RAK Insurance

4th Floor, 405, Sultan Business Center Bldg, Oud Metha,

Next to Lamcy Plaza, Dubai UAE.

GARANT BUSINESS CONSULTANCY DMCC AE/Q/2023091200185266/2

Terms & Conditions
Please refer to the Policy Wording for exclusion list and definitions.
All Benefits shown are per insured person, per Period of Cover (One year)
All limits and Co-payments are expressed in Arab Emirates Dirham
This quotation is valid for residents of Dubai and Northern Emirates only

Third Party Administrator MEDNET UAE

Salient Benefits
Category Cat A nlsb
Annual Aggregate Limit per person AED 250,000
Geographical Scope of Coverage for Elective Treatment
Worldwide
(Free access: UAE & SEA only)
Geographical Scope of Coverage for Life-threatening Emergency Worldwide
* Coverage outside UAE is limited to 90 days per treatment
Coverage Criteria for Treatment outside UAE
*A single holiday or business trip may not exceed 90 days
Network Applicable*
TPA reserve the right to review and update Providers list periodically and for the current list, please Emerald
refer to your insurer.
Group consists 11 Employees or more:
Medical History disregarded (MHD)
Individual Medical Underwriting Group consists 10 Employee or less:
All members have to fill Medical Application Form(MAF)
and premium will be quoted based on declaration
Pre -existing and Chronic Conditions All Pre-existing and Chronic conditions are covered
Inpatient Treatment
Coverage is up to the relevant Annual Aggregate Limit per person/per policy year with Prior Approval
Hospital Accommodation and related Services Covered
Hospitalization Class Private Room
Intensive care unit and coronary artery disease treatment Covered
Consultant’s, Surgeon’s and Anesthetist’s Fees Covered
Various therapies including physiotherapy, chemotherapy, radiation therapy, etc Covered
Recipient Organ transplantation service, excluding any charges related to Donor Covered
Use of hospital medical equipment’s (e.g. heart and lung support systems, etc.) Covered
Ambulance Services (in Medical Emergency only and if followed by admission) Covered
Companion Room & Board expenses for Beneficiary below 16 years of age Covered maximum up to 300 AED per night
The cost of accommodation of a person accompanying an patient in the same room in cases of
medical necessity at the recommendation of the treating doctor and after the prior approval of the Covered maximum up to 300 AED per night
insurance company providing coverage
Hospital Cash Benefit if Inpatient Treatment is received free of charge in a Government Hospital AED 300/- per day up to a maximum of 20 days
Repatriation costs for the transport of mortal remains to the country of origin Covered up to AED 10,000/- (Per member per year)
Nursing at Home, for recovery and in lieu of a hospital stay up to a maximum of 14 days per Covered up to Maximum AED 15,000 per person per
admission or procedure annum

Quotation #: AE/Q/2023091200185266/2 | Generated on 09/12/2023 15:13:05 v1.01 | Page 1 of 4

