Area I
Area of Cover Area IV
Area II
Pre-existing Conditions
Covered Covered
and Chronic Conditions
Cigna Insurance Middle East S.A.L. (Dubai Branch), is the local insurer in UAE, Oman, Kuwait and Lebanon. Products are designed and internationally
serviced by Cigna.
Registered and authorised by the UAE Insurance Authority as a branch of a foreign insurance company under registration No. 48 on 31 December
1984.
Companion Accommodation
The cost of accommodation of a person accompanying an in-patient
Paid in Full Paid in Full
member in the same room in cases of medical necessity at the
recommendation of the treating doctor. Subject to prior approval.
Parental Accommodation
This applies to dependent children under the age of 18. We will pay Paid in Full Paid in Full
reasonable costs for a parent staying in the same hospital with the child.
Organ Transplant
We will consider charges made for or in connection with approved organ
transplant services, including immunosuppressive medications, organ
procurement costs, and donor’s medical costs. The amount payable for
donor’s medical costs is reduced by the amount payable for those costs
Paid in Full Paid in Full
from any other plan or source. Certain transplants will not be covered
based on general limitations (i.e. experimental procedures).
Cigna Insurance Middle East S.A.L. (Dubai Branch), is the local insurer in UAE, Oman, Kuwait and Lebanon. Products are designed and internationally
serviced by Cigna.
Registered and authorised by the UAE Insurance Authority as a branch of a foreign insurance company under registration No. 48 on 31 December
1984.
Psychiatric Care
This benefit will be paid in respect of in-patient non-emergency psychiatric
Paid in Full Paid in Full
conditions, other mental disorders or addictive conditions for a maximum
of 20 days in any one year of insurance.
Private Ambulance
This benefit is payable for transport to or from a hospital when ordered for Paid in Full Paid in Full
medical reasons.
US$13 - Deductible
(No additional
Consultations with Medical Practitioners, Family Doctors and Specialists Paid in Full
coinsurance applies if
follow up visit made
within 7 days)
Cancer Treatment
This benefit includes: radiology, radiography, chemotherapy, pathology Paid in Full Paid in Full
and radiotherapy.
Non-Surgical and Minor Surgical Procedures and Treatment Paid in Full Paid in Full
Alternative Therapies
This benefit includes: acupuncture, chiropody, chiropractor, osteopathy Excluded Paid in Full
and homeopathy.
Cigna Insurance Middle East S.A.L. (Dubai Branch), is the local insurer in UAE, Oman, Kuwait and Lebanon. Products are designed and internationally
serviced by Cigna.
Registered and authorised by the UAE Insurance Authority as a branch of a foreign insurance company under registration No. 48 on 31 December
1984.
Well Child Tests
Up to US$272.48
This benefit will be payable for dependent children aged 6 and under, with Paid in Full
per year of insurance
immunisation covered up to the age of 18.
Psychiatric Care
This benefit will be paid in respect of non-emergency out-patient Paid in Full Paid in Full
psychiatric conditions, other mental disorders or addictive conditions
Routine In-Patient
This benefit is payable to eligible females covered under this plan.
Paid in Full Paid in Full
Routine Out-Patient
This benefit is payable to eligible females covered under this plan.
Complicated In-Patient
This benefit is payable to eligible females covered under this plan, and
includes non-elective Caesarean sections.
Paid in Full Paid in Full
Complicated Out-Patient
This benefit is payable to eligible females covered under this plan.
Newborn Care
Paid up to 30 days under the mother’s policy for dependants.
This benefit provides cover for newborns for up to 30 days from birth. Paid in Full Paid in Full
Includes BCG, Hepatitis B and neo-natal screening test. (Phenylketonuria
(PKU), Congenital Hypothyroidism, sicklecell screening, congenital adrenal
hyperplasia).
Cigna Insurance Middle East S.A.L. (Dubai Branch), is the local insurer in UAE, Oman, Kuwait and Lebanon. Products are designed and internationally
serviced by Cigna.
Registered and authorised by the UAE Insurance Authority as a branch of a foreign insurance company under registration No. 48 on 31 December
1984.
Mammograms for Breast Cancer Screening
This benefit will be paid in respect of:
• one baseline mammogram for asymptomatic women aged 35-39;
• a mammogram for asymptomatic women aged 40-49 every two years;
• a mammogram every year for women aged 50 and over.
All chronic conditions requiring hemodialysis or peritoneal dialysis, and Paid in Full Paid in Full
related investigations, treatments or procedures
Emergency medical, dental, gum, hearing and vision treatment, if life Paid in Full Paid in Full
threatening*
(Emergency is defined as a situation that calls for immediate medical
intervention by a health services provider for the rescuing of a person’s life
or the elimination of the danger threatening that person’s life.)
Cigna Insurance Middle East S.A.L. (Dubai Branch), is the local insurer in UAE, Oman, Kuwait and Lebanon. Products are designed and internationally
serviced by Cigna.
Registered and authorised by the UAE Insurance Authority as a branch of a foreign insurance company under registration No. 48 on 31 December
1984.
Emergency Psychiatric Conditions*
This benefit will cover in-patient and out-patient acute emergency
psychiatric conditions.
