Introduction:
CEO's Message
Nothing is more important than the 'Individual'. No organization
can survive and prosper without the efforts, creative instincts and
attributes of the 'Individual'. It is on this basis that we at
Green Crescent have embarked on creating a locally based, globally
reaching, solution-orientated operation that holds at its very
essence a genuine endearment and regard for the 'Individual'. By
employing proven industry procedures, quality associates and
providers, and high-end service focused innovations, we aim at
delivering a health Insurance experience that is easy, secure and
reliable - in a word, superior.
It is indeed an exciting time for us as we prepare to launch a
host of services - including Care Management, Flexible Plan
Structures and the E-Claims System - that target your health and
peace of mind. More than an Insurance company, I'd like to think of
Green Crescent as a health company that specializes in insuring
your health. It is this commitment to quality and service that will
ultimately set us apart and allow us to transform the health
Insurance industry in this region. After all, our success (and the
corporation's) depends not only on numbers and features, but rather
on how well 'taken care of' you feel as you enjoy your lives. It is
on that note that I present to you Green Crescent - a company that
truly puts your health first.
Welcome
Message
Welcome to Green Crescent Insurance Company. This member guide
will help you identify the benefits and rules of your health
Insurance plan. For specific details of your insurance contract,
please refer to your employer, or contact Green Crescent
directly.
Thanks to the package negotiated by your company, you and your
family have access to the best healthcare available. As far as
Green Crescent is concerned, your health is the number one
priority.
About Green
Crescent
Our organization was founded in 2008 as a public joint stock
company with a vision of bringing health back into health insurance
by introducing professional, affordable, high caliber healthcare
services to clients. Subsidized by a paid up capital of AED 250
million, we currently operate in Abu Dhabi and Dubai, providing
tailor-made health insurance solutions to groups and corporate
clients throughout the UAE.
What our organization offers is a global commitment to providing
clients with world-class healthcare, utilizing product innovations,
technology and a network of leading Healthcare Providers. We have
adopted the industry's most stringent international quality
measures and practices to ensure that first class medical service
provision is a nothing short of a tangible reality for our
customers. We have forged contractual agreements with two of the
most reputable Insurance companies in the US. These associations -
along with other international agreements - translate into
convenient, reliable and comprehensive solutions for our
clientele.
At Green Crescent, we believe that an ounce of prevention is
better than a pound of cure. So along with our commitment to
quality, we are dedicated to running numerous awareness and
prevention campaigns in order to promote a healthier, happier
'you'. Ultimately, what we aim to achieve is a paradigm shift in
quality, convenience and professional service, changing the way
that you view healthcare insurance.
Green Crescent Insurance
Card
As individuals, our needs are different. That is true for
corporations as well. To meet these different needs, we have
provided the flexibility for your employer to design a health
insurance plan that is individually tailored to the needs of the
organization. Green Crescent offer plans that define your
territorial coverage and annual limit combined with selections from
our menu of benefits.
Coverage
Your Green Crescent Insurance card ensures that you receive
services and benefits that are offered in your specific Health
Insurance Plan. You can use these services from the effective date
that appears on your card.
Please carry your Green Crescent card with you at all times and
identify yourself as a Green Crescent card holder whenever you seek
any of the services provided by our extensive range of Network
Providers.
As a Green Crescent Card holder, you are entitled to enjoy free
medical services from our worldwide range of Network Providers
after paying your share of Deductibles/Co-Payments if indicated on
your card. These include both In-patient and Out-patient
services.
What are my
Benefits?
For full details on the services you are eligible to use, please
refer to your personalized Schedule of Benefits. This Schedule
contains all the necessary information you need, including
guidelines on your Benefits, Exclusion, Network Providers and
Territorial Coverage.
Click here
What are; Reimbursement',
Co-Insurance,' and 'Deductible'?
Reimbursement is the repayment of expenses that
have been incurred by the Insured Person for medical services that
are covered under their Health Insurance Plan but are carried out
at a Non-network facility within the scope of geographical coverage
of their policy.
Deductible
refers to a defined monetary amount that is deducted from the
Eligible Expenses and which the Insured Person is liable and is
defined under the terms of the Insured Person's specific Green
Crescent Health Plan. There is no reimbursement for this amount.
For example at each provider visit you will pay a small amount.