 Maximum AED 5,000 per person (Air fare ticket) subject to
• Economy Air-fare only for the patient/claimant
(accompanying persions not covered)
• Treatment is taken economically i.e. Treatment cost is
Air Ticket Benefit (Transportation Treatment for In-patient treatment abroad) within the geographical
maximum 70% of the UAE Benchmark Rate (including the
scope of cover
cost of the airfare)
• Subject to medical necessity and prior approval from TPA
medical team
• Reimbursement or GOP Basis only
Outpatient Treatment
Deductible / Co-pay Option
Do not require hospitalization or day treatment
Physician Consultation Covered with co-payment AED 20%, max up to 50 /-
Deductible will not applicable for follow up within 7 days
Diagnostics (X-Ray, MRI, CT- Scan, Ultrasound etc.) and Laboratory Tests Covered with NIL co-payment
Pharmaceuticals Up to AAL
Covered with NIL co-payment
Covered
Physiotherapy Prior Approval is required for Free Access facility
Up to 15 sessions/ PMPY
Vaccination Covered as per MOH schedule (For Children up to 6 years) Prior Approval is required for "Inside Network: 100% covered after applicable co-pay /
Free Access facility deductible
Other Salient
Day care Treatment Covered
Out Patient Surgery Covered
Emergency Mental health Treatments Covered
Coverage up to limit of AED 10,000/- per year
Psychiatry and Mental Health
Outpatient: 20% coinsurance payable by the insured per
visit
Inpatient and outpatient and emergency coverage
No coinsurance if a follow-up visit made within seven days
*Covered on Reimbursement basis only
Emergency covered up to Annual Aggregate Limit
Work Related Injuries Covered
Frequency restricted to:
Preventive services as stipulated by DHA to include initially diabetes screening • Diabetes: Every 3 years from age 30
• High risk individuals annually from age 18
Cancer Treatment:
Screening, healthcare services, investigations and treatments only for members who are enrolled
under ""Patient Support Program"" only
Covered as per terms, conditions and exclusions of the
Hepatitis B&C Virus infection:
program defined by the respective regulator (DOH/DHA)
Screening, healthcare services, investigations and treatments related to viral Hepatitis and
associated complications related to Hepatitis B&C shall only be for members enrolled under Patient
Support Program.
Covered - Medical Emergency Cases Only
Emergency Dental treatment for accidental damage to natural teeth
(Covered fully)
Covered - Medical Emergency Cases Only
Emergency Hearing & Vision in case of medical emergencies
(Covered fully)
New Born Cover As per DHA
*For detailed information please refer Assist America
Emergency Assistance services coverage through Assist America
Table of Benefit
Exclusions As per DHA
Covered - Once per Annum
Influenza Vaccine
**Only on reimbursement basis
Maternity Benefit
Hospitalization, day treatment and out-patient benefits required by MOH
In case of a sub-limit, the benefit is subject to TPA pre-approval.
* Covered up to AED 10,000 per married eligible female
employee & spouse.
Inpatient *Where any condition develops which becomes an
emergency, the medically necessary expenses will be
covered up to the annual aggregate limit

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 * Cover includes 8 visits to PHC; All care provided by PHC
obstetrician for low risk or specialist obstetrician for high
risk referrals Initial investigations to include:
FBC and Platelets Blood group, Rhesus status and
antibodies VDRL MSU & urinalysis Rubella serology
Out Patient HIV Hep C offered to high risk patients GTT if high risk.
FBS, Random blood sugar OR HbA1C for all due to high
prevalence of diabetes in UAE
Visits to include reviews, checks and tests in accordance
with DHA Antenatal Care Protocols 3 ante-natal ultrasound
scans
*10% coinsurance payable by the insured on all Out
Maternity Deductible (not applicable for follow up within 7 days
Patient Maternity Claims
Claim Settlement
Direct Billing 100% covered after applicable co-pay / deductible
80% of UCR as per UAE network tariffs for same or similar
Reimbursement (Within UAE & Outside UAE) - Elective
treatment
Reimbursement (Within UAE)- Emergency 100% covered
100% of actual costs or 100% of the UCR as per UAE
Reimbursement (Outside UAE)- Emergency network tariffs for same or similar treatment whichever is
less
Dental Benefit
Dentist consultations, X-ray, root canal treatments, teeth extractions, composite fillings, glass ionomer, amalgam, medication (e.g. antibiotics and
painkillers) and gum treatment related to infection and scaling and polishing if part of the same gum treatment
The benefit is subject to TPA pre-approval.
Annual Limit Not Covered
Co-Payment Not Covered
**Refer Schedule Of Dental Benefit for further details on coverage Not Covered
Optical Benefit
Eye-sight test once per year and prescribed plain glasses for spectacles once per year
The benefit is subject to TPA pre-approval.
Annual Limit Not Covered
Co-Payment Not Covered
*Can be Opted only along with Dental Benefit Not Covered
Alternative Medicine Benefit
Alternative Medicine Benefit covers
Alternative Medicine Limit
Alternative Medicine Benefit covers Homeopathy and Ayurveda Osteopathy, Chiropractic, Homeopathy, Annual Limit AED 2500 /- per member per year
Acupuncture, Ayurveda and Herbal Treatments
NIL Co Payment applicable Covered on Reimbursement
Alternative Medicine Co-Payment
only
Schedule of Dental Benefit
Schedule of Dental Benefit (Applicable only if Dental Benefit is Covered)
Services Coverage eligibility
Dental Consultation Covered
Tooth Extraction
. Simple Extraction Covered
.Surgical Extraction
Scaling & Polishing Covered
Tooth filling
. Amalgam filling
Covered
.Glass Ionomer filling
. Composite filling
Root Canal Treatment (R.C.T) Covered
Crown – Covered followed by R.C.T Covered
X- Ray:
. Intra Oral { Bite wing/ Periapical / Occlusal} Covered
. Extra Oral { Panoramic X-ray & Tomograms}

