HEALTHCARE INSURANCE

TABLE OF BENEFITS

Plan code: SME-SKN-DXB-P11

The Table of benefits is to be read along with the list of exclusions applicable and Sukoon Insurance
PJSC Glossary.
All amounts are in AED
General Cover
Indemnity Limit 3,000,000
Basic Territory for Elective & Emergency treatment Worldwide excluding USA and Canada
Emergency extension cover in USA and Canada
is limited to 90 days per year and only applies in
Extended Territory for Emergency treatment only case of accident / emergency during business
trips or holidays abroad (Elective treatment is not
covered)
Pre-existing conditions (Subject to Exclusions List) Covered up to 150,000 per person per year
Non Pre-existing Chronic Conditions (Subject to
Covered up to Indemnity Limit
Exclusions List)

Elective Treatment
Inside UAE / Inside Network – (Direct Billing) Covered
Inside UAE / Outside Network – (Reimbursement) Covered
Outside UAE / Inside Network – (Direct Billing) Covered
Outside UAE / Outside Network – (Reimbursement) Covered

Emergency Treatment
Inside UAE / Inside Network – (Direct Billing) Covered
Inside UAE / Outside Network – (Reimbursement) Covered
Outside UAE / Inside Network – (Direct Billing) Covered
Outside UAE / Outside Network – (Reimbursement) Covered

Medical Providers Network

Subject to ongoing changes. Available online at
www.sukoon.com
Premium Network
MSH Network: mena.msh-intl.com

Inpatient Benefits – with PAR

Room Accommodation Suite
Diagnostic Investigations (Lab, Scan and X-ray) and other
prescribed medically necessary diagnostic procedures e.g. Covered
endoscopy & histopathology.
Accommodation Costs for one parent staying with a child up
500 Per day
to the age of 18 years.
Accommodation Costs for one accompanying family
member in case of critical medical conditions.*1 500 Per day
Subject to treating doctor recommendation
Daycare treatment including out-patient minor surgeries > 6
Covered
hours stay.
Internal Prosthetic devices implanted during covered
1 Covered
surgeries.*

SUKOON.COM | +971 4 233 7777 | P.O. Box 5209 | Dubai, United Arab Emirates
١٠٠٢٥٨٥٩٤٩٠٠٠٠٣ ‫ ﺭﻗﻢ ﺍﻟﺘﺴﺠﻴﻞ ﺍﻟﻀﺮﻳﺒﻲ‬،24\12\1984 ‫ ﺑﺘﺎﺭﻳﺦ‬9 ‫ ُﻣﺭﺧّﺻﺔ ﻣﻦ ﻗﺒﻞ ﺍﻟﻤﺼﺮﻑ ﺍﻟﻤﺮﻛﺰﻱ ﻟﺪﻭﻟﺔ ﺍﻹﻣﺎﺭﺍﺕ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﻤﺘﺤﺪﺓ ﺑﻤﻮﺟﺐ ﺭﻗﻢ ﻗﻴﺪ‬,٢٠٣٩٧٠ ‫ﺕ‬.‫ﺭ‬. ‫ ﺭﻗﻢ‬،‫ ﺩﺭﻫﻢ ﺇﻣﺎﺭﺍﺗﻲ‬٤٦١٫٨٧٢٫١٢٥ ‫ ﺭﺃﺱ ﺍﻟﻤﺎﻝ ﺍﻟﻤﺪﻓﻮﻉ‬،‫ﺳﻜﻮﻥ ﻟﻠﺘﺄﻣﻴﻦ ﺵ ﻡ ﻉ‬
Sukoon Insurance PJSC, Paid up Capital AED 461,872,125, C.L. No. 203970, Regulated by the Central Bank of the UAE No. 9 dated 24/12/1984, TRN 100258594900003

Classification: Sukoon-Business
 Outpatient Benefits
Consultation
(Follow up on same medical condition and at the same provider is free within 7 days from first consultation date)
General Practitioner – GP Covered
Specialist or Consultant – SP Covered
Virtual Consultation Covered
Pharmacy
Prescribed Pharmaceuticals (Pre-approval is required for
Covered
long term medication above 30 days)
ONLY Formulary products (Generic Medication) No
Vitamins prescribed as replacement therapy for known
vitamin deficiency conditions up to prescribed Covered
pharmaceutical limit only.
Diagnostic Investigations & Procedures (Lab, Scan, X-ray,
Covered
endoscopy, etc.)
Outpatient procedures Covered
1
Physiotherapy * prescribed by respective specialist doctor Covered
and administered by a qualified physiotherapist.

