HEALTH INSURANCE - SEHATI AMAAN

Affordable Health Insurance Tailored for Individuals

Features of the policy

  • Coverage up to BD 1500*
  • Eligible for individuals aged 18 to 60 years*
  • Cashless treatment at Designated Provider network

Table of Benefits

Benefit Category Details
Annual Maximum Limit BHD 1500 Per Person Per Year
Scope Outpatient benefits
Network Medical Provider Dar Al Shifa Hidd & Hoora
Third Party Administrator (TPA) Health 360
Territorial Limit Kingdom Of Bahrain
Out-Patient Coverage Covered
Out-Patient Deductible BHD 3 with free follow-up within 7 days with same doctor and same complaint
Consultant General Physician Consultation - Covered; Specialist consultations and super-specialist consultations covered only upon referral from General Physician
Medications Generic Medicines, Injections, and IV fluids covered
Laboratory Investigations Covered
Radiology Investigation X-Ray – Covered. Ultrasound, CT scan, MRI, Mammogram - Prior Approval required
Other Investigations All Other Investigations are covered as per available at Provider
Minor Outpatient Procedures Covered (only under local anesthesia / I&D, drainage of abscess, nail removal, POP, cast application, foreign body removal)
Minor Outpatient Procedures (Co-Payment) 10% Co-payment
Emergency Outpatient Care Emergency covered for initial treatment and stabilization. The case will be further referred to Salmaniya Medical Complex/KHUH/BDF for further management evaluation
Clinic Care Covered
Pharmacy Medications Covered (Generic Only)
Outpatient Care for minor and primary work-related injuries Minor Injuries covered under emergency care to stabilize before shifting to ministry hospital or health centers
Dental Covered only in Dar Al Shifa centers – Consultation, immediate relief of pain, X-Rays, Teeth Extractions, Amalgam Filling, Composite Filling, Medications. (Up to max. of BHD 50 per person per year). (Maximum 2 visits allowed in a year)
Dental (Co-Payment) 20% copayment with 1 free follow-up within 7 days
Maternity Prenatal Services are covered as per MOH guidelines (Subject to 20% Copayment and waiting of 180 days)
Vaccinations & Vitamins Not Covered
Physiotherapy Covered – Maximum 8 Sessions subject to referral from Orthopedics doctor
Pre-Existing & Chronic conditions Covered after waiting period of 180 days (annual limit of BD 300 per person per year)
Pre-Existing and chronic Patients (Co-Payment) 10% copayment for all treatments
Waiting Period First 30 days, except for accidental treatment

General Exclusions

The following conditions and services are NOT covered under this policy:

