Abu Dhabi Health Insurance Coverage Definitions

This page has been created to provide you with general explanations for the phrases and terminology most commonly used in Abu Dhabi Health Insurance policies. Also included on this page is a list of typical exclusions under an Abu Dhabi Medical Insurance plan.

Acute illness: Any illness that generally develops suddenly and for a short period of time. Examples include some infectious diseases, common colds and influenza (flu).

Anniversary date: The date your health insurance policy begins and terminates. For 12 month policies, it is also the renewal date.

Applicant: The individual requesting medical insurance.

Application: The paperwork that must be completed by the individual and returned to the insurance company.

Claim: The process whereby the individual seeks to be reimbursed for the payment of medical costs covered by the medical insurance plan.

Commencement date: The start date of the insurance policy.

Deductible: A pre-determined figure agreed upon by both insurance company and the person to be insured which sets an initial amount the individual must pay for treatment before the insurance company will begin to reimburse.

Documents: All legally valid documents and paperwork which relate directly to your medical insurance policy.

Due date: The date upon which payment of the premium must be paid.

Hospitalization: The benefit or provision which ensures partial or full coverage of hospital treatment and costs.

In-patient: Treatment at a medical facility or hospital which requires an overnight stay.

Out-patient: Treatment at a medical facility or hospital which does not require an overnight stay.

Policy conditions: The specific benefits and provisions of your medical insurance policy. Examples include exclusions, deductibles and length of cover.

Policyholder: The individual to whom the insurance policy is issued. The policyholder’s name will be entered on to the insurance contract and with regard to group plans; the policyholder is one individual who acts as a trustee for the overall group.

Policy schedule: A document which provides an overview of the insurance contract. The policy schedule contains information such as the amount of coverage, benefits, provisions, exclusions and policyholder details.

Pre-existing condition: Classified as any illness or injury suffered by the insured prior to the commencement of the insurance policy. Some policies may or may not cover pre-existing conditions.

Reimbursement rates: The total amount of money that will be reimbursed by the insurance company during a 12 month period, as agreed by both parties.

Region: The geographical area where medical cover is provided.

Renewal: The annual anniversary date in which your insurance policy must be renewed.

Serious injury: Any serious or life threatening injury that may result in permanent damage to limbs and organs and which may restrict bodily functions. The seriousness of an illness is determined by the insurance company’s medical consultants and the individual’s physician or doctor.

Special terms: Any specific terms and conditions included with your policy.

Standard terms: The general terms and conditions included with all health insurance policies.

Subrogation: A legal initiative in which the insurance company attempts to claim part or all of the costs already paid out an individual policyholder from a third party which was deemed responsible for the original costs.

Surgery: A medical procedure involving invasive techniques in an attempt to treat an illness or disease.

Terminal phase: The period when an individual can no longer be medically treated or cured and death is expected to occur in the near future.

Waiting period: A pre-agreed timeframe during which the policyholder is unable to submit a claim against a specific provision or benefit. More information on waiting periods can be found here.

Abu Dhabi Health Insurance Exclusions

All medical plans from Abu Dhabi Health Insurance will contain some benefits or provisions which will be excluded from coverage. Exclusions can vary between the different health insurance companies although there are some general exclusions which will apply to most Abu Dhabi Medical Insurance policies.

It is also worth noting that pre-existing medical conditions are typically excluded from Abu Dhabi Health Insurance plans. Additional information on pre-existing conditions can be found at Pre-Existing Condition Insurance Coverage.

General exclusions common to Abu Dhabi Health Insurance policies include:

  • Treatment for HIV/AIDS.
  • Conditions related to the use or abuse of Drugs (Narcotics) or Alcohol.
  • Fertility Testing and Treatment, such as IVF, unless otherwise specified.
  • Cosmetic Surgeries or cosmetic procedures: Plastic Surgery.
  • Psychological Conditions and Treatment.
  • Sterilization and other forms of contraception.
  • Sexual Dysfunction: Impotence or Erectile Dysfunction.
  • Treatments related to morbid obesity.
  • Experimental Treatments with no proven treatment record.
  • Epidemics and Pandemics under the direction of the Authorities (WHO, CDC, etc).
  • Early Termination of Pregnancy: Abortion
  • Injuries as a result of a terrorist act.

Although the exclusions listed above are common to the Abu Dhabi Health Insurance industry, you may be able to include one or more exclusions depending on which plan and insurance company you wish to use.

Abu Dhabi Health Insurance Quote

By entering your details in the form section at the top of this page you can apply for a free Abu Dhabi Health Insurance quote. One of our advisors will then contact you to ascertain your healthcare preferences and once we have the required information, we will provide you with a detailed list of the options available to you. Further information can also be obtained by contacting us here.