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Box Al Ain P. Daman: Your Health Insurance Specialist Our Specialized Services What Is Covered? What Is Not Covered? Important To Know Your Rights and Responsibilities Contact Us 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. Our products are a result of industry knowledge, market research, and a deep understanding of our. Basic Plan is an optimal health insurance plan, covering benefits like. This plan offers you health insurance cover of AED , per person annually. You can use your health insurance card Emirates ID , digital insurance card or Daman card to get direct. Main Cover-Your Benefit Summary. Covered at Network Notes Providers. Medical appliances, Used as part of inpatient procedures. 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. 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 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. 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. Note: This is only an extract from the General Exclusions list that applies to your plan. Please refer to the Policy Wording for the complete list and details of exclusions, definitions, terms and conditions. It is designed to mange your pharmaceutical benefits better. PBM will help us enhance our service quality by following established frameworks and best practices related to drug prescription and dispensing. We will be able to review every drug prescribed for consistency with your diagnosis, age, gender and previous medical history. We can avoid any potential health hazard by rejecting clinically inappropriate drugs or where we suspect negative drug-to-drug interaction. PBM will further help us with automated checks for cases like a particular drug is not covered in your policy Drug Formulary or you have already consumed your pharmacy benefit limit or the drug is not medically necessary or you requested for a prescription refill too soon. However, you may get a refill approved on an exceptional basis. You may contact our Customer Service Centre by calling the toll free number mentioned on Daman website, digital app or Daman card if you require further information or wish to file for an appeal in case for exceptional circumstances. Pre-Authorization Your policy may contain specific services that require prior-approvals or pre-authorizations. This is necessary to ensure that your Health Services Provider has appropriate information on services covered under your policy. Your Network Provider, along with Daman, will carry out the pre-authorization process where necessary and notify you once the approval is granted. If the authorization is not granted, you have the right to ask for an explanation by calling our Customer Service Centre at the toll free number mentioned on Daman website, digital app or Daman card. Coverage for Specific Conditions Your policy covers this listed conditions after a waiting period for 6 months. The waiting period applies to inpatient treatment only for the following medical conditions:. The waiting period is not applicable if you were continuously covered without any break for atleast 6 months under a health insurance plan approved by Health Authority Abu Dhabi HAAD. Our Network Directories are continuously updated as we establish new agreements with health service providers within the territories specified in your plan. Going to a Network Provider would ensure that you can enjoy the direct billing facility and avail cashless benefits for Health Services covered in your policy. You can check the Provider details on our website or call our Customer Service Centre on the toll free number mentioned on Daman website, digital app or Daman card for any assistance. Drug Formulary If your policy covers outpatient prescription drugs, these drugs will be subjected to a Drug Formulary. Your Drug Formulary covers both brand-name and generic drugs. Generic drugs have the same active ingredients as brand-name drugs and are equally safe and effective. In case the prescribed drug is not covered in your Drug Formulary, you will have to pay the drug bill directly to the Provider. You can refer to our website to check if the medicines prescribed for you are covered in the Drug Formulary of your policy. For any general inquires related to your policy benefits, or specific complaints concerning your pharmacy benefits such as adjudication of your claims declining the pre-authorization request for a drug , dispensing oversight or provider related issues access, quality and safety , you can call our Customer Service toll free number mentioned on Daman website, digital app or Daman card. For cases where a drug cannot be found with your Network Provider, you have the option to request exceptional consideration for coverage. If your request is declined, you may further approach us through our appeal process. Daman will discuss the merits of your case internally and externally and will communicate the decision to you within 30 calendar days from the date of appeal. Preserve the confidentiality of your treatment records to the extent protected by Federal and Emirate laws in the UAE. You are also entitled to receive an explanation regarding exceptions to confidentiality. Voice complaints or to appeal to Daman on benefits offered, claim settlement, services offered, PBM services or any other grievance. To read your insurance policies for the details of benefits, exclusions, other terms and conditions applicable under your health insurance plan. If you do not understand the information, you should contact Daman Customer Service for explanations on the covered benefits, limitations and authorization procedures. To present your health insurance card Emirates ID, digital insurance card or Daman card when accessing covered health services from our Network Providers. To know how to access covered health services and pharmacy benefit you are entitled to as part of your health insurance plan benefits. To demonstrate mutual respect and courtesy towards providers including hospitals, pharmacies, dental clinics etc. Co-insurance - the percentage of eligible expenses that you need to pay for specified medical services availed under your policy. Deductible - the defined fixed amount that you need to pay for the specified medical services received under your policy. Health Services - the health care services and supplies covered under the Policy, unless such health care services and supplies are not limited or not excluded in the policy. Inpatient Benefit - Hospitalization or Day Treatment or observation or treatment in an Emergency room or facility which cannot be carried out on an outpatient basis. Network - Used to describe a Health Services Provider, which holds an agreement in effect with Daman to provide Health Services to members. Coverage for the Non-Network Benefits is only provided if the services are assured in Schedule of Benefits. Pre-authorization - a prior approval or official permission, granted by Daman to the Network Provider, before initiating certain medical procedures. Pre-Existing Condition - any known or unknown injury, sickness, disease or other medical, mental or nervous condition, disorder or ailment that with reasonable medical certainty that existed at the time of applying for this policy. Provider - a Physician, Hospital, group practice, pharmacy or any facility, individual or group of individuals that provides a health care service. Refill-too-soon - Replenishment or dispensing of a prescribed medicine before the previous dispense of the same pharmaceutical is consumed. Appeal - A request contesting a denial or reduction of coverage for services which have been availed or are intended to be availed. Disclaimer This document is for information purposes only and does not form part of the Policy. The complete list of benefits, definitions, exclusions, terms and conditions are set out in the Policy. While every effort is made to ensure the accuracy of the content, Daman cannot be held liable for any typographical errors, errors of fact or any other error or inconsistency found in this document. Open navigation menu. Close suggestions Search Search. User Settings. Uploaded by Mohamed Imran. This document provides information about Daman health insurance plans, including their Basic Plan. It then summarizes what is covered under the Basic Plan, such as hospital stays, treatments, medicines, and emergency services within the UAE. It explains how members can obtain benefits either within Daman's network of providers using their health insurance card, or by getting bills reimbursed for emergency services received outside the network. Important notes on deductibles and coinsurance are also mentioned. Save Save basicplanmanual For Later. AI-enhanced title and description. Document Information click to expand document information This document provides information about Daman health insurance plans, including their Basic Plan. Original Description:. Original Title basicplanmanual. Did you find this document useful? Is this content inappropriate? Download now. Jump to Page. Search inside document. 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. 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. Coverage for Emergencies We are committed to provide you the best coverage for health care services, especially when it matters the most. The waiting period applies to inpatient treatment only for the following medical conditions: 4 DAMAN www. Be treated with respect and dignity and have the right to privacy. Receive services in English and Arabic when contacting Daman Customer service. Make suggestions and give comments on ways Daman can improve its services. As a Daman member, your Responsibilities are: 1. To pay any applicable co-insurance and deductible at the time of availing a health service. Enhanced Bronze Plan Document 2 pages. Healium - Io Pitch Deck Document 12 pages. Business Basics for Dentists From Everand. David O. Basic Plan Manual Document 11 pages. Medkad Digital Company Profile Document 22 pages. Essential Benefits Plan Manual Document 28 pages. Laya Allpmirules Document 48 pages. Guide For Members Document 80 pages. Gulf Care Members Guide Document 31 pages. 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