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WIPRO

EffectiveDate:17July2016
SUMMARYOFBENEFITS

Category1

AetnaSummitDubai5000

CategoryDescription 1Dubai
AreaofCover CoverArea2
NetworkTier Tier2
1.0 Overallplanlimit
Wewillnotpayanymorethantheoverallplanlimitshownforanyoneormoreclaimsonanyoneormoreofthebenefitsbelow.This
1.1 includestheoverallDHAlimitshowninsection1.2.WhereabenefitlimitisshownasPaidinfull,thisisstillsubjecttotheoverallplan US$125,000
limit.Unlessstated,allbenefitlimitsshownapplyfortheplanyear.
WewillnotpayanymorethantheoverallDHAlimitshownforanyoneormoreclaimswherethesymbolisshownineachplanyear.If
1.2 coverprovidedunderthisplandoesnotmeettheminimumrequirementsofDubaimandatoryhealthcoverageasstatedbytheDubai $41,000
HealthAuthority(DHA),themandatedcostswillbepaidfromtheoverallDHAlimitshown.

Inpatientanddaycare(seesection27fordeductibles)
2.0
Foracuteandchronicmedicalconditions
Medicalcostsincludingintensivecarecosts,theatrecosts,hospitalaccommodation,medicalpractitioners'andspecialists'fees,
2.1 Paidinfull
anaesthetists'fees,nursingfees,kidneydialysis,appliancesandprescribeddrugsanddressings.
2.2 MRI,PETandCTscans,Xrays,pathologyandotherdiagnostictestsandprocedures. Paidinfull
2.3 Reconstructivesurgerytorestorenaturalfunctionorappearancewithin12monthsofanaccidentorsurgery. Paidinfull
Speechandlanguagetherapyandoccupationaltherapyaspartofyourinpatienttreatment.Thisbenefitisonlyavailableifthemedical
2.4 Paidinfull
conditioniscoveredundersection2.1or2.3.
Medicalservicesofanurseaspartofyourinpatientordaycaretreatmentwhenthesearereceivedinyourhomeinsteadofinhospital.
2.5 Paidinfull
Thisbenefitisonlyavailableifthemedicalconditioniscoveredundersection2.1or2.3
Inpatienttreatmentneededforacutemedicalconditionsthatbeginbeforeaninsuredmemberiseightdaysoldif
Paiduptoalifetimelimitof
2.6 thepregnancywastheresultofnaturalconception,and
$150,000
thetreatmentwouldnormallybecoveredundersections2.1to2.3,2.5or8.1
Inpatienttreatmentneededforacutemedicalconditionsthatbeginbeforeaninsuredmemberiseightdaysoldif
Paidinfullwithinthelimitshown
2.7 thepregnancywastheresultofassistedconception,and
insection1.2
thetreatmentwouldnormallybecoveredundersections2.1to2.3,2.5or8.1
3.0 Companionaccommodation(seesection27fordeductibles)
Hospitalaccommodationcostsforacompaniontostaywithyouifyouareaged17orunderandreceivinginpatienttreatmentcovered
3.1 Paidinfull
undersections2.1to2.4.
Hospitalaccommodationcostsforacompaniontostaywithyouifyouareaged18oroverwhenyouarereceivinginpatienttreatment
3.2 Paidupto$30foreachnight
coveredundersections2.1to2.4,22.3,22.4or22.6andyourmedicalconditioniscritical
Ifthecostsofyourinpatientadmissionarerelatedtoamedicalconditioncoveredundersections2.6,2.7,5,6,9.1,9.3,11to14,19.5,22.5or26.1,thehospitalaccommodation
costsforacompaniontostaywithyouwillbecoveredwithinthebenefitlimitsofthesamesection.IftherelevantsectionissubjecttotheoverallDHAlimitshowninsection
3.3
1.2costswillbelimitedto$30foreachnight.IftherelevantsectionisnotsubjecttotheoverallDHAlimitshowninsection1.2andyouareaged18orover,coverwillonlybe
availableifyourmedicalconditioniscriticalandcostswillbelimitedto$30foreachnight.

Outpatientposthospitalisationtreatment (seesection27fordeductibles)
4.0
Foracutemedicalconditions

Outpatienttreatmentforaperiodof90daysfromthedateofdischargefollowingeachadmissionforinpatientordaycaretreatment
4.1 relatedtothesameacutemedicalcondition.Thisbenefitcoversmedicalpractitioners'andspecialists'fees,surgicalprocedures, Paidinfull
prescribeddrugsanddressings,MRI,PETandCTscans,Xrays,pathologyandotherdiagnostictestsandprocedures.