Quotation #: AE/Q/2023091200185266/2 | Generated on 09/12/2023 15:13:05 v1.01 | Page 3 of 4

 Medications
. Antibiotics
. Analgesics
Covered
. Antacids
. Enzyme preparations ( Edema reductions)
. Vitamins ( only with antibiotics)
Medications exclusion:
. Mouth wash
. Tooth pastes Not Covered
. Dentures cleaning agents
. Desensitizing agents . Anti septic
Lab Work up Not Covered
Anesthesia
Covered
L .Anesthesia
G. Anesthesia Not Covered

Orthodontics Not Covered

Quotation #: AE/Q/2023091200185266/2 | Generated on 09/12/2023 15:13:05 v1.01 | Page 4 of 4

 RAK Insurance
4th Floor, 405, Sultan Business Center Bldg, Oud Metha,
Next to Lamcy Plaza, Dubai UAE.

Policy Holder Information Quote# AE/Q/2023091200185266/2

GARANT BUSINESS CONSULTANCY DMCC Quotation Date: 12-Sep-2023
Contact Person : Inception Date: 17-Oct-2023
Contact Email : Valid till: 12-Oct-2023

# Category Total Members Gross Premium

01 Cat A nlsb 19 86,696.00

Total Gross AED 86,696.00

VAT (5.00%) AED 4,334.79
Basmah Premium AED 738.15
Final Gross Premium AED 91,768.94