Follow up within ten days of initial consultation is not applicable
(conditions apply).
Co-Insurance refers to the part of Eligible
Expenses generally expressed as a percentage and which the Insured
Person are required to pay, or do not get reimbursed, for certain
Health Services provided under the Insurance contract.
When would I need a
Pre-approval?
Some procedures that are offered
by Green Crescent providers require a 'Pre-approval' before they
are given. These procedures include (but are not restricted
to):
- Hospitalization and Day-Care;
- Surgery;
- Catheterization and endoscopies;
- Physiotherapy;
- Long term medication for more than 30 days;
- Dental Services;
- Health Services which needs a prior approval as mentioned on
your Schedule of Benefits
A request for a Pre-approval is
intended to help the Insured Person:
- Understand their medical care choices
- Avoid unnecessary Health Services, Hospital stays and
Surgery
- Receive maximum Benefits from the Plan
- Find Network Providers.
If Pre-approval is
required, what should I do?
Pre-approval procedure will be taken care of by the respective
Network Provider. For out of network, you will have to obtain the
necessary pre-approval by asking the doctor to fill the
Pre-approval form and then call our toll- free number to send the
request
How long should I wait
for the Pre-approval?
Pre-approval is initiated once all the medical information
relating to your case has been given by your Network Provider. The
services will then be approved (according to the terms and
conditions of your policy) within a maximum of 24 hours.
Do I need a Pre-approval
for emergency admissions?
Emergency health services do not require Pre-approval, but
notification should be made to Green Crescent within 24 hours, or
as soon as reasonably possible. If these emergency services were
delivered by Non-Network Providers, full details of the occurrence
must be communicated to Green Crescent in order for
reimbursement.
In order to enjoy the service of direct billing and to avoid
out-of-pocket expenses, we advise you to use the medical services
provided by our extensive range of Network Providers.
How do I submit a claim
for Reimbursement?
To submit a claim for Reimbursement, you need to get the Green
Crescent Claim Reimbursement form duly filled, signed and stamped
by your consulting doctor. The form can be downloaded from our
website www.green-crescent.com or obtained from our customer
service center 800-42-GCIC (4242) or by clicking here.
Please ensure that all the
required forms and documents are correctly completed and attached
to the form. These include:
- Copy of your Green Crescent Card
- Dated itemized bill/invoice
- Original medication prescription, as supplied by the physician
responsible for your treatment.
- Investigation results (such as laboratory test results,
x-rays)
- Medical report or discharge summary (for In-patients stays,
this must be stamped and signed by the physician responsible for
your treatment).
- Copy of passport or similar document, (such as e-gate ticket)
that shows exit and re-entry to UAE (required for treatment outside
of the UAE only).
Please Note:
- DOCUMENTS THAT ARE WRITTEN IN ANYTHING OTHER THAN ARABIC OR
ENGLISH WILL REQUIRE TRANSLATION INTO EITHER ONE OF THESE
LANGUAGES. Once completed, the form and documents can be submitted
to your Human Resource Department.
- FORMS SUBMITTED WITH INCOMPLETE OR MISSING DOCUMENTS WILL NOT
BE PROCESSED AND WILL BE RETURNED TO YOU.
When can I expect my
payment for Reimbursement and how should I collect
this?
On submitting a complete claim (refer to Guidelines on claim
form) an acknowledge receipt is issued. From the day of
acknowledgement receipt the claim will be processed within 10
working days.
How do I appeal my claim?
You are entitled to resubmit your claim for a second,
independent review, or you can call our customer service department
for any queries regarding your claim settlement. 800 42 GCIC
(4242)
Dental
Coverage:
If dental coverage has been included in your Plan, this will be
indicated on your card as "DB". For exact details of coverage and
limit, please refer to your Schedule of Benefits
Maternity
Coverage:
If maternity services have been included in your Plan, this will
be indicated on your card as "MB". For exact details of coverage
and limit, please refer to your Schedule of Benefits.
Please Note:
INSIDE THE EMIRATE OF ABU DHABI, ALL MARRIED FEMALES ARE
ENTITLED TO MATERNITY COVERAGE BY LAW.
Optical Coverage:
If optical services have been included in your Plan, this will
be indicated on your card as "OB". For exact details of coverage
and limit, please refer to your Schedule of Benefits.