Paid in Full Paid in Full
(Emergency is defined as a situation that calls for immediate medical
intervention by a health services provider for the rescuing of a person’s life
or the elimination of the danger threatening that person’s life.)
Injuries resulting from attempted suicide or self-inflicted injuries Paid in Full Paid in Full
Prosthetic devices and medical equipment when determined as medically Paid in Full Paid in Full
necessary and approved by the insurance company
Dental Care
Up to
Plan Annual Maximum US$680
Not Covered
Annual list of benefits maximum per member or dependant. per year of
insurance
Dental Benefits Core Voluntary
Cigna Insurance Middle East S.A.L. (Dubai Branch), is the local insurer in UAE, Oman, Kuwait and Lebanon. Products are designed and internationally
serviced by Cigna.
Registered and authorised by the UAE Insurance Authority as a branch of a foreign insurance company under registration No. 48 on 31 December
1984.
Class One
Investigative and Preventative Treatment.
Paid in Full
Benefits include:
• X-rays, Scale and Polish.
Class Two
Basic Restorative Treatment, Periodontal Treatment and Treatment of
Dental Injury.
Paid in Full
Benefits include:
• Root canal treatment, extractions, surgical procedures, occasional
treatment, anaesthetics, periodontal treatment. Not Covered
Class Three
Major Restorative Treatment.
Notes
1. Examinations and Scale and Polish will both be limited to 2 visits per year of insurance.
2. Full case assessment will be limited to one per year of insurance.
3. X-rays will be limited to four Bitewings and six Intra Oral per year of insurance and OPG every 3 years.
4. Prolonged periodontal treatment limit of one course per year of insurance.
Medical expenses for the treatment of below items or consequences as a result of it are not covered
unless specifically mentioned as covered in the list of benefits.
We will not pay benefit for the following treatment and extras:
Cigna Insurance Middle East S.A.L. (Dubai Branch), is the local insurer in UAE, Oman, Kuwait and Lebanon. Products are designed and internationally
serviced by Cigna.
Registered and authorised by the UAE Insurance Authority as a branch of a foreign insurance company under registration No. 48 on 31 December
1984.
a. used to improve speech skills that have not fully developed;
b. can be considered custodial or educational; or
c. intended to maintain speech communication.
2. Dental or orthodontic benefit unless benefit is specifically provided in the list of benefits.
5. Charges for residential stays in a hospital that is arranged wholly or partly for domestic
reasons or where treatment is not required or where the hospital has effectively become
the place of domicile or permanent abode.
9. Treatment by way of nursery care for a dependent in a hospital following childbirth, unless
due to medical necessity during treatment that is otherwise covered by this policy where
pregnancy is a covered benefit under the plan
10. Supportive treatment for chronic kidney failure or kidney failure that cannot be cured.
Treatment for kidney dialysis will be covered if such treatment is available in the location of
assignment.
11. Treatment to change the refraction of one or both eyes, including refractive keratotomy (RK)
and photorefractive keratectomy (PRK), unless we agree in writing.
12. Injury or disability directly or indirectly caused or contributed to whilst engaging in or taking
part in war, invasion, act of terrorist activities, rebellion (whether war be declared or not),
civil war, commotion, military or usurped power, martial law, riot or the act of any lawfully
constituted authority, or while the employee or dependents are carrying out army, naval or
air services operations, whether or not war has been declared.
13. Treatment outside the selected area of coverage if one of the reasons the patient travelled
was for that treatment, except if the medical assistance service has arranged emergency
evacuation or medical repatriation.
14. Any expenses for international emergency services that were not approved in advance by
the medical assistance service.
15. Expenses for emergency evacuation, medical repatriation and transportation costs for third
parties where the treatment needed is not covered under the plan or where authorization
procedures have not been properly followed.
18. Treatment for or in connection with developmental disorders, including but not limited to:
Cigna Insurance Middle East S.A.L. (Dubai Branch), is the local insurer in UAE, Oman, Kuwait and Lebanon. Products are designed and internationally
serviced by Cigna.
Registered and authorised by the UAE Insurance Authority as a branch of a foreign insurance company under registration No. 48 on 31 December
1984.
• Developmental reading disorders;
• Developmental arithmetic disorders;
• Developmental language disorders;
• Developmental articulation disorders;
19. Treatment for or in connection with non-medical counselling or ancillary services for
learning disabilities, developmental delays, autism or cognitive or developmental
disabilities.
20. Private prescription or dressing for use as an out-patient unless the out-patient list of
benefits has been chosen and benefit is covered under that list.
21. Hospital accommodation costs that are more expensive than those of a standard private
room unless mentioned in the list of benefits.
22. Sex change operations or any treatment needed to prepare for or recover from these
operations (for example, psychological counselling) including complications arising out of
such treatment.
23. Treatment that arises from or is any way connected with injury, sickness or disablement as
a result of:
• taking part in a sporting activity on a professional basis; or
• solo scuba-diving or scuba diving at depths below 30 metres unless the diver is PADI
qualified (or equivalent) for that depth.
