insurance are as follows —
|
Benefit
|
Coverage Details
|
Coverage Limit / Notes
|
|
Annual Benefit Limit
|
Overall maximum coverage per policy year
|
AED 150,000 per person
|
|
Territorial Limit
|
Main coverage area
|
Emirate of Abu Dhabi
|
|
Emergency Cover
|
Within UAE (outside Abu Dhabi)
|
100% covered, reimbursement basis
|
|
Inpatient & Day Treatment
|
Hospital stay, surgeries, and pre and post-hospital treatment
|
Up to annual limit
80% covered in-network (Out-of-pocket limit AED 500 per encounter, AED 1,000 annual aggregate)
|
|
Accommodation Type
|
General room (2+ beds)
|
80% covered
|
|
Hospital Services & Accommodation
|
Includes necessary medical services during stay
|
80% covered
|
|
Fees for Consultants, Surgeons, and Anesthetists
|
For approved procedures
|
80% covered
|
|
Ambulance (Medical Emergency)
|
Road ambulance transport
|
100% covered in-network and non-network
|
|
Parent Accommodation
|
For child under 16 years
|
Max AED 100/day, 80% covered
|
|
Companion Accommodation
|
If medically necessary
|
Max AED 100/day, 80% covered
|
|
GP Consultation (Outpatient)
|
At network clinics/PHC
|
80% covered
|
|
Specialist Consultation (Outpatient)
|
Requires GP referral from network provider
|
100% covered
|
|
Diagnostics & Laboratory
|
X-ray, MRI, CT Scan, Ultrasound, Endoscopy (with pre-authorisation)
|
80% covered
|
|
Pharmaceuticals
|
Basic formulary drugs only
|
70% covered, AED 1,500 annual limit (inclusive of coinsurance)
|
|
Physiotherapy
|
Network providers only
|
80% covered, max 6 sessions/year
|
|
Vaccines & Immunizations
|
Essential vaccinations as per MOHAP policy
|
80% covered, reimbursement basis
|
|
Maternity – Inpatient
|
Normal delivery
|
AED 7,000 (90% covered in-network)
|
| |
C-section, complications, and medically-necessary termination
|
AED 10,000 (90% covered in-network)
|
| |
Newborn care
|
Up to 30 days from birth (includes BCG, Hep B, neonatal screening)
|
|
Maternity – Outpatient
|
Antenatal care
|
90% covered, includes 8 PHC visits, tests and care by obstetrician (low-risk) or specialist (high-risk)
|
|
Emergency Dental & Gum Treatment
|
Only for medical emergencies
|
80% covered in-network and non-network
|
|
Emergency Hearing & Vision Aids, Correction Surgery
|
Only for medical emergencies
|
80% covered in-network and non-network
|
|
Pre-existing Conditions
|
Covered if declared
|
6-month waiting period for inpatient treatment of listed conditions — no waiting if uninterrupted prior coverage
|
Exclusions of Flexi Health Insurance
Check out the common exclusions of Flexi health insurance in the UAE —
- Outpatient treatment in network hospitals without GP referral
- Non-basic formulary drugs
- Dental, gum, hearing, or vision treatments unless due to a medical emergency
- Any services not listed in the Schedule of Benefits
- Pre-existing conditions not declared in the application form
- Elective treatment outside Abu Dhabi (except covered emergencies)
- Coverage for retirement visa holders
Claim Process of Flexi Health Insurance
Daman has made the Flexi Health Insurance claim process simple. This holds true whether you’re using direct billing at a network provider or claiming reimbursement for an emergency at a non-network facility.
- Using Network Providers (Direct Billing)
- Visit a clinic, primary healthcare centre, or hospital in the Flexi network
- Present your Daman insurance card at reception
- Pay only your share (coinsurance or any applicable limits) — the rest is billed directly to Daman
- Emergency at Non-Network Providers (Reimbursement)
- Seek treatment immediately — no pre-approval is needed for emergencies
- Inform Daman within 24 hours of admission
- Pay the medical bill in full at the hospital or clinic
- Submit a reimbursement claim with —
- Original invoices and receipts
- Medical reports and discharge summary
- Your insurance card details
- Daman processes and reimburses as per the policy coverage and limits
- Pre-Authorisation for Certain Treatments
- Non-emergency hospitalisation, some outpatient procedures, maternity care, and specialised diagnostics require pre-approval from Daman
- Your network provider will handle the approval request through the Daman system
Role of Policybazaar.ae in Finding the Right Health Insurance in the UAE
Finding the right medical insurance in the UAE can be tricky. There are many plans to choose from, each with its own set of rules, limits, and costs. Policybazaar.ae helps make this process much easier.
On the website, you can view and compare different health insurance plans from top providers. You can find all the important details — like what’s covered, benefit limits, and exclusions — side by side. This way, you can clearly see the differences and make an informed choice.
Policybazaar.ae also has a team that can guide you through the small details, such as how pre-existing conditions are handled, what maternity benefits include, and what coinsurance really means for your budget.
For business owners, investors, and freelancers, it’s a quick and easy way to choose a policy that offers good protection without paying for benefits you don’t need.
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