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.