Terms & Conditions

NOTE: As per ICP directive (Reference circular number 18/4/13; Dated 2 March 2023) : All members getting enrolled on and / after 15-05-2023 will be charged
ICP Fee of (AED 28 + VAT per member), this fee is for data integration with the Federal Authority for Identity, Nationality, Customs and Port Security for all UAE visa
holders excluding Dubai visa holders.
This will be applicable for members enrolling into newly incepted policies and addition of members on existing policies. Uploading/adding a member record with
a unique UID is chargeable (AED 28 + 5% VAT) and so is updating a UID (in case the original record of a member was added with a wrong UID).
This quotation is valid for 30 days from the day of issuance.
The insurer reserves right to re-price or re-validate the quotation for cases where later findings reveal that we received misrepresented or undisclosed data
making the insured risk significantly different than at the time of the initial quotation.
The insurer reserves the right to re-price or re-validate the premium if the membership changes by over 5%from the date the quotation until the policy inception
date.
Group sizes of 10 or few employees are subject to individual medical underwriting through a medical application form(MAF). The premiums provided are
indicative and nonbinding subject to MAF. Please refer to your insurer for final premiums.
The maximum eligible age limit at inception of the policy is 64 years. Members 65 years of age and older are subject to individual medical underwriting and MAF.
This quotation should be issued for group sizes greater than or equal to 5 employees. Groups with less than 5 employees should be referred to your insurer for
quotation.
This quotation is valid for UAE only. The quote assumes insurance coverage for all employees residing in UAE on valid resident visa along with their direct
dependents (Spouse and Children). For any deviation kindly refer to your insurer for quotation.
The Quotation is restricted to 150 members only at the time of inception. For larger groups kindly refer to your insurer for quotation.
The Quotation for groups between 100-150 members will not be valid on standard SME terms and the insurer reserves the right to re-price / re-validate if claims
information is available.
The Quotation for special risk groups is valid subject to final insurer approval. Groups such as (i) Taxi and transportation companies, (ii) Medical providers, (iii)
Insurance company or brokerages or TPA, (iv) Associations and charitable organizations, (v) Recruitment and Manpower Co., (vi) Airline Company and (vii) Military
or Police organizations. Kindly refer to your insurer for final quotation.
This Quotation is applicable only for groups employees and their dependents (Spouse and Children only). Parents, other family’s members and/or Maids under
employees visa are to be excluded.
Quotation is not valid if the group (or a sub-group) is part of another parent company.
The premium and refunds for all additions and deletions respectively during the policy period will be based on pro-rata calculations.
The final census list upon “confirmation of terms” should be in line with the census list used at the time of quotation. Kindly refer to your insurer for final quotation
in case of any deviation. Additionally, the insurer reserves the right to invalidate the quotation if it is generated based on falsified census.
All confirmed quotation will be subject to Ministry of Labour (MOL) checks.
Kindly refer to your insurer for final decision if a group fails MOL checks due to the reasons listed below:
If the entire group, including employees and dependents, is not enrolled under this scheme (i.e. voluntary instead of mandatory enrolment), Or
Group is split into sub categories i.e. Guardian Med+ and EBP or any other product, Or
Any other reasons
This Quotation is not valid for groups with deviation of more than 10% between confirmed census of employees and MOL list of Employees. Kindly refer to your
insurer for final quotation. In addition to the above, herewith also find other mandatory documentation required at the time of “Confirmation of Terms”:
Signed and stamped Quotation. (Rates & TOB)
HR declaration form confirming the entire group, including all employees and *eligible dependents are enrolled under this scheme.
VALID Trade License & Establishment ID
MOL registry list of employees, confirming that all employees have enrolled.If there is no MOL for Free zone companies, then please provide alternative
documents with list of employees, confirming that all employees have enrolled.

Quotation #: AE/Q/2023091200185266/2 | Generated on 09/12/2023 15:13:02 v1.01 | Page 1 of 2

 RAK Insurance
4th Floor, 405, Sultan Business Center Bldg, Oud Metha,
Next to Lamcy Plaza, Dubai UAE.

Category : Cat A nlsb Members (19)

Members Gross(PMPY) Total Gross Premium

Age Band Employee Dependent Employee Dependent Employee Dependent
Male Female Male Female Male Female Male Female Male Female Male Female
[0-17] 0 0 2 3 3,662.00 3,662.00 3,662.00 3,662.00 0.00 0.00 7,324.00 10,986.00
[18-40] 4 8 0 2 3,571.00 4,261.00 3,571.00 4,261.00 14,284.00 34,088.00 0.00 8,522.00
[41-59] 0 0 0 0 6,350.00 7,482.00 6,350.00 7,482.00 0.00 0.00 0.00 0.00
[60-99] 0 0 0 0 11,175.00 11,390.00 11,175.00 11,390.00 0.00 0.00 0.00 0.00
14,284.00 34,088.00 7,324.00 19,508.00
Total Premium (Base Benefits)
48,372.00 26,832.00

Additonal Benefits Coverage Members Premium PMPY Total Premium Grand Total
MATERNITY (18-50) Covered 5 1,736 8,680.00 Members Premium
DENTAL Not Covered 19 0 0.00 19 86,696.00
OPTICAL Not Covered 19 0 0.00
ALTERNATIVE TREATMENT Covered 19 147.99 2,812.00
Total Premium (Additional benefits) 11,492.00

Client Signature :

Date :

Quotation #: AE/Q/2023091200185266/2 | Generated on 09/12/2023 15:13:02 v1.01 | Page 2 of 2