Network
Providers
- What is a 'Network'?
A Network is an arrangement of various contracted Healthcare
Providers that provide Healthcare Services to members on direct
billing basis designated for a particular Healthcare Plan.
- What is a
'Network Provider'
A provider is a health care professional or facility that provides
medical care, such as a doctor, specialist, nurse, health center,
physical therapist, laboratory, or hospital
- What does 'Territorial Limit' mean?
This is a specified country or geographical region that is
designated for a particular Insurance Plan. Inside this area, you
are covered for healthcare Insurance according to the terms of your
individual Schedule of Benefits.
Green Crescent's Network Providers
NAS
is one of our associates that provides healthcare coverage in UAE,
Qatar, Kuwait, Oman, Bahrain, Egypt, Thailand, Jordan, Yemen,
Libya, Saudi Arabia, India. NAS is a leading Third Party
Administrator in the UAE.
UnitedHealthcare (UHC) is an operating division
of UnitedHealth Group, the second largest health carrier in the
United States. UHC's nationwide network includes approximately
700,000 physicians and health care professionals. Revenues exceed
$80 billion annually. Through UHC, eligible Green Crescent members
will have access to approximately 700,000 physicians, and health
care professionals in the U.S. on a Direct Billing basis for
in-patient and out-patient services.
a. How do I receive medical treatment in the US?
Green Crescent services in the US are provided at the UHC
network facilities by UnitedHealthcare on a direct billing basis .
For any enquiries related to your coverage in the United States,
contact 800 382 9084 inside the USA.
HTH
Worldwide
Green Crescent has partnered with HTH to provide healthcare
cover at over 180 countries Worldwide (excluding USA & Canada).
Members registered on Green Crescent website have access to the
Global Health and Safety services provided by HTH for the following
services.
- A Provider search tool
- Physician profiles
- Country healthcare profiles
- Country security profiles
- Translation (in over 12 languages) of:
- Drug names and dosages
- Medical phrases and terminology
4. Which Network
applies in which countries?
- NAS Networks - UAE, Qatar, Kuwait, Oman, Bahrain, Egypt,
Thailand, Jordan, Yemen, Libya, Saudi Arabia, India, Germany,
UK
- UnitedHealthcare Network - USA
- HTH - Over 180 countries Worldwide ( excluding USA &
Canada)
5. What are 'International Emergency Assistance
Services?'
International Emergency Assistance Services are offered
worldwide by IPA (Inter Partner Assistance) based in Munich,
Germany. These services include:
- Medical evacuation
- Assistance with lost or delayed baggage
- Repatriation after treatment and repatriation of mortal remains
to Home Country
- Advance payment of medical expenses
- Transmission of urgent messages
Members covered for International Emergency cover through IPA
can contact +49 895 007 0255 for any enquiries or assistance.
6. How can I receive treatment through HTH?
Healthcare services worldwide, except in countries mentioned
under NAS Network are provided through HTH Network Providers. If
your Healthcare Insurance Plan offers coverage in a country covered
by HTH, you can receive treatment by:
- Pre-arranged service, i.e. filling the International Treatment
Request form and submitting it to GCIC, along with your medical
reports at least four 4 or 5 days in advance of your proposed
treatment date, upon which GCIC will issue a 'Guarantee Of Payment'
(GOP), which is sent to HTH for arranging services through their
network providers.
Terminology and Definitions
This section defines terminology used in this Insurance Contract
that is not defined elsewhere. It is not intended to give any
indications with respect to the Insured Person's eligibility or
non-coverage.
1. Annual Limit
The Annual Limit refers to the maximum total amount per year that
Green Crescent will pay or reimburse as Eligible Expenses per
annum, and depending on the case either for the Health Services as
a whole or related to a certain type of Health Services.
2. Accident
Accident refers to an unforeseen, unexpected or unintended event
involving an external force or impact to the body.
3. Co-Insurance
Co-Insurance refers to the part of Eligible Expenses generally
expressed as a percentage and which the Insured Person is required
to pay and is not eligible for reimbursement for certain Health
Services provided under the Insurance Contract.
4. Congenital Anomaly
Congenital Anomaly refers to a physical or chemical defect, disease
or malformation etc. which may be either
hereditary/familial/genetic, or due to an influence occurring
during gestation up to birth and which may or may not be obvious at
birth.
