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Adamjee Insurance is one of the largest health insurance providers catering to the health and medical needs of the Corporate and SME sectors for their employees with customized benefits structure and value added services.

Coverage
The benefits covered under our Health care insurance are briefed as follows:

Hospitalization Benefit
This benefit covers hospital stay expense payment up to the “Per Annum Limit” in case of different diseases and prolonged illnesses.

Major Medical Care Benefit
Enhancement in the annual limit of in-patient expenses (except maternity related expense) for each insured person for all eligible hospitalization expenses covered under specified benefits structure.

Maternity Benefit
Maternity Care (MC) benefit pays for medical expenses related to pregnancy and child birth. All expenses directly related to pregnancy are paid within this annual limit and is separate from hospitalization.

Out Patient Cover
Adamjee also provides out-patient benefits to its clients who can be reimbursed upon presentment of original prescriptions and bills.

Additional Benefits
Terrorist cover The policy also covers hospitalization and surgical expenses of any innocent insured person (not taking part in terrorist activities) who is injured due to an act of terrorism.

International cover The policy covers emergency hospitalization during overseas travel of insured persons. However, the hospitalization expenses will be reimbursed in UAE in UAE-Dirhams on the basis of what it will cost for a similar procedure to be carried out in UAE.

Complimentary cover for accidental injury The per annual available limit for each category is automatically increased by 50 per cent in case of hospitalization due to an accidental injury.

Exclusions
  • Cosmetic treatment or plastic surgery
  • Treatment of infertility / sterilization and contraception
  • Psychiatric treatment
  • Personal expenses like, telephone, guest meals & non medical items
  • Self inflicted injury
  • Eye glasses, contact lenses, hearing aids, artificial limbs etc
  • Dental treatments
  • Epidural Anesthesia (for painless delivery)
  • Charges for visiting consultant
Premium Payment Procedure
Premium payment can be made through cash, cheque, pay order, demand draft, telex transfer to the Adamjee Insurance office.

    a. After the acceptance of proposal by client, the updated details of employees are
        required to be sent to Health Department in prescribed format.
    b. The processing of information is carried out and policy is drafted along with premium bill
        and credit letters.
    c. The client is required to make the payment within 15 days of receiving the bill.
    d. The premium cheque shall be made in favor of ‘Adamjee Insurance Company Limited’
        with mentioning the name and policy number at the back of the cheque.
Claim Process

Hospitalization & Maternity claim (Network hospitals)
The frequency of Health Insurance claims is very high as compared with other insurance classes. Our dedicated doctors/case managers are available to facilitate the emergency queries of insured. All insured will have to show their authority letter / card and their admission is authorized without any waiting in an emergency or normal hospitalization.
 
 
 
  
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