1. Pre-existing conditions, if not included in the Policy schedule, Table of benefits and Membership cards
2. Unless Pre-existing condition is covered, Maintenance treatment of Chronic conditions, except for necessary investigations until a diagnosis for the condition is confirmed
3. Home visits
4. Services or Treatment in any rest home, spa, hydro-clinic, health resorts, massage centers, sanatorium or long-term care facility that is not a Hospital unless covered in the table of benefits
5. Admissions for rehabilitation and isolation purposes
6. Routine medical examinations or regular check-ups (e.g. Vitamin D deficiency test, thyroid test, mammogram, pap smear etc.), unless specified in the Table of Benefits
7. Medical certificates and examinations for residence, employment or travel
8. Provider registration fees, and medical report charges unless requested by Us
9. Vaccinations, unless specified in the Table of Benefits
10. Cosmetic, plastic, reconstructive or restorative Treatments, unless Pre-authorized by Us
11. Cosmetic products such as shampoos, soaps, hair stimulants, hair removers, moisturizers, creams or other similar products
12. Alternative treatments (other than those specified in the Table of Benefits) including but not limited to ayurvedic (such as herbal medicine), holistic medicine, hypnosis, yoga, chiropractic and other similar Treatments
13. Any Illness caused by, or resulting from sexually transmitted Illnesses, and any treatment or test for acquired immune deficiency syndrome (AIDS), Chlamydia, Genital Herpes, Syphilis, Gonorrhea, HPV, Trichomoniasis and any similar conditions
14. Organ transplantation and its related expenses, unless specified in the Table of Benefits but not covering the organ-donor related charges and organ acquisition charges
15. Prosthesis (including stents & pacemakers) and medical appliances including but not limited to knee brace, collar brace, lumbar support, heel pads, arch support, slings, and hearing aids, unless covered in the table of benefits
16. Surgical & Non-surgical treatment medical treatment of obesity (including morbid obesity) and any other weight control programs, services, or supplies including Liposuction, Gastric Bypass, Laparoscopic Gastric Banding, Sleeve Gastrectomy & any related/similar procedures
17. Vitamins, mineral supplements, hormones replacement therapy, steroids and organic preparation
18. Skin disorders like warts, skin tags, keloid, acne, and molluscum contagiosum, sebaceous cyst (unless infected), epidermal cyst, lipoma
19. Maternity care, if not included in the Policy schedule, Table of benefits and Membership cards. Even if it's part of Policy schedule, standard exclusions will be applicable such as 3D/4D scans, genetic tests, abortion due to voluntary, psychological or social reasons
20. Infertility, impotency, sexual dysfunction, contraception, sterilization or other similar conditions
21. Birth defects, congenital Illness, hereditary conditions (e.g. sickle cell disease, G6PD deficiency, hereditary spherocytosis), bleeding disorder (e.g. thrombocytopenia, hemophilia), auto immune diseases (e.g. systemic lupus erythematosus, myasthenia gravis, multiple sclerosis etc.), developmental disorders and behavioral problems
22. Non-medically necessary Amniocentesis
23. Children under 15 days unless covered in table of benefits
24. All cases related to maternity in respect of unmarried females
25. Dental related services, if not included in the Policy schedule, Table of benefits and Membership cards. Even if it's part of Policy schedule, standard exclusions will be applicable such as cosmetic treatment related to tooth & gums, orthodontic treatments, crown, dentures, braces, inlays, onlays, mouth guard occlusal splint, adhesive reconstructions/restorations, bridges and implants
26. Optometry/optical Treatment and surgeries for correction of refraction errors, if not included in the Policy schedule, Table of benefits and Membership cards
27. All transportation costs occurring during trips specifically made for the purpose of obtaining Treatment
28. Corrective Treatment for hearing defects
29. Injuries arising from professional and hazardous sports including but not limited to scuba diving, sky diving, parachuting, paragliding, mountaineering ski jumping, bungee jumping and martial arts
30. Treatments resulting from work related Accidents and/or Illnesses that are eligible under any Workers Compensation scheme
31. Injury or Illness caused by, contributed to, or resulting from self-infliction, suicide, use of alcohol, intoxicants, hallucinogenic, illegal drugs or any drugs and medicines that are not taken in the dosage or for the purpose as prescribed by the Physician
32. Health Service, which are not medically necessary
33. Personal comfort and convenience items or services such as television, telephone, barber, gust service and similar incidental services and supplies
34. Health Services and associated expenses for experimental, investigational or unproven services
35. Services and supplies for smoking cessation and alcohol and drugs programs and the treatment of nicotine addiction
36. Growth hormone therapy, unless medically necessary
37. Treatment directly or indirectly associated with gender change and any consequence thereof
38. Treatment for learning-difficulties, hyperactivity, attention deficit disorder, speech therapy, developmental and behavioral problems in children. Unless covered in the Table of benefits
39. Treatment for sleep related breathing disorders, including snoring and sleep apnea, fatigue, jet lag or work-related stress or any related conditions
40. Air ambulance transportation in general and terrestrial transportation in non-emergency cases or by non-licensed providers
41. All cases requiring emergency in-hospital treatment / services, which have not been notified to the Company within forty-eight (48) hours from admission
42. Complications directly arising from services not covered
43. Officially (WHO and / or national law) recognized epidemics/pandemics
44. Any Health Services and associated expenses for alopecia, baldness, hair falling, dandruff, wigs, or toupees
45. Natural perils, such as but not limited to avalanches, earthquake, volcanic eruptions, tsunamis, hurricanes, tornados or any other kind of natural hazard
46. All preventative cares, including vaccinations, immunizations, dietary supplements, hyaluronic acid injection, allergy testing & desensitization; any physical, psychiatric or psychological examinations or testing during these examinations, unless covered in the table of benefits
47. Biological Response Modifiers and Monoclonal Antibody Therapy, Disease-modifying drugs and other types of immunotherapy
48. Phototherapy except for neonatal jaundice
49. Nasal septum deviation and/or nasal concha resection for cosmetic purpose. Treatment to cure snoring related conditions
50. All cases requiring non-emergency In-Hospital treatment / services, which have not been approved by the Company prior to admission
51. Any test and / or treatment not required by a medical Physician
52. Any In-Hospital treatment, tests and other procedures, which can be carried out on Out-of-Hospital basis without jeopardizing the Participant Member's health
53. Any pharmaceutical product not considered as medicine including but not limited to lozenges, mouthwashes or gargles, baby formula, soaps, lotions and shampoos (medicated or non-medicated), cosmetic preparations, antiseptic solutions, dietary supplements, skin care products and slimming product
54. Any treatment which only offers temporary relief of symptoms rather than dealing with the underlying medical condition
55. The costs of providing or fitting any external prosthesis or appliance
56. Genetic engineering and cloning
57. Psychiatric treatment, mental disorders not due to sickness or accident such as anxiety, depression, attention deficit disorder including but not limited to mental retardation and insomnia
58. All types of Hepatitis except Viral Hepatitis A
59. Treatments resulting from participating in war (declared or not), passive war (if not included in the Policy schedule, Table of benefits and Membership cards), acts of terrorism, riot, civil commotion, or any illegal act, including resultant imprisonment and any Accident or Illness incurred while serving as a full-time member of a police or military unit
60. Injury caused by nuclear fission, nuclear fusion or radioactive contamination, chemical or biological warfare
61. Any liability, loss, cost or expense arising out of, resulting from, caused or contributed to by any medical condition that is declared to be an outbreak or epidemic by the World Health Organization, or any Government or ruling body of a country that the outbreak or epidemic has occurred in
62. Claims in respect of treatment received outside the area of cover or if the member travelled against medical advice even inside the area of cover
63. Any condition that is not included under the scope of each benefit covered

Important Terms & Conditions

Key Points to Remember:

  • Network Provider: Cashless treatment available at Dar Al Shifa Hidd & Hoora
  • Generic Medications: Only generic medicines, injections, and IV fluids covered
  • Specialist Referral: Specialist and super-specialist consultations require referral from General Physician
  • Emergency Notification: Emergency in-hospital treatment must be notified to the Company within 48 hours from admission
  • Non-emergency Approval: Non-emergency in-hospital treatment must be approved by the Company prior to admission
  • Waiting Period: 30 days applies from policy commencement (except accidental treatment)
  • Pre-existing Waiting: 180 days waiting period for pre-existing and chronic conditions
  • Pre-existing Limit: BHD 300 per person per year with 10% co-payment
  • Dental Limit: Maximum BHD 50 per year for dental treatment, limited to 2 visits per year
  • Maternity Services: Available only after 180 days waiting period from policy commencement
  • Physiotherapy: Maximum 8 sessions with referral from Orthopedics doctor
  • Vaccinations & Vitamins: Not Covered

*Terms and Conditions Apply

© 2026 New India Assurance Bahrain. All Rights Reserved