5. Day-Care
This refers to procedures of Health Care Services and Supplies:
- that must be provided in and require specialized medical
attention and care in a Hospital before, during and/or after a
surgery, treatment or test; and
- that are performed on a same day basis in that Hospital;
and
- that do not medically require an overnight stay in the
Hospital; and
- that cannot be provided in an Out-patient facility, as, for
instance, a Physician's office
6. Deductible
Deductible refers to the defined monetary amount that is deducted
from the Eligible Expenses and which an Insured Person is required
to pay and is not eligible for reimbursement for certain Health
Services provided under the Insurance Contract.
7. Durable Medical Equipment
Durable Medical Equipment refers to medical equipment used
externally from the human body which:
- can withstand repeated use; and
- is not designed to be disposable; and
- is used to serve a medical purpose; and
- is generally not useful to a person in the absence of a
Sickness or Injury; and
- is used outside of the Hospital.
8. Effective Date
The Effective Date refers to the first day that the Insurance
Coverage becomes effective for an Insured Person, taking into
account all of the conditions of the Insurance Contract that apply
before the commencement of Insurance Coverage for that person.
9. Effective Period of Insurance Coverage
The Effective Period of Insurance Coverage refers to the period
that an Insured Person is effectively insured between the
Commencement Date and Termination Date of the Contractual Insurance
Coverage (both days inclusive)
10. Eligible Expenses
Eligible Expenses refers to reasonable and customary expenses,
charges and fees incurred for a covered medical treatment by the
Insured Person.
11. Emergency
An Emergency refers to an acute onset of a medical or surgical
condition, manifested by acute symptoms of sufficient severity,
including pain. It is defined by a concern that the absence of
immediate treatment at a Healthcare facility until stabilization of
the patient could reasonably be expected to result in placing the
patient's health or bodily functions in serious jeopardy or
dysfunction of any body organ or part.
12. Emergency Health Services
Emergency Health Services refers to the Health Care Services and
Supplies necessary for the treatment of an Emergency.
13. Experimental, Investigational or Unproven
Services
This refers to Health Care Services and Supplies, including
medical, surgical, diagnostic, or other health care services,
technologies, supplies, treatments, procedures, drug therapies or
devices that, at the time GCIC makes a determination regarding
eligibility in a particular case, is determined to be:
Subject to formal review and approval by local medical
authorities for the proposed use; or
The subject of an ongoing clinical trial; or
Not demonstrated through prevailing pre-reviewed medical
literature to be safe and effective for treating or diagnosing the
condition or illness for which its use is proposed.
GCIC, in its judgment, may deem an Experimental, Investigational
or Unproven Service to be a Covered Health Service for treating a
life threatening Sickness or condition, if it is determined by GCIC
that the Experimental, Investigational or Unproven Service at the
time of the determination:
- Is safe with promising efficacy; and
- Is provided in a clinically controlled research setting.
14. Green Crescent Card
Green Crescent's Card refers to the identification card Green
Crescent issues for every Insured Person under this Insurance
Contract.
15. Green Crescent Insurance Certificate
Green Crescent Insurance Certificate refers to the certificate
Green Crescent issues for every Insured Person that contains
certain information that is specific to the Insured Person;
including, but not limited to:
- Insured Person's s identification information;
- Personal Information; such as birth date, gender, marital
status and family status;
- Specific Insured Person's Exclusions, if applicable
- Any Pre-Existing Medical Conditions accepted by Green Crescent
for the Insurance Coverage, if applicable
- Any other information that GCIC deems appropriate.
16. Health Services
The term 'Health Services' refers to Health Care Services and
Supplies as described below.
17. Health Care Services and Supplies
Health Care Services and Supplies is a generic name for health care
services and supplies including Physician consultation, other
Providers consultation, prescribed drugs, diagnostic tests and
treatments, Surgery, and room and board in case of
Hospitalization.
18. Hospital
Hospital refers to an institution, licensed as a Hospital,
which:
- is primarily engaged in providing Health Services on an
In-patient basis for the care and treatment of injured or sick
individuals through medical, diagnostic and surgical facilities by
or under the supervision of a staff of Physicians; and
- has a 24 hour skilled nursing service.
The following are not considered as Hospital:
- a place for rest, custodial care, or care of the aged;
- a nursing home, convalescent home or similar institution.