Rehabilitation (seesection27fordeductibles)
5.0
Foracutemedicalconditionsandstabilisationofacuteepisodesofchronicmedicalconditions

Rehabilitationforamedicalconditioncoveredundersection2.1or2.3.Thisbenefitisonlyavailableif:
youhavereceivedinpatienttreatmentforthreeormoreconsecutivedaysforthesamemedicalcondition,and
youhavestayedinhospitalforthreeormoreconsecutivenights.

Rehabilitationmustbereferredbyamedicalpractitionerorspecialistandstart:
afteryouaredischargedfromhospitalfollowingyourinpatienttreatment,or Paidinfullforupto120days
5.1
whenyouaretransferredtoarehabilitationunitfollowingyourinpatienttreatment. followingeachadmission

Yourfirstsessionmustbenomorethan14daysafteryouaredischargedortransferred.

Thisbenefitcoversinpatient,daycareandoutpatientphysiotherapy,speechandlanguagetherapyandoccupationaltherapy.Wewillalso
payforaccommodationcostsattherehabilitationunitwhenmedicallynecessary.

Section5.1appliesbeforeanyavailablebenefitlimitshowninsections8.1,8.2and8.3.Ifposthospitalisationoutpatientphysiotherapyisneededfollowingrehabilitation,the
5.2 benefitlimitshowninsection8.2willonlybeavailableifthenumberofdaysshowninsection5.1islessthan90days.Ifthisappliestoyou,thenumberofdaysoftreatment
availableundersection8.2willbe90daysminusthenumberofdaysshowninsection5.1.

6.0 Cancercare(seesection27fordeductibles)
6.1 Alltreatmentfor,orrelatedto,adiagnosedcancer.Thisincludespalliativetreatmentandcareduringtheendstagesofacancer. Paidinfull
WIPRO
EffectiveDate:17July2016
SUMMARYOFBENEFITS

Category1

AetnaSummitDubai5000

Outpatienttreatment(seesection27fordeductibles)
7.0
Foracuteandchronicmedicalconditions
7.1 Surgicalprocedures. Paidinfull

7.2 Outpatientpreoperativetestsbeforeinpatientordaycaretreatmentcoveredundersections2.1to2.3. Paidinfull

7.3 Medicalpractitioners'andspecialists'fees,prescribeddrugsanddressings,Xrays,pathologyanddiagnostictestsandprocedures. Paidinfull

7.4 MRI,PETandCTscans. Paidinfull


7.5 Kidneydialysis. Paidinfull
Physiotherapyandcomplementarymedicine(seesection27fordeductibles)
8.0
Foracuteandchronicmedicalconditions
8.1 Physiotherapyaspartofinpatientordaycaretreatment. Paidinfull
Posthospitalisationoutpatientphysiotherapyfollowingadmissionsforinpatientordaycaretreatmentcoveredundersections2.1to2.3,
8.2 Paidinfull
2.6or2.7.Thisbenefitisavailableforaperiodof90daysfollowingeachadmission
Outpatientphysiotherapywhenreferredbyamedicalpractitionerorspecialist.Furthermedicalinformationmaybeneededifyoureceive
8.3 Paidinfull
furthertreatmentafteryouhavecompletedthenumberofsessionsthatwerereferredbythemedicalpractitionerorspecialist.
Outpatientpodiatry,osteopathicandchiropractictreatment,whenreferredbyamedicalpractitionerorspecialist.Furthermedical
8.4 informationmaybeneededifyoureceivefurthertreatmentafteryouhavecompletedthenumberofsessionsthatwerereferredbythe Nocover
medicalpractitionerorspecialist.
OutpatienttraditionalChinesemedicine,ayurvedicmedicine,acupunctureandhomeopathictreatment.Furthermedicalinformationmay
8.5 Nocover
beneededafteranyfoursessionsforanyonemedicalcondition.
Psychiatrictreatment(seesection27fordeductibles)
9.0
Foracuteandchronicmedicalconditions
Inpatientpsychiatrictreatmentandpsychotherapywhenyourmedicalconditionisnotanemergency.Thisbenefitisavailableforupto30
9.1 Nocover
daysintheplanyear.