Other Benefits
Covered. Transportation expenses for non-
Local Emergency Transportation by Road Ambulance emergency and for excluded medical conditions
shall not be covered.
1
Birth Defects, Genetic Disorders & Congenital Conditions* Not Covered
1
DHA minimum preventive services*
Diabetes screening Covered
(a) Every 3 years from age 30
b) High risk individuals annually from age 18)
Hepatitis C virus screening and treatment Covered
To be followed as per the guidelines laid out in the
Hepatitis C support program)
Basmah Initiative Covered
(To be followed as per the guidelines laid out under
Basmah program)
Adult Pneumococcal Conjugate Vaccine (As per DHA Covered
Adult Pneumococcal Vaccination guidelines)
Hepatitis B Virus Screening and treatment (To be Covered
followed as per the guidelines laid out in the Hepatitis
B program)
Influenza Vaccine (Covered once a Year) Covered
Herpes Zoster Vaccine (Shingrix) (For Non-LSB Dubai Covered for people above the age of 50 and
visa and family book holders only) on reimbursement immunocompromised patients above the age of
18. Covered dose: 2 doses, 2 to 6 months apart
basis. once per lifetime.
Basic Vaccination: Vaccines for Children (Age 0-6) as per
1 Covered
MOH mandatory schedule*
Essential vaccinations and inoculations for children(Age 7-
18) and adults as stipulated in the DHA’s policies and its Covered up to limit of AED 100
1
updates (currently the same as Federal MOH) *
Medical Expenses related to Work Related Accidents,
1 Covered up to 5,000 per person per year
Injuries and Illness*
1
Injuries related to Road Traffic Accidents* Not Covered
Immunotherapy & Immunomodulators Covered if medically necessary
Hepatitis A Covered
Hormone replacement therapy. (Excluding growth hormone
Covered
and excluded medical conditions)

SUKOON.COM | +971 4 233 7777 | P.O. Box 5209 | Dubai, United Arab Emirates
١٠٠٢٥٨٥٩٤٩٠٠٠٠٣ ‫ ﺭﻗﻢ ﺍﻟﺘﺴﺠﻴﻞ ﺍﻟﻀﺮﻳﺒﻲ‬،24\12\1984 ‫ ﺑﺘﺎﺭﻳﺦ‬9 ‫ ُﻣﺭﺧّﺻﺔ ﻣﻦ ﻗﺒﻞ ﺍﻟﻤﺼﺮﻑ ﺍﻟﻤﺮﻛﺰﻱ ﻟﺪﻭﻟﺔ ﺍﻹﻣﺎﺭﺍﺕ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﻤﺘﺤﺪﺓ ﺑﻤﻮﺟﺐ ﺭﻗﻢ ﻗﻴﺪ‬,٢٠٣٩٧٠ ‫ﺕ‬.‫ﺭ‬. ‫ ﺭﻗﻢ‬،‫ ﺩﺭﻫﻢ ﺇﻣﺎﺭﺍﺗﻲ‬٤٦١٫٨٧٢٫١٢٥ ‫ ﺭﺃﺱ ﺍﻟﻤﺎﻝ ﺍﻟﻤﺪﻓﻮﻉ‬،‫ﺳﻜﻮﻥ ﻟﻠﺘﺄﻣﻴﻦ ﺵ ﻡ ﻉ‬
Sukoon Insurance PJSC, Paid up Capital AED 461,872,125, C.L. No. 203970, Regulated by the Central Bank of the UAE No. 9 dated 24/12/1984, TRN 100258594900003

Classification: Sukoon-Business
 Ophthalmology: Medical conditions related to it
(Illness/Injury) of the eye excluding vision, sight test & Covered
refraction error.
Recreational non-hazardous sports activities (professional
and hazardous sports activities even if recreational are not Covered
covered)
In emergency cases:
i. Diagnostic and treatment services for dental
and gum treatments.
ii. Hearing and vision aids, and vision correction Covered
by surgeries and laser.
Circumcision for new Muslims subject to the following:
i. The member is insured with Sukoon
ii. The member declared Islam in the Emirate of Abu Not Covered
Dhabi in line with all the legal formalities in this
aspect along with a letter from Judicial Department
in the Emirate.
Air fare for outside UAE treatment (Limited to Geographical
Covered
area specified) (On Reimbursement)

