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Member Guide Basic (Abu Dhabi Plan) Member Guide Basic (Abu Dhabi Plan) 800 4 DAMAN (32626) | www.damanhealth.ae 1 Daman Headquarters Abu Dhabi Service Points Next to Centro Rotana Hotel and Aloft Hotel Infinity Services – Moroor Street ADNEC Area, Abu Dhabi Zones Corp. Mussafah Telephone: 02 614 9555 Abu Dhabi Immigration Fax: 02 614 9775 Dept. of Economic Development P.O. Box 128888 Abu Dhabi Chamber of Commerce Central Branch Marina Mall Airport Road, Abu Dhabi Masdar City Telephone: 02 417 3609 Al Shahama Municipality P.O. Box 128888 Mussafah Branch Al Ain Service Points Global Ascent Business Center Infinity Services Al Musaffah 4, Abu Dhabi Al Wagan Municipality Behind Mercedes-Benz Mazyad Municipality Plot No. 12 behind SEHA Al Hayer Municipality Telephone: 02 815 0209 Sweihan Municipality P.O. Box 128888 Al Qoaa Municipality Al Ain Immigration (Visit Visa Only) Al Ain Branch Al Khaznah Municipality G01-G02, Ground Flr, Al Wadi Trading Al Maqam Municipality Centre, Khalifa Bin Zayed Al Awwat St. Al Ain P.O Box 69988 Western Region Service Points Tel: 03-7011001/7011002/7011003 Madinat Zayed, Tamm Center Ghayathi, Tamm Center Western Region Branch Silaa, Tamm Center Saeed Bin Humaid Complex - Block A – Delma, Tamm Center Al Marfa’a, Tamm Center 1st Floor Liwa, Tamm Center Western Region, Abu Dhabi Telephone: 02 894 4303 Sharjah Service Point Sharjah Branch Sharjah Immigration Ground Level, Crystal Plaza, Corniche Road Sharjah Telephone: 06 517 15 55 Ras Al Khaima Service Points Ras Al Khaimah Immigration Dubai Office Al Barsha 1, Next to Sharaf DG Metro Station Hassanicor bldg. (Roche Bobois Furniture Shop), 5th Floor Room 501 Telephone: 04 436 0222 Dubai Direct Sales Office Office#601 Capricorn Bldg, Sheikh Zayed Road, Dubai Telephone: 04 311 7911 800 4 DAMAN (32626) | www.damanhealth.ae 2 Table of Contents Daman: Your Health Insurance Specialist ........................................................................4 Our Specialized Services ..............................................................................................5 What Is Covered? ........................................................................................................6 How To Obtain Your Plan Benefits? ................................................................................7 What Is Not Covered? ............................................................................................8 Important To Know .....................................................................................10 Your Rights and Responsibilities ..........................................................................12 Definitions ..................................................................................................13 Contact Us ...............................................................................................15 800 4 DAMAN (32626) | www.damanhealth.ae 3 Daman: Your Health Insurance Specialists Daman is the first specialized health insurer in the United Arab Emirates. Our strategic partnership with Munich Re, one of the largest and most reputable reinsurer in the world, has helped us develop a renowned stretch of competencies in the region, backed by the strong and reliable support of Abu Dhabi Government. Our products are a result of industry knowledge, market research, and a deep understanding of our customer’s health insurance needs. Basic Plan is an optimal health insurance plan, covering benefits like hospital stays, treatments, and medicines within the Emirate of Abu Dhabi; as well as coverage for emergency services in UAE. This plan offers you health insurance cover of AED 250,000 per person annually. You can use your health insurance card (Emirates ID , digital insurance card or Daman card) to get direct billing facility at health service providers across our plan’s Network which includes hospitals, clinics, pharmacies and diagnostic centres. 800 4 DAMAN (32626) | www.damanhealth.ae 4 Our Specialized Services We offer you a distinctive set of world class services as listed below: . Network of more than 600 health service providers in the Emirate of Abu Dhabi . 24/7 in-house Customer Service Centre staffed with bilingual representatives . 