9.2 Outpatientpsychiatrictreatmentandpsychotherapywhenyourmedicalconditionisnotanemergency. Nocover

9.3 Inpatientandoutpatientpsychiatrictreatmentandpsychotherapywhenyourmedicalconditionisanemergency. Paidupto$41,000

10.0 Durablemedicalequipment(seesection27fordeductibles)

Durablemedicalequipmentincludingprostheticandorthoticsupplies.Wewillpayfor:
Itemsprescribedbyamedicalpractitionerorspecialist,whichareneededtodeliver,orfacilitatethedeliveryof,prescribeddrugsand
dressings
Thepurchaseandfittingofdevicesoritemsmedicallynecessaryfortreatment,including,butnotlimitedto,spinalsupports,
orthopaedicbracesandaircastboots
Therentalorinitialpurchaseofcrutchesorawheelchairifmedicallynecessary
10.1 Theinitialpurchaseandfittingofexternalprosthesesneededfollowingsurgery,including,butnotlimitedto,artificialeyesandlimbs Nocover
Thepurchaseandfittingofmedicallynecessaryorthoticsupplies,including,butnotlimitedto,insolesandorthoticsupports

Thisbenefitdoesnotextendtosightorhearingaids,thesupply,modificationorfittingoffurniture,oranymodificationstoyourpersonal
orworkenvironment.

Coverisonlyavailableunderthisbenefitifthetreatmentiscoveredundersections2,4,5,7to9or24.

Ifthecostsarerelatedtoamedicalconditioncoveredundersections6,11to14,22.2,22.3or25thesewillbecoveredwithinthebenefitlimitsofthesamesection.Cover
10.2
underthesesectionsdoesnotextendtosightorhearingaids,thesupply,modificationorfittingoffurniture,oranymodificationstoyourpersonalorworkenvironment.

11.0 Congenitalabnormalities(seesection27fordeductibles)
Alltreatmentfordiagnosedcongenitalabnormalitiesandanyrelatedmedicalconditions.Thisincludespalliativetreatmentandcare
11.1 Nocover
duringtheendstagesofacongenitalabnormalityoranyrelatedmedicalcondition
Alltreatmentfordiagnosedcongenitalabnormalitiesandanyrelatedmedicalconditionsthatarediagnosedbeforeaninsuredmemberis
31daysold:
ifthepregnancyistheresultofnaturalconception,
iftheyareaddedtotheplanbeforetheyare31daysold,and
11.2 Notapplicable
thetreatmentwouldnormallybecoveredundersection11.1.
Oncethememberreachesfiveyearsofage,coverwillonlybeavailableundersection11.1.Anycostspaidundersection11.2willnotbe
deductedfromthelifetimelimitshowninsection11.1.
Ifthepregnancyistheresultofassistedconception,coverwillonlybeavailableundersection11.1
11.3 Fororgantransplantsforcongenitalabnormalitiesandanyrelatedmedicalconditions,seesection13.
WIPRO
EffectiveDate:17July2016
SUMMARYOFBENEFITS

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AetnaSummitDubai5000

12.0 HIVorAIDS(seesection27fordeductibles)
12.1 Alltreatment,includingpalliativetreatmentandcare,fordiagnosedHIVorAIDSandallrelatedmedicalconditions. Nocover

Organtransplants(seesection27fordeductibles)
13.0
Foracuteandchronicmedicalconditionsandcongenitalabnormalities
13.1 Kidney,pancreas,liver,heartorlungtransplantsandanyrelatedtreatment. Paidinfull
14.0 Terminalcare(seesection27fordeductibles)
14.1 Palliativetreatmentandcareforamedicalconditionwhichisdiagnosedasterminal. Paidinfull
14.2 Forterminalcarerelatedtocancercare,congenitalabnormalitiesandHIVorAIDS,seesections6,11and12.

15.0 Medicalevacuation

Thecoststotransportyoutothenearestlocationwhereappropriatemedicalfacilitiesareavailable,asagreedbyusandbyyour
attendingmedicalpractitioner.
Thisbenefitwillonlybepaidifyourmedicalconditionisanemergencyandweagreeappropriatetreatmentisnotavailablelocally.
Thisbenefitextendstothecostsforemergencytreatmentyoureceiveduringthejourney.
15.1 Paidinfull
Whereitisnecessarytotransportyououtsideyourareaofcover,anyrelatedcoststhatareincurredinthecountryyouareevacuatedto
willbepayableunderthesectionsofyourBenefitsschedulethatwouldnormallyapplywhenyouarewithinyourareaofcover.
Coverisonlyavailableunderthisbenefitifthetreatmentiscoveredundersections2.1to2.6,4,6,7,9,11to14,22.5or23andyouhave
completedanywaitingperiodsshownintherelevantsection.