24. Any form of experimental treatment (or procedure) that does not amount to orthodox
treatment or does not adhere to the commonly accepted, customary or traditional practice
of medicine in the country where the services were rendered and which meet minimum
international standards of medicine.
25. For claim payments that are illegal under applicable law in particular where claim payment
contravenes any applicable sanction laws as more specifically stated in the Preamble.
26. Assistance in the activities of daily living, including but not limited to eating, bathing,
dressing or other custodial services or self-care activities, homemaker services and services
primarily for rest, domiciliary or convalescent care.
27. Medical and surgical services, initial and repeat, intended for the treatment or control of
obesity, including: medical and surgical services to alter appearance or physical changes that
are the result of any surgery performed for the management of obesity and weight loss
programs or treatments, whether prescribed or recommended by a medical practitioner or
under medical supervision.
28. For reports, evaluations, physical examinations, or hospitalization not required for health
reasons including, but not limited to, employment, insurance or government licenses, and
court-ordered, forensic or custodial evaluations.
29. Routine foot care, including the paring and removing of corns and calluses or trimming of
nails.
30. Membership costs or fees associated with health clubs, weight loss programs and smoking
cessation programs.
Cigna Insurance Middle East S.A.L. (Dubai Branch), is the local insurer in UAE, Oman, Kuwait and Lebanon. Products are designed and internationally
serviced by Cigna.
Registered and authorised by the UAE Insurance Authority as a branch of a foreign insurance company under registration No. 48 on 31 December
1984.
• any form of sterilisation or contraception including vasectomy;
• any form of plastic, cosmetic or reconstructive surgery, even for psychological reasons,
unless it is of medical necessity as a direct result of the patient having an accident which
had happened when the plan was in force.
• appliances (including spectacles unless the vision benefit has been selected and hearing
aids).
• hearing tests, except for one hearing test per annum for a dependant child under the age
of 15 year only where medically necessary.
• incidental costs including newspapers, taxi fares, telephone calls, guests’ meals and hotel
accommodation;
• routine examinations or tests including health screens and medical examinations except
for Child Wellness Tests where this benefit has been selected
• costs or fees for filling in a claim form or other administration charges.
• costs that have been or can be paid by another insurance company, person, organization
or public program. If the employee or dependant is covered by other insurance, we will
only pay its part of the benefit. If another person, organization or public program is
responsible for paying the costs of treatment, we may claim back any of these costs it has
paid.
• costs for treatment that has not yet taken place irrespective of whether advance
authorization has been given or a guarantee of payment has been put in place.
33. We will not offer cover or pay benefit when it is illegal to do so under applicable laws.
Example including but not limited to, exchange controls, local licensing regulations,
sanctions, anti-corruption or trade embargo.
a. purely cosmetic;
b. not necessary for continued oral health;
c. in any way caused by the patient carrying out an illegal act.
Cigna Insurance Middle East S.A.L. (Dubai Branch), is the local insurer in UAE, Oman, Kuwait and Lebanon. Products are designed and internationally
serviced by Cigna.
Registered and authorised by the UAE Insurance Authority as a branch of a foreign insurance company under registration No. 48 on 31 December
1984.
c. replacing a bridge, crown or denture within five years of original fitting unless:
I. the replacement is needed because of the placement of an original opposing full
denture or extraction of natural teeth is needed; or
II. the bridge, crown or denture, while in the mouth, has been damaged beyond repair
because of an injury the employee or their dependant receives while covered under
the plan.
d. porcelain or acrylic veneers on the upper and lower first, second and third molars and
premolars;
e. crowns or pontics on or replacing the upper and lower first, second and third molars
unless:
I. they are constructed of either porcelain bonded-to-metal or metal alone, e.g. gold
alloy crown; or
II. a temporary crown or pontic is required as part of routine or emergency dental
treatment.
g. procedures and materials which are experimental or which do not meet accepted
dental standards;
j. orthodontic treatment for employees and dependants who are over the age of 18
(orthodontic treatment will only be paid for dependant children who are under the age
of 18. In this case, the employee or dependant must send the following information
prepared by the dentist who is to carry out the proposed treatment to us before
treatment starts, so that we can confirm how much benefit will be payable (benefit will
be payable only if we have confirmed cover before treatment starts):
I. a full description of the proposed treatment;
II. X-rays and study models;
III. an estimate of the cost of the treatment.
Cigna Insurance Middle East S.A.L. (Dubai Branch), is the local insurer in UAE, Oman, Kuwait and Lebanon. Products are designed and internationally
serviced by Cigna.
Registered and authorised by the UAE Insurance Authority as a branch of a foreign insurance company under registration No. 48 on 31 December
1984.
These exclusions are applicable if a Vision option has been selected
We will not pay benefit for the following treatment and extras:
• Lenses which are not a medical necessity and are not prescribed by an Optometrist or
Ophthalmologist or frames for such lenses
Cigna Insurance Middle East S.A.L. (Dubai Branch), is the local insurer in UAE, Oman, Kuwait and Lebanon. Products are designed and internationally
serviced by Cigna.
Registered and authorised by the UAE Insurance Authority as a branch of a foreign insurance company under registration No. 48 on 31 December
1984.