24/7 access to medical authorizations (pre-approvals required to receive specific medical treatments) . Automated systems for effective management of your pharmacy benefits . Efficient claims processing . Easy access to information on your network directory (including hospitals, pharmacies, clinics, doctors etc.) through our online portal www.damanhealth.ae . Wide geographical representation of branches and service points across the United Arab Emirates offering you convenience and choice . Easy and safe access to our online portal to submit and track your claims, search for health services providers, and ask questions through your “My Daman” account . Access to ActiveLife Program, a community engagement platform designed to give our members and the community at large a platform to support them in leading a healthier, more active life. 800 4 DAMAN (32626) | www.damanhealth.ae 5 What is covered? Main Cover-Your Benefit Summary Covered at Network Notes Providers Inpatient benefits Including room, meals, nursing, drugs and Hospital Charges dressings. Surgeries, day procedures, radiotherapy, Inpatient Treatments chemotherapy, etc. Medical appliances, Used as part of inpatient procedures. diagnostic tests Specialist’s or Consultant’s Fee Outpatient Benefits Including General Physician consultation and Doctor’s consultation Specialist consultation on referral basis. Prescribed medicines Covered as per your Drug Formulary. Including X-rays, blood tests, ultrasounds, CT Diagnostic tests Scans and MRI. Physiotherapy sessions Maternity Benefits Including childbirth, complications of pregnancy Inpatient Maternity or delivery, newborn accommodation and care. Doctor’s Consultation, Prescribed medicines Additional Benefits Including Ambulance Services, Dental or Vision Correction treatments in case of medical Any emergency treatments emergency. Emergency treatments or services or services within UAE will also be covered outside Daman’s Network within UAE. 800 4 DAMAN (32626) | www.damanhealth.ae 6 How to obtain your plan benefits? Within Daman’s Network: Use your health insurance card You will have direct billing access at our Network Providers for health services covered under your policy. Just remember to carry your health insurance card (Emirates ID , digital insurance card or Daman card) when going to the network provider and comply with the administrative procedures there. Some health services may have deductibles or co-insurance charges that you will have to pay for. Such charges will be clearly mentioned on your Schedule of Benefits and will be due and payable to the provider on the date that the service is provided. Outside Daman’s Network: Get your bills reimbursed (incase of Emergency only) If you go to a Health Services provider that is not part of Daman’s Provider Network, you will have to pay directly for the services provided. Only in case it is a medical emergency, and if such services are covered in your plan, you will be eligible to reimburse the cost of the health service from Daman. For reimbursement, you have to submit a claim form, along with the documents like original itemized bills, medical or investigational reports, etc. The claim form and details of our reimbursement requirements are available on our website. These documents must be submitted to Daman within 180 days from the date of service received. You can apply for reimbursement through our website or by visiting any of our branches or service points. Coverage for Emergencies We are committed to provide you the best coverage for health care services, especially when it matters the most. In case of a medical emergency within the United Arab emirates, you will be eligible to get coverage for your medical bills, whether you were treated at a Network or Non-network Provider. Prior approval is not required in case of emergency or services. However, you must notify us within 24 hours of the services received so that we can help you with the claims process. You can reach us on the Customer Service toll free number mentioned on Daman website, digital app or Daman card in case you need further information. 800 4 DAMAN (32626) | www.damanhealth.ae 7 What is not covered? Your policy does not cover you for: . Health Services, including treatments and supplies, not medically necessary . Health Services including pharmaceuticals not prescribed by a physician . Health Services received outside the plan Network, except in case of an Emergency . Dental and gum treatment, Vision and Hearing Correction treatments and Aids, except in case of medical emergency . Assistance in activities of daily living which do not change the medical condition of the member (for example-custodial care, private duty nursing, etc.) . Vitamins . Personal comfort and convenience items or service (fro example-beauty services) . Cosmetic procedures, surgeries which are not incidental to any injury, sickness or congenital deformities . Treatment or obesity and weight management programs . Experimental, investigational or Unproven services, treatments, drug and supplies or devices . Outpatient medical supplies including prosthetic devices and durable medical equipment (for example- bandages, syringes , wheel chair) . Any services for hair fall (for example- alopecia) . All cases resulting from alcoholism , use of drugs and hallucinatory substances . Smoking cessation programs
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