Economyclasstravelcostsforyoutogobacktoyourcountryofresidence,oryourhomecountry,afteryouremergencymedical
15.2 Paidinfull
evacuationundersection15.1.
Costsofonedependantorcompanionhavingtoaccompanyyouforanemergencymedicalevacuationundersection15.1.Thisbenefit
willonlybecomeavailableifyourmedicalconditioniscriticaloryouareexpectedtostayinhospitalforsevenormorenights.Wewill
cover:
15.3 Paidinfull
Costsforreturneconomyclasstravel,includingtaxitransferstoandfromthehotelonarrivalanddeparture
Ataxifromthehoteltothehospital,andback,onceaday
Reasonableovernightaccommodationcosts,toincludebreakfast
Thecoststotransportyoutoappropriatemedicalfacilitiestoreceivetreatmentwhenyourmedicalconditionisnotanemergency.
Wewillcovercostsforreturneconomyclasstraveltoalocationofyourchoicewithinyourareaofcoverif:
weagreeappropriatetreatmentisnotavailablelocally,and
15.4 Notcovered
weagreeappropriatetreatmentisavailableinyourchosenlocation.
Wewillalsopayforairporttaxitransfers.
Coverisonlyavailableunderthisbenefitifthetreatmentiscoveredundersections2.1to2.6or4to14.
Thecoststotransportyoutoappropriatemedicalfacilitiesfortreatmentrelatedtoyourpregnancyifthemedicalconditionisnotan
emergency.
Wewillcovercostsforreturneconomyclasstraveltoalocationofyourchoicewithinyourareaofcoverif:
weagreeappropriatetreatmentisnotavailablelocally,and
15.5 weagreeappropriatetreatmentisavailableinyourchosenlocation. Notcovered
Wewillalsopayforairporttaxitransfers.
Youarelimitedtothreereturnjourneysforeachpregnancy.
Coverisonlyavailableunderthisbenefitifthetreatmentiscoveredundersection23andyouhavecompletedanywaitingperiodsshown
insection23.
Costsformedicalevacuationsdonotextendtoairsearescue,oranymountainrescueunlessrelatedtoamedicalconditionyousufferatarecognisedskiresortorsimilar
15.6
wintersportsresort.
16.0 Localambulance
Costsoftheappropriatetypeofambulanceneededtotransportyoutothenearestavailableandappropriatelocalhospitalbecauseofan
emergencyorduetomedicalnecessity.
16.1 Paidinfull
Coverisonlyavailableunderthisbenefitifthetreatmentiscoveredundersections2,4,6,7,9,11to14,19.3,20.2,22.5,22.6,23.2or
23.3andyouhavecompletedanywaitingperiodsshownintherelevantsection.
Costsforlocalambulancesdonotextendtoairsearescue,oranymountainrescueunlessrelatedtoamedicalconditionyousufferatarecognisedskiresortorsimilarwinter
16.2
sportsresort.
17.0 Mortalremains
Intheeventofyourdeathwewillpayreasonablecostsfor:
thetransportationofyourbodyormortalremainstoyourhomecountryoryourcountryofresidence,or
yourburialorcremationattheplaceofyourdeath.
Thisbenefitisonlyavailableifyoudieoutsideyourhomecountry.
Intheeventofburialthisbenefitwillcover:
Thecostofopeningorreopeningagrave
17.1 Anyexclusiverightofburialfee Paidinfull
Burialcosts
Intheeventofcremationthisbenefitwillcover:
Thecostofanydoctorscertificates
Cremationcosts,includingtheremovalofanymedicaldevicebeforethecremation
Thisbenefitdoesnotextendtothepurchaseofaburialplot,orfuneralcosts,including,butnotlimitedto,flowersandthefuneral
directorsfees.
WIPRO
EffectiveDate:17July2016
SUMMARYOFBENEFITS