19. Hospitalization
Hospitalization refers to an uninterrupted overnight stay in a
Hospital.
20. Hospitalization Class
Hospitalization Class refers to the class of Hospitalization
accommodation (including room and services) for which Insured
Persons are eligible and for which the charges are considered as
Eligible Expenses.
21. Illness
Illness refers to a disease, impairment, interruption, cessation or
disorder of bodily function(s), system(s) or organ(s).
22. Injury
Injury refers to bodily damage other than Sickness and Mental
Illness, including all related conditions and recurrent
symptoms.
23. In-Patient
In-patient refers to procedures of Health Care Services and
Supplies during Hospitalization.
24. Insurance Application Form
This refers to an application form to be filled in by the Insured
Persons with the details pertaining to their treatment (or
treatment of their dependent in the case that the Insured Person is
an Insured Dependent and under 18 years of age) as part of the
Medical Underwriting and contains questions concerning the
Pre-Existing Medical Conditions and the health of the Insured
Person.
25. Insurance Coverage
Insurance Coverage refers to the provisions of Insurance Coverage
under the terms of this Insurance Contract by GCIC to the Policy
Holder, which consists of paying or Reimbursement all or part of
the Eligible Expenses following Health Services incurred by or
provided to an Insured Person.
Depending on the case, Insurance Coverage refers to the contractual
Insurance Coverage as specified in the previous paragraph or to the
specific Insurance Coverage of an Insured Person as part of the
contractual Insurance Coverage.
26. Medical Condition
Medical Condition is a generic name referring to an Illness,
Injury, Sickness, or Mental Illness.
27. Medically Necessary
Medically Necessary refers to Health Care Services and Supplies
which are determined by Green Crescent to be:
- Necessary to meet the basic health needs of the Insured Person;
and
- Based on the prevailing standards of medical practice relative
to a specific Medical Condition;
- Rendered in an appropriate manner and type, taking into account
both cost and quality of care within reasonable boundaries;
and
- Consistent in type, frequency and duration of treatment with
scientifically based guidelines of medical, research or healthcare
organizations or governmental agencies that are accepted by Green
Crescent; and
- Consistent with the diagnosis of the Medical Condition;
and
- Required for reasons other than the convenience of the
Healthcare Provider or attending Physician; and
- Legally available in the country of prescription; and
- In the case of In-patient care, cannot be provided safely on an
Out-patient basis; and
- Demonstrated through prevailing pre-reviewed medical literature
to be either
- Safe and effective for treating or diagnosing the Medical
Condition for which their use is proposed or,
- Safe with promising efficacy for treating a life threatening
Medical Condition, in a clinically controlled research
setting.
The fact that a Physician has performed or prescribed a
procedure or treatment or the fact that it may be the only
procedure or treatment for a particular Medical Condition does not
mean that it falls into the category of Medically Necessary Health
Care Services and Supplies as defined by the GCIC Insurance
Contract. The definition of Medically Necessary used in this
Insurance Contract determines eligibility for coverage for the
Insured Person and may differ from the way in which a Physician or
Provider engaged in the practice of medicine may define Medically
Necessary.
28. Medical Underwriting
Medical Underwriting refers to the process by which Green Crescent
takes into account the Insured Person's Pre-Existing Medical
Condition before accepting the Insured Person for Insurance
Coverage under this Insurance Contract. This process is done
through declaration by the Insured Person of his or her
Pre-Existing Medical Conditions on an Insurance Application Form
and may include a medical examination as part of the medical
evaluation for underwriting as requested by Green Crescent. As a
result of this process, Green Crescent can accept all or certain
Pre-Existing Medical Conditions and can limit the Insured Person
through Specific Exclusions.
29. Mental Illness
Mental Illness refers to a mental or bodily condition marked
primarily by sufficient disorganization of personality, mind, and
emotions to seriously impair the normal psychological, social, or
work performance of the individual.
30. Network
Network refers to a group of Providers for the purpose of providing
Health Services in certain regions. It is possible that certain
specific Healthcare Services are limited to certain specific
Providers within a Network.
Network providers' status will be updated regularly
31. Non-Emergency
Non-Emergency refers to a medical condition or symptom that is not
an Emergency.
