Health Insurance
Overview
Dhofar Insurance Company has state of the art arrangement for providing medical insurance. We have partnered with one of the industry’s leading Third Party Administrator of managed care services in the United Arab Emirates and neighboring countries and together we are able to offer quality solutions that meet long-term healthcare needs.
Due to our special arrangements we are able to adopt a unique full-service approach to our corporate customers and provide high quality services, know-how and an international resource pool of the well recognized specialist in the field of medical insurance.
Product Name
We have three tier products covering a wide range of benefits with option to select different sums insured:
- Dahab
- Dana
- Almas
Note: These products are currently available to only corporate clients.
Additional Benefits (Optional)
The following additional benefits (which are optional) are also being offered to all clients
by charging extra premium.
| BENEFITS | LIMITS AVAILABLE | REMARKS |
| Dental | As per client’s need | On Reimbursement basis |
| Optical | As per client’s need | On Reimbursement basis (20% access applicable) |
| Maternity | As available in the market | Subject to 280 days waiting period |
PRODUCT COVERAGE
| PLAN NAME | DAHAB |
| Territorial Limit | Oman SEA Travel WW |
| Network | Option 1: Premium Option 2: Premium Plus |
| Pre-existing / Chronic Conditions | Covered |
| Inpatient & Daycare (up to the relevant Annual Benefit Limit per person per policy year) |
|
| Annual Benefit Limit per person | Option 1: RO 5,000 Option 2: RO 10,000 |
| Accommodation Type | Private Room |
| Hospital Accommodation & Services: - at Designated/Network Provider |
100% |
| - at Non-Designated/Non-network Provider up to a max. of |
RO 60 |
| Consultant’s, Surgeon’s & Anesthetist’s Fees, etc - at Designated/Network Provider |
100% |
| - at Non-Designated/Non-network Provider in Oman | 80% |
| - at Non-Designated/Non-network Provider in SEA | 100% up to a max of 80% of cost incurred in Oman |
| Ambulance (followed by Hospital Admission) up to a max of | RO 50 |
| Parent Accommodation for accompanying an Insured Child under 10 years of age (up to a max per day) | RO 10 |
| Hospital Cash Benefit if Inpatient Treatment is received free of charge in a Government Hospital | RO 10 (up to a max. RO 100) |
| Outpatient | |
| Deductible Option | Option1: RO 1
Option 2: RO 2 |
| Consultations: - at Designated/Network Provider |
100% |
| - at Non-Designated/Non-network Provider up to a maximum of |
RO 10 |
| Diagnostics (x-ray, MRI, CT-scan, ultra sound, etc.), Laboratory, Pharmaceuticals - at Designated/Network Provider |
100% |
| - at Non-Designated/Non-network Provider | 80% |
| Physiotherapy (up to a max. of 12 sessions per person per policy year): |
|
| - at Designated/Network Provider | 100% |
| - at Non-Designated/Non-network Provider per session up to a max. of |
RO 8 |
| Inpatient Emergency Treatment Abroad During Business Trips and Holidays (subject to a maximum of 45 consecutive days per trip) |
100% within territory of coverage |
| Any Treatment Outside Territory of Coverage other than Emergency | Not covered |
| Repatriation of Mortal Remains to the Country of Domicile up to max. | RO 750 |
| Maternity (280 days waiting period) | |
| Inpatient | Normal Delivery/Complications RO 400
Cesarean: RO 1,000 Abortion/Miscarriage: RO 300 |
| Outpatient (ante-/postnatal - outpatient deductible option applies) | RO 150 |
| Deductible as per chosen outpatient plan option applicable for maternity outpatient service | |
| All Maternity Treatment (in- as well as outpatient) is subject to Pre-approval | |
| Dental | |
| Consultations, Extractions, X-Ray, Composite Fillings, Root Canal Treatment and Medication (Painkiller, Antibiotics) per policy year up to a max of |
Option 1: RO 200
Option 2: RO 250 Option 3: RO 300 |
| Coinsurance for all Dental Treatment | 20% |
| All Dental Treatment is subject to Pre-approval | |
| Optical | |
| Vision tests for errors of refraction & One Pair of Lenses for Spectacles | RO 75 |
| Coinsurance for all Optical Treatment | 20% |
