نايف المطيري و أيمن الشهري بسم الله الرحمن الرحيم إعداد الطالبين نايف المطيري و أيمن الشهري بأشراف د /ناصر الجارالله

LIMIT OF BENEFITS (In SAR) Class VIP Class A Class B Class C Work related lnjury / illness Not covered Not covered Not covered Not covered Georaphical scope KSA ONIY KSA ONIY KSA ONIY KSA ONIY Dependents Covered Yes Yes Yes Yes Waiting period of newborn baby NIL NIL NIL NIL Global Annual Limit person SR 250.000 SR 250.000 SR 250.000 SR 250.000 In Hospital: Allowed room at APN SUITE private Semi- private Semi- private

Deductible each & every Daily Room & Board in KSA SR.800 SR600 SR.400 SR350 Daily Room & Board ABROAD SR.1.000 SR.600 SR.400 SR.350 COST OF SURGERY & ANESTHESIA Full cover Full cover Full cover Full cover Radiotherapy & chemotherapy Full cover Full cover Full cover Full cover Daycare for surgical procedure Full cover Full cover Full cover Full cover Deductible each & every claim NIL NIL NIL NIL Co- Insurance outside APN in KSA (EMERGENCY) NIL* NIL* NIL* NIL*

Co- Insurance outside APN abroad (EMERGENCY) NIL* NIL* NIL* NIL* OUT Patient covered covered covered covered Deductible each & every claim 20%with maximum of SR.100 per visit**. 20%with maximum of SR.100 per visit**. 20%with maximum of SR.100 per visit**. 20%with maximum of SR.100 per visit**. Co- Insurance outside APN in KSA (EMERGENCY) NIL* NIL* NIL* NIL* Co- Insurance outside APN abroad (EMERGENCY) NIL* NIL* NIL* NIL* Cash reimbursement for Emergency CASES (In. k.S.A or Abroad) @ 100%subject to network rating However, no reimbursement for dental & optical claims incurred outside APN. The visit includes doctor consultation, rlated in vestigations & prescribed medicine.

LIMIT OF BENEFITS (In SAR) Class VIP Class A Class B Class C Pre – Existing & Chronic Covered Covered Covered Covered Maternity Coverage : Annual limit 10.000 10.000 10.000 10.000 Waiting Period Nil Nil Nil Nil Dental Care :Annual Limit 2,000 2,000 2,000 2,000 Co -Insurance 20%with maximum of SR.100 per visit**. 20%with maximum of SR.100 per visit**. 20%with maximum of SR.100 per visit**. 20%with maximum of SR.100 per visit**. Optical Coverage : Annual limit 250 250 250 250

Repatriation OF mortal Remains to country of origin SR.10.000 Co -Insurance 20%with maximum of SR.100 per visit**. 20%with maximum of SR.100 per visit**. 20%with maximum of SR.100 per visit**. 20%with maximum of SR.100 per visit**. Hearing Aids : Annual limit 1,500 1,500 1,500 1,500 Co -Insurance 20%with maximum of SR.100 per visit**. 20%with maximum of SR.100 per visit**. 20%with maximum of SR.100 per visit**. 20%with maximum of SR.100 per visit**. Repatriation Costs covered covered covered covered Repatriation OF mortal Remains to country of origin SR.10.000 SR.10.000 SR.10.000 SR.10.000 Worldwide Emergency services covered covered covered covered When traveling for more than 150 km away from home or abroad Full Cover Full Cover Full Cover Full Cover

LIMIT OF BENEFITS (In SAR) Class VIP Class A Class B Class C Children aged up to 17 Years As Agreed As Agreed As Agreed As Agreed Adult Males aged 18 to 64 Years As Agreed As Agreed As Agreed As Agreed Adult Females aged 18 to 64 Years As Agreed As Agreed As Agreed As Agreed Total Annual Premium As Agreed Mode of Payment Due Dates 100% at inception on 21 July, 2008. Mode of Payment

The visit includes doctor consultation, related investigations & Prescribed medicine. SPECIAL CONDNITIONS: 1- Class c members will be assigned a network of clinics, such clinic (s) can only be changed subject to 30 days notice. Members will receive outpatient treatment / medical services at their assigned clinic (s) and con only call on their network hospitals in case of emergency (as defined), or (b) by referral from an assigned clinic and upon approval from Medivisa. 2- The policyholder agrees that some changes cannot be implemented during the period of insurance. E.g. upgrading the cover of a member (even if promoted), etc… such changes can only be implemented upon renewal of the policy. 3- Territorial limits are extended worldwide for emerency (and /or non emergency) treatment only whilst on business trips vacation, not exceeding 60 days per policy year.

