Watania Takaful - Dependent Enhanced 2 - Aafiya

Your family's health is paramount, and Watania Takaful Dependent Enhanced 2 - Aafiya offers the ideal health insurance coverage to prove it. This Watania Takaful Dependent Enhanced 2 - Aafiya includes a plethora of medical services, such as maternity care, critical illness cover, dental and gum treatment, hearing and vision aids, and more. You can also make changes in your plan by including riders/ add-ons to make it more beneficial for your family.read more

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Plan Summary

Plan NameDependent Enhanced 2 - Aafiya

Cover AmountAED 150,000

Pharmacy LimitUpto AED 1,500

TPANAS

Watania Takaful - Dependent Enhanced 2 - Aafiya Details

Maternity Cover

Waiting Period - This is the time span during which you cannot claim specified benefits from the insurer

6 months( any pregnancy, which arises within 6 months from policy inception will be at the discretion of the insurer)

Out-patient Maternity Services

Requires prior approval from the insurance company.10% co-payment payable by the Policy Holder. 8 Check-ups + 3 ante-natal ultrasound scans are covered at the Primary Health Care Centre. (All Care provided by Primary Health care obstetrician for low risk or specialist obstetrician for high risk referrals.)Covered with 10% co-takaful up to a maximum of 10 visits for low risk primiparas or 8 visits for multiparas

In-patient Maternity Services

10% co-payment payable by the insured.Maximum benefit AED 7,000 per normal delivery, AED 10,000 for medically necessary C-section, complications and for medically necessary termination (All limits include co-payment).

New Born Cover

Cover from 30 days from birth BCD, Hepatitis B and neo-natal screening test.

Waiting Period

Maternity

any pregnancy, which arises within forty calendar days from the date of policy issuance, shall not be covered under this policy under any condition No waiting period for maternity coverage upon payment of an additional premium, as per underwriting guidelines – coverage begins from Day 1.

Chronic Condition

Waiting period of 6 months

Pre-existing diseases (PED)

Covered only if declared on additional payment

Additional Information

No waiting period applies to the above cases upon payment of an additional premium, as per underwriting guidelines—coverage begins from Day 1. Also, for renewals, no waiting period is applicable.

Hospital Access

Referral procedure to be followed:- Customer has to visit GP, after GP refers then customer can visit the specialist in clinics.

Dental and Gum Treatment

Co-Payment

20% co-payment.

Covered

In case of emergency only.

Hearing and Vision Aids

Co-Payment

20% co-payment.

Covered

In case of emergency only.

Coverage Type

GP Clinic

Out-Patient Services

Co-Payment - This is what you'll pay your health provider when claiming with this policy

20% (Max AED 25). (Services are provided in authorized out-patient clinics of hospitals, clinics and health centers)

In-Patient Services

Co-Payment - This is what you'll pay your health provider when claiming with this policy for hospitalization

20% co-payment upto AED 500. Aggregate Co-payment upto AED 1000 (In-patient treatment at authorized hospitals)

Room Type

Semi-Private Room

Ambulance Service

Ground transportation services in the UAE provided by an authorized party for medical emergencies.

Companion Accomodation

Maximum AED 150 per night. (The cost of accomodating a person accompanying an insured child up to the age of 16 years.)Maximum AED 150 per night. (The cost of accommodation of a person accompanying an in-patient in the same room in case of medical necessity at the recommendation of the treating doctor and after the prior approval of the insurance company providing coverage.)

Territorial Scope Of Coverage

Coverage

UAE (except Abu Dhabi & AlAin) and extended to ISCInsurance Coverage is only for Dubai visa holders.

Pre-Existing and Chronic Conditions

Waiting Period

6 Months (Treatment for chronic and pre-existing conditions excluded for first 6 months of first scheme membership. After 6 months covered to the annual policy limit subject to declaration)

Network

AfiaaAfiaa

Other Services

Laboratory Tests

10% Copay

Radiology diagnostic

I10 % Co Pay in Case of non-medical emergiencies, the insurance company's prior approval is required for MRI, CT scans and endoscopies.

Physiotherapy Treatment

10% co-payment.Prior approval of the insurance company is required.Maximum 6 sessions per year.

Test, diagnosis, treatments related to surgeries in hospitals

Prior approval required from the insurance compay / TPA.

Emergency Treatment

Approval required from the insurance company within 24 hours of admission to the authorized hospital.

Healthcare services for emergency cases

Prior approval required from the insurance company (Prior approval required from the insurance company Where a pre-existing or chronic condition develops into an emergency within the 6-month exclusion preriod this must be covered up to the annual aggregate limit.)

Medication

Co-Payment

10% co-payment (co-payment by the insured in respect of each and every prescription.)

Limit

AED 1,500 Annually

Description

No cover for drugs and medicines in excess of the annual limit. Restricted to a list of formulary products where available at the physician and the pharmacist.