| All Optical Treatment is subject to Pre-approval | |
Covered Territories:
| Territory / Country | Coverage at designated / network provider | Coverage at non-designated / non-network provider |
| Oman | 100% | 80% |
| SEA (South East Asia) | 100% | 100% |
Territory Definition (other than Oman)
| Territory | Country |
| SEA (South East Asia) | Bangladesh, Bhutan, Burma India, Indonesia, Malaysia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, Vietnam |
| PLAN NAME | DANA |
| Territorial Limit | Oman, SEA, AC Travel WW |
| Network | Premium Plus |
| Pre-existing / Chronic Conditions | Covered |
| Inpatient & Daycare (up to the relevant Annual Benefit Limit per person per policy year) |
|
| Annual Benefit Limit per person | Option 1: RO 10,000 Option 2: RO 25,000 |
| Accommodation Type | Private Room |
| Hospital Accommodation & Services: - at Designated/Network Provider |
100% |
| - at Non-Designated/Non-network Provider up to a max. of |
RO 100 |
| Consultant’s, Surgeon’s & Anesthetist’s Fees, etc - at Designated/Network Provider |
100% |
| - at Non-Designated/Non-network Provider in Oman | 80% |
| - at Non-Designated/Non-network Provider in SEA | 100% up to a max of 80% of cost incurred in Oman |
| - at Non-Designated/Non-network Provider in AC | 80% |
| Ambulance (followed by Hospital Admission) up to a max of | RO 50 |
| Parent Accommodation for accompanying an Insured Child under 10 years of age (up to a max per day) | RO 10 |
| Hospital Cash Benefit if Inpatient Treatment is received free of charge in a Government Hospital | RO 15 (up to a max. RO 150) |
| Outpatient | |
| Deductible Option | Option 1:RO 1
Option 2: RO 2 |
| Consultations: - at Designated/Network Provider |
100% |
| - at Non-Designated/Non-network Provider up to a maximum of |
RO 12 |
| Diagnostics (x-ray, MRI, CT-scan, ultra sound, etc.), Laboratory, Pharmaceuticals - at Designated/Network Provider |
100% |
| - at Non-Designated/Non-network Provider | 80% |
| Physiotherapy (up to a max. of 12 sessions per person per policy year): |
|
| - at Designated/Network Provider | 100% |
| - at Non-Designated/Non-network Provider per session up to a max. of |
RO 8 |
| Inpatient Emergency Treatment Abroad During Business Trips and Holidays (subject to a maximum of 45 consecutive days per trip) |
100% |
| Any Treatment Outside Territory of Coverage other than Emergency | Not covered |
| Repatriation of Mortal Remains to the Country of Domicile up to max. | RO 750 |
| Maternity (280 days waiting period) | |
| Inpatient | Normal Delivery/Complications RO 400
Cesarean: RO 1,000 Abortion/Miscarriage: RO 400 |
| Outpatient (ante-/postnatal - outpatient deductible option applies) | RO 150 |
| Deductible as per chosen outpatient plan option applicable for maternity outpatient service | |
| All Maternity Treatment (in- as well as outpatient) is subject to Pre-approval | |
| Dental | |
| Consultations, Extractions, X-Ray, Composite Fillings, Root Canal Treatment and Medication (Painkiller, Antibiotics) per policy year up to a max of |
Option 1: RO 200
Option 2: RO 250 Option 3: RO 300 |
| Coinsurance for all Dental Treatment | 20% |
| All Dental Treatment is subject to Pre-approval | |
| Optical | |
| Vision tests for errors of refraction & One Pair of Lenses for Spectacles | RO 75 |
| Coinsurance for all Optical Treatment | 20% |
| All Optical Treatment is subject to Pre-approval | |
Covered Territories:
| Territory / Country | Coverage at designated / network provider | Coverage at non-designated / non-network provider |
| Oman | 100% | 80% |
| SEA (South East Asia) | 100% | 100% |
| AC (Arab Countries) | 100% | 80% |
Territory Definition (other than Oman)
| Territory | Country |
| SEA (South East Asia) | Bangladesh, Bhutan, Burma India, Indonesia, Malaysia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, Vietnam |
| AC (Arab Countries) | Afghanistan, Algeria, Djibouti, Egypt, Iran, Iraq, Jordan, KSA, Kuwait, Lebanon, Libya, Mauritania, Morocco, Oman, Palestine, Qatar, Somalia, Sudan, Syria, Tunisia, UAE, Yemen |
| PLAN NAME | ALMAS |
| Territorial Limit | Worldwide excl. USA & Canada Travel WW |