Maternity (Limits & Coverage)

Inside UAE – Inside Network Covered
Ante/Post-Natal Consultation Covered
Ante/Post-Natal Investigations Covered
Maternity complications
(Life threatening maternity complications are covered up to Covered up to the Indemnity Limit
indemnity limit)
Normal Delivery*1 Covered
Medically necessary C-Section*1 Covered
Legal Abortion/Miscarriage*1 Covered
Inside UAE – Outside Network & Abroad. Limit specified is an
30,000
aggregate for all services (Subject to policy deductibles)

Newborn Cover (Covered services are as per MOHAP guidelines and protocols)
A New born delivered in UAE is covered up to 30 days as part of
the mother’s insurance and shall share the same indemnity limit.
Continuity of cover is subject to scheme opted for allows Covered
dependents, addition notification within 30 days and the newborn
added to the policy.
If the scheme allows dependents addition, then
i. DOH: A New born will be enrolled to the scheme from
date of birth subject to the notification within 30 days
from that date.
ii. DHA: A New born will be enrolled to the scheme from
date of birth subject to the notification within 7 days Covered
from that date.
iii. When a baby is born outside UAE, he/she will be
enrolled to the scheme only following their entry to the
UAE, with a valid entry permit and entry stamp.

Co-Insurance/Deductible
Inside UAE – Inside Network*2
Inpatient Services & Daycare cases/surgeries
Coinsurance NIL
Maximum copay amount per encounter Not Applicable
Annual aggregate maximum copay amount Not Applicable
Outpatient
Consultation Deductible/Coinsurance Nil
Physiotherapy Nil
SUKOON.COM | +971 4 233 7777 | P.O. Box 5209 | Dubai, United Arab Emirates
١٠٠٢٥٨٥٩٤٩٠٠٠٠٣ ‫ ﺭﻗﻢ ﺍﻟﺘﺴﺠﻴﻞ ﺍﻟﻀﺮﻳﺒﻲ‬،24\12\1984 ‫ ﺑﺘﺎﺭﻳﺦ‬9 ‫ ُﻣﺭﺧّﺻﺔ ﻣﻦ ﻗﺒﻞ ﺍﻟﻤﺼﺮﻑ ﺍﻟﻤﺮﻛﺰﻱ ﻟﺪﻭﻟﺔ ﺍﻹﻣﺎﺭﺍﺕ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﻤﺘﺤﺪﺓ ﺑﻤﻮﺟﺐ ﺭﻗﻢ ﻗﻴﺪ‬,٢٠٣٩٧٠ ‫ﺕ‬.‫ﺭ‬. ‫ ﺭﻗﻢ‬،‫ ﺩﺭﻫﻢ ﺇﻣﺎﺭﺍﺗﻲ‬٤٦١٫٨٧٢٫١٢٥ ‫ ﺭﺃﺱ ﺍﻟﻤﺎﻝ ﺍﻟﻤﺪﻓﻮﻉ‬،‫ﺳﻜﻮﻥ ﻟﻠﺘﺄﻣﻴﻦ ﺵ ﻡ ﻉ‬
Sukoon Insurance PJSC, Paid up Capital AED 461,872,125, C.L. No. 203970, Regulated by the Central Bank of the UAE No. 9 dated 24/12/1984, TRN 100258594900003

Classification: Sukoon-Business
 Diagnostic Services
i. Laboratory Nil
ii. Radiology Nil
Prescribed Pharmaceuticals
i. Co-Insurance Nil
ii. Maximum out of pocket limit Not Applicable
Maternity
Delivery Maternity 10%
Outpatient Ante Natal Consultation Deductible/Coinsurance Nil
Outpatient Ante Natal Investigations Coinsurance 10%
Outpatient Ante/Post-Natal Prescribed Pharmaceuticals (including Ante-Natal Vitamins)
i. Co-Insurance 10%
ii. Maximum out of pocket limit Not Applicable
Additional Benefits (If opted)
Dental Co-Insurance 20%
Optical Co-Insurance 20%
Alternative Medicine Co-Insurance Nil