Category1

AetnaSummitDubai5000

18.0 Compassionateemergencyvisit
Costsyouhavetopayforaneconomyclassreturntravelticketfromacountrywithinyourareaofcoverforyoutovisitaclosefamily
member:
18.1 iftheirmedicalconditioniscritical,or Paidinfull
toattendtheirburialorcremationfollowingtheirdeath.
Youarelimitedtoonereturnjourneyintheplanyear
19.0 DentalTreatment (seesection27fordeductibles)
Outpatientdentaltreatmentforaccidentaldamagetosound,naturalteethwhen:
thetreatmentcanonlybeprovidedafteryouhavereceivedinpatienttreatmentrelatedtotheaccident,and
19.1 Paidinfull
thetreatmentisreceivednomorethan90daysafteryouaredischargedfromhospitalfollowingyourrelatedinpatienttreatment.
Thisbenefitincludesthecosttosupplyandfitdentalimplants.
Outpatientdentaltreatmentforaccidentaldamagetosound,naturalteeth,exceptwhenthedamageiscausedthrougheating.Coveris
19.2 onlyavailablewhentreatmentfortheaccidentaldamageisreceivedwithintendaysoftheaccident.Thisbenefitalsoincludesonefollow Paidupto$1,500
upconsultationwithin30daysoftheaccident.
Outpatientdentaltreatmentwhenyourdentalconditionisanemergency.Wherecoverisprovidedunderthisbenefit,costsarenot
19.3 Paidupto$41,000
payableundersections19.1or19.2.
Routineoutpatientdentaltreatment,includingtreatmentforaccidentaldamagetosound,naturalteethwhenthedamageiscaused
througheating.Thisbenefitcoversdentalexaminations,scraping,cleaningandpolishing,gumtreatment,Xrays,compositefillingsand
19.4 simplenonsurgicalextractionsonly.
Coverisavailableafteryouhavehad182days'continuouscoverfromthedatethatthebenefitwasfirstintroducedonyourplan.This
waitingperiodiswaivedforMHD.
Majorrestorativedentaltreatment,includingtreatmentforaccidentaldamagetosound,naturalteethwhenthedamageiscaused
througheating.Thisbenefitcovers: Paidupto$625
Surgicalextractions,includingwisdomteeth
Rootcanaltreatment
19.5
Coststosupply,fitandrepaircrowns,bridgesanddentures
Xraysneededtosupportmajorrestorativedentaltreatment
Coverisavailableafteryouhavehad182days'continuouscoverfromthedatethatthebenefitwasfirstintroducedonyourplan.This
waitingperiodiswaivedforMHD.
Orthodontictreatment.Thisbenefitcovers:
Orthodonticexaminations
19.6 Coststosupply,fitandrepairorthodonticdevicesoritems Notcovered
Xraysneededtosupportorthodontictreatment
Surgicalandnonsurgicalextractionsneededaspartofyourorthodontictreatment
Dentalimplants.Thisbenefitcovers:
Dentalexaminationsneededfordentalimplants
19.7 Notcovered
Coststosupply,fitandrepairdentalimplants
Xraysneededtosupportthefittingorrepairofdentalimplants
20.0 Opticalcare (seesection27fordeductibles)
Costsofprescription:
Contactlenses
Spectacles
20.1 Spectaclelenses Paidupto$340
Spectacleframes
Thisbenefitalsocoversthecostsofoneconsultationandsightexaminationforthesignsorsymptoms,ormanagementof,naturalornon
medicaldegenerativesightdisorders.Thisincludes,butisnotlimitedto,myopia,hypermetropiaandastigmatism.

Visionaids,visioncorrectionbysurgeryandhearingaids,whentreatmentisneededforamedicalconditionthatisanemergency.Where
20.2 Paidupto$41,000
coverisprovidedunderthisbenefit,costsarenotpayableundersection20.1.

21.0 Wellness
Membersaged18orover:routinehealthchecksincludingcancerscreening,cardiovascularexaminations,neurologicalexaminations,vital
21.1
signtestsandvaccinations. Notcovered
21.2 Membersaged17orunder:routinehealthchecksandvaccinations.
21.3 Preventativeservicesforsightandhearing:onesightexaminationandonehearingexaminationintheplanyear. Paidupto$250
Membersaged17orunder:essentialvaccinationsasshownintheDHAspoliciesandupdates.Wherecoverisprovidedunderthis
21.4
benefit,costsarenotpayableundersection21.2.Vaccinationsfornewbornsarecoveredwithinsection22.8
Paidupto$41,000
PreventativeservicesasshownintheDHAspoliciesandupdates.Wherecoverisprovidedunderthisbenefit,costsarenotpayableunder
21.5
section21.1,21.2or21.3.
VaccinationsandInoculations
21.6 PaidinFull
(Includingthosethataremedicallynecessaryfortravel)Applicableonlyformembersaged18andunde
Pregnancyandchildbirth(seesection27fordeductibles)
22.0
Forpregnanciesresultingfromnaturalandassistedconception

Costsforeightroutineantenatalvisitsforeachpregnancy,toincludereviews,checksandtestsasshownintheDHAspoliciesand Paidinfullwithinthelimitshown
22.1
updates.Thisbenefitalsoincludesantenatalvitaminsandthreeantenatal2Dultrasoundscansforeachpregnancy. insection1.2

22.2 Normaldeliverycostsincludingnursingfeesandhospitalaccommodation.

22.3 Inpatienttreatmentformedicalcomplicationsofmaternityduringpregnancyorchildbirthifthemedicalconditionisnotanemergency. Paidupto$2,750withinthelimit


showninsection1.2
Costsofamedicallynecessarycaesareansectionifthemedicalconditionisnotanemergency.Thisbenefitincludesnursingfeesand
22.4
hospitalaccommodation.
WIPRO
EffectiveDate:17July2016
SUMMARYOFBENEFITS