COMPULSORY BASIC COVER Section I: *Accident *Allergy * Beneficiary (Insured person): Benefit : *Premium (contribution): *Congenital Deformity : *Insurance Cover * Coinsurance/deductible (Co- payment): *Employee : *Dependent : *Claim supporting Documents *Direct billing or company billing : *Inception Date : *Effective Date : *Endorsement : *Hospital : * Hospitalisation : *Insurance :

*Licensed doctor : *limit of cover : *Service Provider : *Pregnancy and Delivery : * Daycase or Daycare : *Treatment in outpatient clinics: *Service providers, Network : *Grace Period: *Period of Insurance : *Policyholder: *Reasonable and customary medical expenses: *Basis of compensation:

Section ii: Recoverable Expenses/Benefits 1- Health benefits: 2- The cost of repatriating the bodily remains of a beneficiary to his home country. Section III: Limitations and Exclusions A - THIS policy shall not cover claims arising from: 1-Intentional self – inflicted injury. 2- Sicknesses resulting form the abuse of some medicine stimulants or tranquilizers, or from the use of alcohol, drugs or similar substances 3- Cosmetic treatment or surgery unless necessitated by a bodily injury not excluded in this secion

4- general checkup inoculation drug or preventive measure that are not require for medical treatment cover under this policy ( excluding preventive procedures as define by the ministry of health like vaccinations and mother care and childcare 5- pregnancy and delivery of woman contractual status in un - married 6- treatment received by beneficiary free of charge 7- rest cures general health cures and treatment in social healthcare institution 8- any disease or injuries resulting directly from the beneficiary profession 9- all costs relating to tooth implant artificial teeth and fixed 10- vision or hearing test and visual or hearing aids unless required by the license doctor 11- loss of hair baldness artificial hair 12- psychological treatment mental or nervous disorder unless of an acute nature 13- allergy testing of any nature unless relating to medicine diagnosis or treatment

14- any congenital defect or deformity B- THIS POLICY SHALL NOT COVER ANY MEDICAL BENEFITS AND REPATRIATION OF THE BODY TO HOME COUNTARY IN CASE CLAIM IS DIRECTLY RESULTING FROM 1- war ,invasion act of foreign enemy , hostilities ( whether war is declared or not , civil war 2 – the beneficiary services or participation in armed forces or policy activity 3- riots , strikes , terrorism or similar events

section Iv: general conditions - proof of validity - Records and reports - Eligibility - Premium payment - Effective date of cover - Adding and deleting beneficiaries and relating premiums

-Termination of beneficiaries insurance cover. - Subrogation of rights - Non duplication of benefits. - Basis of direct billing of the company by the Assigned providers network. - coinsurance / deductible . - Reimbursement basis.

- Cancellation - Pre-authorisation - Gender - Notices - Abiding with policy conditions - Arbitration - Participating in the surplus of Insurance Operations (Concept of Cooperative Insurance)

Global emergency services - SERVICES PROVIDED: 1- medical consultation evaluation & referral . 2- hospital admission guarantee. 3- emergency medical evacuation . 4- critical care monitoring . 5- medically supervised repatriation . 6- prescription assistance. 7- emergency message transmission. 8- compassionate visit . 9- care of minor children . 10- return of mortal remains. 11- lost luggage or document assistance. Interpreter & legal referrals.-12 13- pre – trip information.

CONDITION & EXCLUSION- This extension is subject to the following exclusion : 1- travel undertaken specifically for securing medical treatment . 2- injuries resulting from participation in acts of war or insurrection. 3- attempt at suicide . 4- incidents involving the use of drugs unless prescribed by physician. 5- commission of unlawful acts. 6- transfer of participant from one medical facility to another medical facility of similar capabilities and providing a similar level of care . QENERAL EXCLUSION : 1- trips . 2- participant traveling.