Co-Insurance/Deductible
Inside UAE – Outside Network (Co-Insurance applies over and above Network Deductions)
Emergency in UAE. (In Emergency cases as defined by PD 02-2017, healthcare services outside the scope of
health insurance must be covered until stabilization at minimum)
Coinsurance (with or without PAR) 0%
Basis of Claims Settlement Reimbursed at Actual value
Elective in UAE. If treatment / service is not available within the network then cover is 100% at actual subject to
PAR*1
Coinsurance (with or without PAR) 20%
Basis of Claims Settlement Reimbursed at Actual value

Abroad (within agreed territory) (Co-Insurance applies over and above Network
Deductions)
Emergency Abroad
Coinsurance 20%
Basis of Claims Settlement Reimbursed at Actual value
Elective Abroad
Coinsurance 20%
Basis of Claims Settlement Reimbursed at Actual value

Basmah Initiative – The Patient Support Program (PSP)

The Dubai Health Authority (DHA) announced the launch of Basmah initiative for Dubai Residents only,
making Dubai the first government entity in the world to provide a complete spectrum of care from screening to
treatment for three types of cancer under the enhanced as well as the basic mandatory benefit plans in Dubai.

The 3 inlcuded cancer types are Breast, Colorectal and Cervical cancer. Screening is strictly as per MOHAP
guidelines and protocols.

Prior to this scheme, cancer coverage was limited to the annual limit or the pre-exisitng limits defined in the
policies. Now, that is no longer the case. Patients detected with breast, colorectal or cervical cancer will have
the choice to be part of the PSP program, where they will receive coverage from screening until treatment
in Dubai’s centers of excellence (COE) without a limit.

SUKOON.COM | +971 4 233 7777 | P.O. Box 5209 | Dubai, United Arab Emirates
١٠٠٢٥٨٥٩٤٩٠٠٠٠٣ ‫ ﺭﻗﻢ ﺍﻟﺘﺴﺠﻴﻞ ﺍﻟﻀﺮﻳﺒﻲ‬،24\12\1984 ‫ ﺑﺘﺎﺭﻳﺦ‬9 ‫ ُﻣﺭﺧّﺻﺔ ﻣﻦ ﻗﺒﻞ ﺍﻟﻤﺼﺮﻑ ﺍﻟﻤﺮﻛﺰﻱ ﻟﺪﻭﻟﺔ ﺍﻹﻣﺎﺭﺍﺕ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﻤﺘﺤﺪﺓ ﺑﻤﻮﺟﺐ ﺭﻗﻢ ﻗﻴﺪ‬,٢٠٣٩٧٠ ‫ﺕ‬.‫ﺭ‬. ‫ ﺭﻗﻢ‬،‫ ﺩﺭﻫﻢ ﺇﻣﺎﺭﺍﺗﻲ‬٤٦١٫٨٧٢٫١٢٥ ‫ ﺭﺃﺱ ﺍﻟﻤﺎﻝ ﺍﻟﻤﺪﻓﻮﻉ‬،‫ﺳﻜﻮﻥ ﻟﻠﺘﺄﻣﻴﻦ ﺵ ﻡ ﻉ‬
Sukoon Insurance PJSC, Paid up Capital AED 461,872,125, C.L. No. 203970, Regulated by the Central Bank of the UAE No. 9 dated 24/12/1984, TRN 100258594900003