Category1

AetnaSummitDubai5000

22.5 Costsofterminatingapregnancywhenmedicallynecessary. Paidinfull

22.6 Treatmentforanemergencyrelatedto,ordueto,apregnancy.Thisbenefitdoesnotextendtotheonsetofanormaldelivery.

22.7 Wewillpayreasonablehospitalaccommodationcostsforthenewborntostaywithyouimmediatelyafterchildbirth.

Wewillpaythefollowingroutinecostsforthenewborn
Onephysicalexamination
VitaminK,hepatitisBandBCGvaccinations Paidinfullwithinthelimitshown
22.8 ScreeningtestsforPKU,congenitalhypothyroidism,G6PDorsicklecellandcongenitaladrenalhyperplasia insection1.2
Onehearingexamination
Thisbenefitisonlyavailableforthefirst30daysfrombirth.Wherethenewbornisaninsuredmember,coverwillstillbeprovidedunder
theinsuredmothersplan.
Treatmentneededforuninsurednewborns.Thisbenefitisonlyavailableforthefirst30daysfrombirth,andcoverwillbeprovidedunder
22.9 theinsuredmothersplan.Thisbenefitextendstohospitalaccommodationcostsforacompaniontostaywiththenewborn.Costswillbe
limitedto$30foreachnight.
Thebenefitlimitsshownforsections22.2to22.4applyforeachpregnancy.Whereapregnancyspansmorethanoneplanyear,anybenefitpaidfortreatmentorservices
22.10 receivedintheplanyearwhenthepregnancybeganwillbedeductedfromthebenefitlimitshowninthefollowingplanyear.Thisbenefitdoesnotextendto3Dor4D
ultrasoundscans.
23.0 EnhancedbenefitforPregnancyandchildbirth(seesection27fordeductibles)
Costsfor:
Antenatalcheckupsforanuncomplicatedpregnancy
Antenatalvitamins
Deliverycosts,nursingfeesandhospitalaccommodationcostsforuncomplicatedchildbirth
Postnatalcheckups
Thisbenefitincludescoverforpregnanciesresultingfromnaturalorassistedconception.
Coverforantenatalcheckupsincludesnomorethan12routineantenatalvisitsduringeachpregnancyandoneroutine2Dultrasound
scanineachtrimester.Ifanyadditionalantenatalvisitsorultrasoundscansaremedicallynecessary,wewillaskforfurthermedical
23.1 informationsowecanconsidercoverundersection23.2or23.3. Paidupto$5,500
Wewillpayreasonablehospitalaccommodationcostsforthenewborntostaywithyoufornomorethanfournightsimmediatelyafter
childbirth.Wewillalsopaythefollowingroutinecostsforthenewborn:
Onephysicalexamination
VitaminK,hepatitisBandBCGvaccinations
ScreeningtestsforPKU,congenitalhypothyroidismandG6PD
Onehearingexamination
Thisbenefitisonlyavailableafteryouhavehad12monthscontinuouscoverfromthedatethatthebenefitwasfirstintroducedonyour
plan. This waiting period is waived for MHD.
Treatmentformedicalcomplicationsofmaternitythathappenduetoamedicalconditionduringpregnancyorchildbirth,ifthepregnancy
istheresultofassistedconception.

Wewillpayreasonableaccommodationcostsforthenewborntostaywithyouimmediatelyafteracomplicatedchildbirth.Wewillalso
paythefollowingroutinecostsforthenewborn:
Coveredinthebenefitlimitshown
23.2 Onephysicalexamination
insection23.1
VitaminK,hepatitisBandBCGvaccinations
ScreeningtestsforPKU,congenitalhypothyroidismandG6PD
Onehearingexamination
Thisbenefitisonlyavailableafteryouhavehad12monthscontinuouscoverfromthedatethatthebenefitwasfirstintroducedonyour
plan.ThiswaitingperiodiswaivedforMHD.
Treatmentformedicalcomplicationsofmaternitythathappenduetoamedicalconditionduringpregnancyorchildbirth,ifthepregnancy
istheresultofnaturalconception.