32. Non-Emergency Hospitalization
Non-Emergency Hospitalization refers to a Hospitalization which is
not as a direct result of Emergency Health Services.
33. Non-Network
Non-Network refers to Providers of Healthcare Services that are not
part of an applicable Network under this Insurance Contract
34. Out-Patient
Out-patient refers to procedures of Health Care Services and
Supplies which do not medically necessitate Hospitalization before,
during and/or after the procedure.
35. Physician
A Physician is any practitioner of Health Care Services who is duly
licensed and qualified under the laws of the country in which
treatment is received.
36. Policy Holder
The Policy Holder refers to the contractual Party that is
contracting this Insurance Contract with Green Crescent.
37. Pre-Existing Medical Condition
Pre-Existing Medical Condition refers to any Medical Condition for
which an Insured Person has received medical advice or treatment,
or any condition which would have caused a reasonable person to
seek diagnosis or treatment prior to the commencement of this
Insurance Contract.
38. Premium
Premium refers to the fee to be paid by the Policy Holder in
exchange for receiving the Insurance Coverage. Depending on the
circumstances, it refers to the Premium for the Insurance Coverage
or to the Premium for the Insurance Coverage of an Insured
Person.
39. Prior Approval
Prior Approval refers to the process used to review certain
proposed Healthcare Services prior to their delivery to ensure that
these services and procedures are Medically Necessary and to
approve and authorize them as such.
40. Prosthetic Device
Prosthetic Device refers to an artificial device, either external
or implanted, that substitutes for or supplements a missing or
defective part of the body; e.g. artificial limbs and
pacemakers.
41. Provider
A Provider is a generic term that refers to a Physician, Hospital,
clinic, medical center, pharmacy, group practice, laboratory,
physiotherapist or physiotherapy center, dentist and other medical
and paramedical institutions or persons that provide and or
licensed to provide Health Care Services and Supplies.
42. Sickness
Sickness refers to the condition of physical illness or disease and
does not include Mental Illness.
43. Specific Insured Person's Exclusions
This refers to certain Health Care Services and Supplies which are
excluded from the Insurance Coverage following Medical Underwriting
and are specific for the Insured Person, provided that these have
been expressly and prior agreed with the Insured Person (or with
the Insured Member in case that the claimant is an Insured
Dependent and under 18 years of age), if applicable prior to the
provision of the related Health Care Services and Supplies.
44. Surgery
Surgery or surgical operation refers to the following:
- A cutting operation
- Suturing a wound
- Treatment of a fracture
- Reduction of dislocation
- Radiotherapy (excluding radioactive isotope therapy) if used in
lieu of a cutting operation for the removal of tumor
- Electrocatherization
- Diagnostic and Therapeutic endoscopic procedures
- Injection treatment hemorrhoids and varicose veins
- Organ transplant
- Angiography
- Normal child birth
45. Waiting Period
Waiting Period refers to the period after the Effective Date that
the Insurance Coverage does not apply for certain Health Services
for an Insured Person.
General
Exclusions:
The following Health Care Services and Supplies, Medical
Conditions and other specifications and also all their related,
associated or consequential expenses are excluded for this
Insurance Contract, unless explicitly approved to the contrary by
Green Crescent in the Terms and Conditions of the Insured Person's
individual Insurance Plan or in the Table of Benefits.
The following Health Care Services and Supplies, Medical Conditions
and other specifications and also all their related, associated or
consequential expenses are excluded as Insurance Coverage for this
Insurance Contract, unless explicitly approved to the contrary by
Green Crescent in the Specific Terms and Conditions:
- Health Services, which are not Medically Necessary.
- In case a Medical Underwriting has been applied, all
Pre-Existing Medical Conditions unless they have been accepted by
Green Crescent and specified as such in the Green Crescent
Insurance Certificate.
- Health Services which are obtained through a non-profit,
charity health program.
- In case a Medical Underwriting has been applied any Specific
Insured Person's Exclusions agreed expressly with the Insured
Member and/or Dependent as detailed in the Insurance Contract or in
another Amendment of Green Crescent.
- Custodial care; domiciliary care; private duty nursing; respite
care; rest cures. Custodial care refers to:
- Non-health related services, such as assistance in activities
of daily living, or
- Health-related services which do not seek to cure or which are
provided during periods when the Medical Condition of the patient
is not changing; or
- Services which do not require continued administration by
trained medical personnel.