| Network | Premium Plus |
| Pre-existing / Chronic Conditions | Covered |
| Inpatient & Daycare (up to the relevant Annual Benefit Limit per person per policy year) |
|
| Annual Benefit Limit per person | Option 1: RO 35,000
Option 2: RO 50,000 |
| Accommodation Type | Standard Suite |
| Hospital Accommodation & Services: - at Designated/Network Provider |
100% |
| - at Non-Designated/Non-network Provider up to a max. of |
RO 150 |
| Consultant’s, Surgeon’s & Anesthetist’s Fees, etc - at Designated/Network Provider |
100% |
| - at Non-Designated/Non-network Provider in Oman | 80% |
| - at Non-Designated/Non-network Provider in SEA | 100% up to a max of 80% of cost incurred in Oman |
| - at Non-Designated/Non-network Provider in all other territories | 80% |
| Ambulance (followed by Hospital Admission) up to a max of | RO 50 |
| Parent Accommodation for accompanying an Insured Child under 10 years of age (up to a max per day) | RO 20 |
| Hospital Cash Benefit if Inpatient Treatment is received free of charge in a Government Hospital | RO 20 (up to a max. RO 200) |
| Outpatient | |
| Deductible Option | Option 1: RO 1
Option 2: RO 2 |
| Consultations: - at Designated/Network Provider |
100% |
| - at Non-Designated/Non-network Provider up to a maximum of |
RO 15 |
| Diagnostics (x-ray, MRI, CT-scan, ultra sound, etc.), Laboratory, Pharmaceuticals - at Designated/Network Provider |
100% |
| - at Non-Designated/Non-network Provider | 80% |
| Physiotherapy (up to a max. of 12 sessions per person per policy year): |
|
| - at Designated/Network Provider | 100% |
| - at Non-Designated/Non-network Provider per session up to a max. of |
RO 12 |
| Inpatient Emergency Treatment Abroad During Business Trips and Holidays (subject to a maximum of 45 consecutive days per trip) |
100% |
| Any Treatment Outside Territory of Coverage other than Emergency | Not covered |
| Repatriation of Mortal Remains to the Country of Domicile up to max. | RO 750 |
| Maternity (280 days waiting period) | |
| Inpatient | Normal Delivery/Complications RO 400
Cesarean: RO 1,000 Abortion/Miscarriage: RO 400 |
| Outpatient (ante-/postnatal - outpatient deductible option applies) | RO 150 |
| Deductible as per chosen outpatient plan option applicable for maternity outpatient service | |
| All Maternity Treatment (in- as well as outpatient) is subject to Pre-approval | |
| Dental | |
| Consultations, Extractions, X-Ray, Composite Fillings, Root Canal Treatment and Medication (Painkiller, Antibiotics) per policy year up to a max of |
Option 1: RO 200
Option 2: RO 250 Option 3: RO 300 |
| Coinsurance for all Dental Treatment | 20% |
| All Dental Treatment is subject to Pre-approval | |
| Optical | |
| Vision tests for errors of refraction & One Pair of Lenses for Spectacles | RO 75 |
| Coinsurance for all Optical Treatment | 20% |
| All Optical Treatment is subject to Pre-approval | |
Covered Territories:
| Territory / Country | Coverage at designated / network provider | Coverage at non-designated / non-network provider |
| Oman | 100% | 80% |
| SEA (South East Asia) | 100% | 100% |
| AC (Arab Countries) | 100% | 80% |
| Worldwide excl. USA & Canada | 100% | 80% |
Territory Definition (other than Oman)
| Territory | Country |
| SEA (South East Asia) | Bangladesh, Bhutan, Burma India, Indonesia, Malaysia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, Vietnam |
| AC (Arab Countries) | Afghanistan, Algeria, Djibouti, Egypt, Iran, Iraq, Jordan, KSA, Kuwait, Lebanon, Libya, Mauritania, Morocco, Oman, Palestine, Qatar, Somalia, Sudan, Syria, Tunisia, UAE, Yemen |
Policy Conditions and Exclusions:
It is pre requisite that the proposed group has at least 11 employees to included in a scheme. Each group is individually rated on the basis of required underwriting information.
The coverage provided is subject to our policy conditions and exclusions.
Required Information:
Generally we require complete list showing names, gender (male/female)nationality,dates of birth, occupation and health declaration forms of all employees. Additional information may be requested on case to case basis.