Wewillpayreasonableaccommodationcostsforthenewborntostaywithyouimmediatelyafteracomplicatedchildbirth.Wewillalso
23.3 paythefollowingroutinecostsforthenewborn: PaidinFull
Onephysicalexamination
VitaminK,hepatitisBandBCGvaccinations
ScreeningtestsforPKU,congenitalhypothyroidismandG6PD
Onehearingexamination
IftheEnhancedbenefitforpregnancyandchildbirthhasbeenchosen,whereverthesymbolisshowninsection22,coverwillalsobeavailableinyourchosentierthroughout
theEmirateofDubaifor:
Normalantenatalcosts
Routinedeliverycosts
Treatmentformedicalconditionsthatarenotanemergency
TreatmentforanymedicalconditionsthatareanemergencywillcontinuetobeavailablethroughouttheUnitedArabEmirates.
Ifanycostsforthesametreatmentorservicesarecoveredundersections22and23,coverundersection23willonlybecomeavailableaftertheapplicablebenefitlimitshown
23.4
insection22hasbeenused.Thetotalnumberofroutinevisitsandultrasoundscansavailableundersection23.1willbethenumbershownminusanyvisitsandscanscovered
undersection22.1.
Thebenefitlimitsshownforsection23applyforeachpregnancy.Whereapregnancyspansmorethanoneplanyear,anybenefitpaidfortreatmentorservicesreceivedinthe
planyearwhenthepregnancybeganwillbedeductedfromthebenefitlimitshowninthefollowingplanyear.
Thisbenefitdoesnotextendto3Dor4Dultrasoundscans.
Routinecostsfornewborns,asshowninsection23,areonlycoveredforthefirst30daysfrombirth.Wherethenewbornisaninsuredmember,coverforroutinecostswithin
thefirst30dayswillstillbeprovidedundersection23oftheinsuredmothersplan.
24.0 Hormonereplacementtherapy(seesection27fordeductibles)
24.1 Hormonereplacementtherapyforsymptomsofthemenopause. Covered
WIPRO
EffectiveDate:17July2016
SUMMARYOFBENEFITS

Category1

AetnaSummitDubai5000

25.0 HospitalCash
Paymentmadetoyouforeachnightyoustayinahospitalwhenreceivinginpatienttreatment:
ifyourinpatienttreatmentandhospitalaccommodationareprovidedfreeofcharge,and
25.1 thetreatmentorservicesreceivedwouldnormallybecoveredundersections2.1to2.6,6,9.1,11to14,19.5,22.5or23andyouhave Paidupto$55
completedanywaitingperiodsshownintherelevantsection.
Thisbenefitispayableforupto20nightsintheplanyear.
26.0 Emergencytreatmentoutsideareaofcover(seesection27fordeductibles)

26.1 Inpatientanddaycaretreatmentwhenyourmedicalconditionisanemergencyandyouareoutsideyourareaofcover. Paidupto$50,000

26.2 Outpatienttreatmentwhenyourmedicalconditionisanemergencyandyouareoutsideyourareaofcover. Paidupto$500

Costsoftheappropriatetypeofambulanceneededtotransportyoutothenearestavailableandappropriatelocalhospital.Thisbenefitis
26.3 $500
onlyavailablewhenyourmedicalconditionisanemergencyandyouareoutsideyourareaofcover.

Coverisonlyavailableunderthisbenefitiftheemergencywouldnormallybecoveredundersections2.1to2.6,4,6,7,9.1,9.2,11to14,22.5or23whenyouarewithinyour
areaofcoverandyouhavecompletedanywaitingperiodsshownintherelevantsection.
26.4 Iftheemergencyisduetopregnancyorchildbirthandyouare26weeksormoreintoyourpregnancy,thisbenefitisonlyavailableifyouhavebeenoutsideyourareaofcover
fornomorethan14daysatyourdateofadmissionforemergencyinpatientordaycaretreatmentorthedateyoureceiveemergencyoutpatienttreatment.Travelmustnotbe
againsttheadviceofamedicalpractitioner,specialistornurseatanytimeduringyourpregnancy.
27.0 Deductibles
Outpatientcoinsuranceonsections4,5,7,8.2,8.3,8.4,8.5,9.2,9.3,10,11,12,13,14,19.1,19.2,24and26.2.Thiscoinsuranceisapplied
toeachclaimformedicalpractitionersandspecialistsfeesforanoutpatientconsultation.
Anadditionaldeductiblemayapplyforanyoutpatienttreatmentorservicesreceived:
20%uptoamaximumofAED75for
27.1 InatierthatisnotyourchosentierintheUnitedArabEmirates
eachconsultationwithDirectbilling
OutsideofthenetworkintheUnitedArabEmirates
OutsideofthenetworkoutsideoftheUnitedArabEmirates
Seesections27.9and27.10formoreinformation.

