| Medical & Dental Benefits | |
|---|---|
| Annual Maximum Limit | BHD 1500 Per Person Per Year |
| Scope | Outpatient benefits. |
| Network Medical | Stellar Health Medical Center,Zayed Town, Kingdom of Bahrain |
| Dr. Saji Abraham Dental Specialists Center,Salmabad, Kingdom of Bahrain (Exclusive Dental Services Only) | |
| Third Party Administrator (TPA) | Health 360 |
| Territorial Limit | Kingdom Of Bahrain |
| Out-Patient | 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* | Medicines, Injections, and IV fluids covered. |
| Laboratory Investigations* | Covered |
| Radiology Investigation* | X-Ray – Covered. Ultrasound, CT scan, MRI, Mammogram - Prior Approval required |
| Other Investigations* | EKG, Audiogram, Tympanogram, Lung Function Test, Echo Cardiogram, TMT Holter monitoring, Endoscopies (Prior Approval required) |
| Minor Outpatient Procedures* | Covered (only under local anesthesia / I&D, drainage of abscess, nail removal, POP, cast application, foreign body removal Covered) |
| Minor Outpatient Procedures (Co-Payment) | 10% Co-payment |
| Emergency Outpatient Care | Emergency covered basis 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 |
| 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 Dr Saji Abraham Dental Specialists center – Consultation, immediate relief of pain, X-Rays, Teeth Extractions, Amalgam Filling, Composite Filling, Medications. (Up to max. of BHD 100 per person per
year).
(Maximum 3 visits allowed in a year) |
| Dental (Co-Payment) | 20% copayment with 1 free follow-up within 7 days |
| Vaccinations | Limit of BD 50 for MOH vaccination and/or other Vaccination subject to 15% co payment |
| Physiotherapy | Covered – Maximum 8 Sessions subject to referral from Orthopedics doctor (Annual limit of BD 100/-). |
| Pre-Existing & Chronic conditions | Covered after waiting period of 1 year (annual limit of BD 500 per person per year) |
| Pre-Existing and chronic Patients | 20% copayment for all treatments*. |
| Waiting Period | First 30 days, except for accidental treatment. |
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