Classification: Sukoon-Business
 Optional Benefits
Patient treatment supplies (Reimbursement) Not Covered
Organ transplant (excluding donor’s expenses) (Limited to
Coverage up to limit of AED 100,000 subject to
Kidney, Liver, Lung, Pancreas, Heart and Small Bowel) -
1 20% co-payment on OP Services
Covered for Dubai visa and family book holders only *
Kidney Dialysis Treatment (Hemodialysis / Peritoneal Covered to a limit of AED 60,000 subject to
Dialysis)*1 20% co-payment on all OP Services
Hepatitis B and its complications*1 Refer to above DHA benefits
Home Nursing following inpatient treatment. Must be
Covered up to 15,000 per person per year,
registered / licensed nurse and with doctor’s
subject to 750 per day
recommendation (Reimbursement)
Enhanced Vaccination (All census) – MOH approved
vaccines. Benefit does not include vaccination against
100% Covered up to 2,000 per person per year
internationally or locally recognized epidemics.
(Reimbursement)
Psychiatric treatment other than mandated by DOH for Abu
25,000
Dhabi schemes (Reimbursement)
Allergy testing (Reimbursement) Not Covered
External Prosthetic devices and medical equipment
Not Covered
(Reimbursement)
Infertility treatment. (Reimbursement) Not Covered
Deviated Nasal Septum (if medically indicated)*1 Not Covered
Cash indemnity benefit (Reimbursement) Not Covered
Passive War Risk (Reimbursement) Covered
Trudoc Telehealth(Virtual Consultation)
- Free consultation
- No booking of appointments is required. Covered
If referred by TruDoc to consult Specialist, consultation co-
payment will be reimbursed by insurer.
Disease management Program Covered
Repatriation of mortal remains to the country of origin Covered up AED 5,000
Assist America Package. All services must be arranged and provided through Assist America. No claims for
reimbursement will be accepted.
Emergency Medical Evacuation Activated at 120 Kilometers
Medical Repatriation Activated at 120 Kilometers
Repatriation of Mortal Remains Activated at 0 Kilometers
Second Medical Opinion Covered
Wellness Benefit (Reimbursement at actual within specified limits and coinsurance)
Covered tests - Blood examination (CBC, Blood
Sugar, Lipid profile, HIV, Hepatitis B),
Electrocardiogram ECG, Fundoscopy, Chest X-
Basic Routine Health Check-Up
ray, Urine routine, Stool OP/OB Consultation
with General Practitioner/Internal Medicine
Specialist.
Alternative Medicine (Reimbursement at actual within specified limits)
Alternative Medicine – Services To be performed only by a
Covered up to 3,000 per person per year
licensed practitioner
Dental Benefit
Routine Dental cover*1 Covered up to 5,000 per person per year
including 20% Co insurance
Optical Benefit (Reimbursement at actual within specified limits and coinsurance)
Covered up to 1,500
Limit for Lenses and
*1 per person per year
Routine Optical cover Frames 500 per
including 20% Co
person per year
insurance
Life Insurance Cover – Death due to any cause 50,000
* 1 PAR = Prior Authorization request (please refer to claim administrative & prior approval procedures)
* 2 Treatment taken inside the network if submitted on reimbursement basis will be settled at the agreed
tariff of the medical provider and subject to policy deductibles/coinsurance. Policy must support
reimbursement for the claim to be considered.

SUKOON.COM | +971 4 233 7777 | P.O. Box 5209 | Dubai, United Arab Emirates
١٠٠٢٥٨٥٩٤٩٠٠٠٠٣ ‫ ﺭﻗﻢ ﺍﻟﺘﺴﺠﻴﻞ ﺍﻟﻀﺮﻳﺒﻲ‬،24\12\1984 ‫ ﺑﺘﺎﺭﻳﺦ‬9 ‫ ُﻣﺭﺧّﺻﺔ ﻣﻦ ﻗﺒﻞ ﺍﻟﻤﺼﺮﻑ ﺍﻟﻤﺮﻛﺰﻱ ﻟﺪﻭﻟﺔ ﺍﻹﻣﺎﺭﺍﺕ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﻤﺘﺤﺪﺓ ﺑﻤﻮﺟﺐ ﺭﻗﻢ ﻗﻴﺪ‬,٢٠٣٩٧٠ ‫ﺕ‬.‫ﺭ‬. ‫ ﺭﻗﻢ‬،‫ ﺩﺭﻫﻢ ﺇﻣﺎﺭﺍﺗﻲ‬٤٦١٫٨٧٢٫١٢٥ ‫ ﺭﺃﺱ ﺍﻟﻤﺎﻝ ﺍﻟﻤﺪﻓﻮﻉ‬،‫ﺳﻜﻮﻥ ﻟﻠﺘﺄﻣﻴﻦ ﺵ ﻡ ﻉ‬
Sukoon Insurance PJSC, Paid up Capital AED 461,872,125, C.L. No. 203970, Regulated by the Central Bank of the UAE No. 9 dated 24/12/1984, TRN 100258594900003

Classification: Sukoon-Business