27.2 Emergencydental,visionandhearingcoinsuranceonsections19.3and20.2.Thiscoinsuranceisappliedtoeachclaim. Notapplicable

27.3 Dentalcoinsuranceonsections19.4and19.5.Thiscoinsuranceisappliedtoeachclaim. 20%


27.4 Orthodonticcoinsuranceonsection19.6.Thiscoinsuranceisappliedtoeachclaim. Notapplicable
27.5 Dentalimplantscoinsuranceonsection19.7.Thiscoinsuranceisappliedtoeachclaim. Notapplicable
27.6 Opticalcarecoinsuranceonsection20.1.Thiscoinsuranceisappliedtoeachclaim. 20%
27.7 Maternitycoinsuranceonsections22.1to22.4.Thiscoinsuranceisappliedtoeachclaim. 10%
Maternitycoinsuranceonsections23.1and23.2.Thiscoinsuranceisappliedtoeachclaim
Anadditionaldeductiblemayapplyfortreatmentorservicesreceived:
InatierthatisnotyourchosentierintheUnitedArabEmirates 10%uptoamaximumofAED75for
27.8
OutsideofthenetworkintheUnitedArabEmirates eachconsultationwithDirectbilling
OutsideofthenetworkoutsideoftheUnitedArabEmirates
Seesections27.9and27.10formoreinformation.

Outoftiercoinsuranceonsections2.1,2.2,2.3,2.4,2.5,2.6,3.1,4,5,6,7.5,8.1,8.2,8.4,8.5,9.1,9.2,11,12,13,14,22.5,23and24ifthe
treatmentorservicesarereceivedataproviderintheUnitedArabEmiratesand:
theproviderisincludedinatierthatisnotyourchosentier,or
27.9 25%
theproviderisnotinthenetwork.
Thiscoinsuranceisappliedtoeachclaimafterthedeductionofanyotherapplicablecoinsuranceshowninsection27.1or27.8.
Thiscoinsurancedoesnotapplyifthetreatmentorservicesreceivedareneededduetoanemergency,orifTier1UAEisyourchosentier.

Outofnetworkdeductibleonsections2.1,2.2,2.3,2.4,2.5,2.6,3.1,4,5,6,7.5,8.1,8.2,8.4,8.5,9.1,9.2,11,12,13,14,22.5,23and24if:
treatmentorservicesarereceivedoutsideoftheUnitedArabEmirates,
anappropriateproviderwithinthenetworkisavailableinthelocationwhereyoureceivetreatmentorservices,butyoureceive
treatmentorservicesataprovideroutsideofthenetwork,and
thecostoftreatmentorservicesisgreaterthanthecostthatwouldhavebeenincurredifthetreatmentorserviceswerereceived Deductionforreasonableand
27.10
withinthenetworkinthesamelocation. customarycosts
Thevalueofthedeductiblewillbethedifferencebetweenthecostofthetreatmentorservicesreceivedandthecostthatwouldhave
beenincurredifthetreatmentorserviceswerereceivedwithinthenetworkinthesamelocation.
Thisdeductibleisappliedtoeachclaimbeforethedeductionofanyotherapplicablecoinsuranceshowninsection27.1or27.8.
Thisdeductibledoesnotapplyifthetreatmentorservicesreceivedareneededduetoanemergency,orifTier1UAEisyourchosentier.

28.0 Healthmanagementservices
28.1 Chronicconditionanddiseasemanagementtoprovidetailoredinformationandaccesstoanursetodiscussyourhealth. Included
EmployeeAssistanceProgrammeonlineandtelephonicconfidentialsupportincludingcounselling,informationandguidance.Logonto
28.2 Included
theSecureMemberWebsiteorcontactourMemberServicesTeamformoreinformation
EmployeeAssistanceProgrammeinpersonconfidentialsupportincludingcounselling,informationandguidance.LogontotheSecure
28.3 Included
MemberWebsiteorcontactourMemberServicesTeamformoreinformation
28.4 Thecoverprovidedundersections28.2and28.3includesacombinedmaximumoffivesessionsofcounsellingineachplanyear.
29.0 red24SecurityServices
AdviceLine24/7personalsecurityinformationandadviceforallyourtravelsafetyqueries.Pleasecontactred24orvisit
29.1 Included
www.red24.com/aetna
WIPRO
EffectiveDate:17July2016
SUMMARYOFBENEFITS

Category1

AetnaSummitDubai5000
ActionResponse24/7internationalrescueandresponseserviceforyouinapotentiallylifethreatening,nonmedicalevent.Please
29.2 Included
contactred24orvisitwww.red24.com/aetna
Circumcision
ElectiveCircumcisionThecostofmedicalproceduresfortheelectivecircumcisionofmalechildrenatanytimebeforetheir5thbirthday. Covered