- Personal comfort and convenience items or services such as but
not restricted to television, telephone, barber or beauty service,
guest service and similar incidental services and supplies.
- Cosmetic procedures which refers to those procedures which
improve physical appearance.However cosmetic Surgery is not
excluded provided it is incidental to an Injury, Sickness or
congenital anomaly and the primary purpose is to improve
physiological functioning of the involved part of the body to its
prior level. Also, breast reconstruction following mastectomy for
cancer is not excluded. Replacement of an existing breast implant
is excluded unless the implant has malfunction and the implant was
initially done for reconstruction due to a cancer treatment.
- Treatment of obesity (including morbid obesity), and any other
weight control programs.
- Experimental, Investigational or Unproven Services. However,
Green Crescent in its judgment, may decide that some of these are
not excluded provided they are for treating a life threatening
Medical Condition and provided it is determined by Green Crescent
that the Experimental, Investigational or Unproven Service at the
time of the determination:
- Is safe with promising efficacy; and
- Is provided in a clinically controlled research setting.
- Health Care Services and Supplies for alopecia, baldness, hair
falling, dandruff, wigs, or toupees.
- Health Care Services and Supplies for smoking cessation
programs and the treatment of nicotine addiction.
- Health Care Services and Supplies for or related to:
- sex transformation operations;
- voluntary sterilization and for reversal of
sterilizations;
- contraception;
- fertility/infertility
- sexual dysfunction.
- Prosthetic Devices and Durable Medical Equipment.
- All costs as a consequence of or relating to hazardous
activities, including but not limited to:
- Any form of aerial flight (including light aircraft,
monoplanes, ballooning, hang-gliding, parachuting);
- Participation in any kind of power-vehicle race, rally or
competition;
- Water sports (powerboats, water skiing, jet skiing,
diving);
- Horse riding activities (hunting, jumping, polo, racing);
- Climbing activities (mountaineering, rock-climbing, pot holing,
abseiling);
- Judo, boxing, karate, wrestling and other martial arts of any
kind;
- Bungee jumping;
- Any professional sports activities.
- Growth hormone therapy.
- Health Care Services and Supplies related to hearing and sight
correction, audiovisual aids and optometry.
- Health Care Services and Supplies as a consequence of or
related to naval or military operations of the armed forces or air
force and participation in operations requiring the use of arms or
which are ordered by military authorities for combating terrorists,
rebels and the like.
- Health Care Services and Supplies as a consequence of or
related to wars and circumstances comparable with a state of war,
invasion, act by a foreign enemy, hostilities and warlike events
(with or without a declaration of war), civil war, riot, mutiny,
revolution, confiscation or nationalization by order of any public
or local government or authority; any act of a person acting in the
name of or in connection with any organization whose activities aim
to overturn a de jure or de facto government violently.
- Health Care Services and Supplies as a consequence of or
related to nuclear risks: e.g. exposure to nuclear energy (nuclear
reactions, radiation, contamination) or nuclear waste of any type
or chemical contamination.
- Health Care Services and Supplies as a consequence of or
related to natural perils: such as but not limited to avalanches,
earthquake, volcanic eruptions, tsunamis, hurricanes, tornados or
any other kind of natural hazard.
- Health Care Services and Supplies as a consequence of or
related any act of terrorism. For the purpose of this endorsement
an act of terrorism means an act, including but not limited to the
force or violence and/or the threat thereof, of any person or
group(s) of persons, whether acting alone or on behalf of or in
connection with any organization(s) or government(s), committed for
political, religious, ideological, or ethnic purposes or reasons
including the intention to influence any government and/or to put
the public, or any section of the public, in fear.
- Health Care Services and Supplies as a consequence of or
related to a criminal act of an Insured Person, violation or
attempted violation of law and resistance to lawful arrest or any
resultant imprisonment.
- Mental Illness unless it is a transient mental disorder or an
acute reaction to stress.
- Outpatient prescribed or non-prescribed medical supplies
including elastic stockings, ace bandages, gauze, syringes,
diabetic test strips, and like products; non-Prescription Drugs and
treatments: (Bandages, gauze etc, are covered as a part of
Emergency treatment given at any appointed Network provider).
- All preventive cares, including vaccinations, immunizations,
allergy testing & desensitization; any physical, psychiatric or
psychological examinations or testing during these
examinations.
- Health Care Services and Supplies rendered by a Provider with
the same legal residence as the Insured Person or who is a member
of the Insured Person's family, including spouse, brother, sister,
parent or child.
- External feedings (infusion formulas via a tube into the upper
gastrointestinal tract) and other nutritional and electrolyte
supplements, unless done as a consequence to other Medically
Necessary In-patient care.
- Health Care Services and Supplies for analysis and adjustments
of spinal subluxation, diagnosis and treatment by manipulation of
the skeletal structure, or for muscle stimulation by any means
(except treatment of fractures and dislocations of the
extremities).
- Health Care Services and Supplies for in-vitro fertilization
(IVF), gamete intra-fallopian transfer (GIFT) procedures, and
zygote intra-fallopian transfer (ZIFT) procedures, and any related
prescription medication treatment, embryo transport; donor ovum and
semen and related costs, including collection and preparation.
- Elective non-accident related surgery for correction of
refraction errors and/or Improvement of vision (quantitative or
qualitative) such as but not restricted to radial keratotomy, photo
keratectomy or laser surgery.
- Nasal septum deviation and its complication; nasal concha and
turbinaute resection.
- All chronic conditions requiring hemodialysis or peritoneal
dialysis, and related test/treatment or procedure.
- Health Care Services and Supplies for HIV, AIDS and all related
medical conditions; after confirming diagnosis.
- All cases related to viral hepatitis & the complication
except hepatitis A and except caused by blood transfusions or
accidental needle pricks.
- All cases resulting from alcoholism, use of drugs &
hallucinatory substances.
- Senile dementia and Alzheimer's disease
- Air ambulance transportation in general and terrestrial
transportation in non-emergency cases or by non-licensed ambulance
services.
- Health Care Services and Supplies resulting from a work-related
accident or Sickness that is Covered by workers' compensation (or
any similar program).
- All cases related to Maternity in respect of unmarried
females.
- All cases requiring non-emergency In-Hospital
treatment/services, which have not been approved by Green Crescent
prior to admission.
- All cases requiring emergency In-Hospital treatment/services,
which have not been notified to Green Crescent within 24 hours from
admission.
- Any test and/or treatment not required by a medical
Physician.
- Any In-Hospital treatment, tests and other procedures, which
can be carried out on a Day-Care basis without jeopardizing the
Insurers health.
- Any test or treatment, which is not related to a specific
symptom and/or disease. This includes examinations required for
employment, travel, immigration, licensing or insurance and related
reports.
- Any pharmaceutical products, which are not, considered as
specific treatment for a particular disease and/or not prescribed
by an approved Physician.
- All substances which are not considered as medicines such as
but not restricted to mouthwash, toothpaste, lozenges, antiseptics,
milk formulas, food supplements, skin care products, shampoos, and
all equipment not primarily intended to improve a medical condition
or injury such as but not restricted to air conditioners or air
purifying systems, arch supports, convenience items/options,
exercise equipment and sanitary supplies. Vitamins (unless
prescribed by doctor for a specific medical condition and not as
supplement).
- More than one Physician consultations in non-excluded cases in
a single day or during free follow up period unless referred by
his/her initial treating doctor & the referral if medically
justified.
- Lesions resulting from attempted suicides or
self-infliction.
- Health services and associated expenses for organ and tissue
transplants if insured person is a donor.
- Officially (WHO and/or national law) recognized
epidemics/pandemics.
- Complications and other consequences directly arising from
services not covered.
- All kind of educational programs and/or learning disabilities
treatments.
- Treatment of venereal diseases transmitted by-intercourse as
medically accepted.
CONTACT US
Abu Dhabi Office
P.O. Box 63323, Abu Dhabi,
United Arab Emirates
Tel: +971 (2) 445 8699
Fax: +971 (2) 445 8717
Dubai Office
P.O. Box 505152, Dubai,
United Arab Emirates
Office G-01, Building 27, Block D,
Dubai Healthcare City
Toll-free: 800 42 GCIC (4242)
Website: www.green-crescent.com
Email:
For general enquiries, please write us at info@green-crescent.com
For information on your policy or to register a complaint, please
write us at customerinfo@green-crescent.com