Medical Insurance

These are insurance benefits provided to AUS employees hired on or before February 15, 2004. Faculty and employee's grade 10 and above hired after February 15, 2004 should refer to the Self Directed Employee Benefit Plan summary for details of their benefits.

Coverage is mandatory for all employees, unless the employee opts out of the plan in writing by providing a supporting proof of medical insurance from an outside insurance company.

Eligible participants: All regular, full time permanent employees of the university under the age of 70 years for faculty and 65 years for staff who regularly work in a position or office designated at AUS

American University of Sharjah has contracted via a private insurance carrier to provide comprehensive medical coverage for full-time employees and their qualified dependents. To meet the requirements of our employees the university offers five plans.

Plan I – effective September 1, 2009

Employees covered under this plan may receive medical treatment in the UAE, Arab Countries, Indian Sub Continent and South East Asia. They are also covered for emergency treatment worldwide when on holiday or business trip.

Scheduled benefits under Plan I are:

• Maximum limit per person per year is US$ 200,000. (Equivalent to AED 735,000)
• Maximum outpatient limit per person per year is US$ 15,000. (Equivalent to AED 55,000)
• Inpatient treatment is covered at 100 percent, within the network providers in the UAE.
• Treatment outside UAE is covered with involvement of SOS (within geographical limits).
• Outpatient treatment is covered at 100 percent within the network providers in the UAE, but a co-insurance of 20 percent is applicable for outpatient treatment at Al Zahra hospital networks, and Welcare hospital Dubai.
• Outside the network providers, outpatient treatment is covered at 80% network rates based on “Reasonable and Customary” charges
• Pharmaceuticals: - Co-insurance of 15 % for pharmaceuticals.
• Deductible: grade 1to 6 – AED 50 per visit, grade 7 to 9 = AED 60 per visit and grade 10 & Faculty =AED 70 per visit  
• Plan I Premium for the period September 1,2009 to August 31,2010     

Plan II – effective September 1, 2009

Employee electing coverage under this plan may receive medical treatment anywhere, i.e., worldwide coverage. However, employees who avail themselves to elective medical treatment or surgeries in the US, Canada or Europe will pay 20 percent (co-insurance) on the total cost of the treatment, inpatient or outpatient.
Scheduled benefits under Plan II are:

• Maximum limit per person per year is US$ 300,000. (Equivalent to AED 1,100,000)
• Maximum outpatient limit per person per year is US$ 15,000. (Equivalent to AED 55,000)
• Inpatient treatment is covered at 100 percent, within the network providers in the UAE but a co-insurance of 20 percent is applicable for bills at American Hospital in Dubai.
• Treatment outside UAE is covered with involvement of SOS.
• Outpatient treatment is covered at 100 percent within the network providers in the UAE, but a co-insurance of 20 percent is applicable for outpatient treatment at American Hospital of Dubai, Welcare Hospital Dubai and Al Zahra hospital networks.
• Outside the network providers, outpatient treatment is covered at 80 percent network rates based on “Reasonable and Customary” charges
• 20% Co-insurance for out-patient treatment at Welcare Hospital, Dubai.
• Pharmaceuticals: - Co-insurance of 15% for pharmaceuticals
• Deductible: grade 1to 6 – AED 50 per visit, grade 7 to 9 = AED 60 per visit and grade 10 & Faculty =AED 70 per visit 
• Plan II Premium for the period September 1,2009 to August 31,2010

Plan III – effective September 1, 2009

Employees covered under this plan may receive medical treatment in the UAE, Arab Countries, Indian Sub Continent and South East Asia. They are also covered for emergency treatment worldwide when on holiday or business trip.

Scheduled benefits under Plan III are:

• Maximum limit per person per year is US$ 200,000. (Equivalent to AED 735,000)
• Maximum outpatient limit per person per year is US$ 15,000. (Equivalent to AED 55,000)
• Inpatient treatment is covered at 100 percent, within the network providers in the UAE.
• Treatment outside UAE is covered with involvement of SOS (within geographical limits).
• Outpatient treatment is covered at 100 percent within the network providers in the UAE, including Al Zahra hospital networks without deducting 20% co-insurance, and Welcare Hospital Dubai with 20% co-insurance deduction.
• Outside the network providers, reimbursement at 100% “Reasonable and Customary” charges at the country of treatment
• Pharmaceuticals: - covered 100% based on medical policy limits under the network pharmacies without 15% co-insurance.
• Deductible: grade 1to 6 – AED 50 per visit, grade 7 to 9 = AED 60 per visit and grade 10 & Faculty =AED 70 per visit 
• Plan III Premium for the period September 1,2009 to August 31,2010 

Plan IV – effective September 1, 2009

Employees covered under this plan may receive medical treatment in the UAE, Arab Countries, Indian Sub Continent and South East Asia. They are also covered for emergency treatment worldwide when on holiday or business trip.

Scheduled benefits under Plan IV are:

• Maximum limit per person per year is US$ 300,000. (Equivalent to AED 1,100,000)
• Maximum outpatient limit per person per year is US$ 15,000. (Equivalent to AED 55,000)
• Inpatient treatment is covered at 100 percent, within the network providers in the UAE.
• Treatment outside UAE is covered with involvement of SOS (within geographical limits).
• Outpatient treatment is covered at 100 percent within the network providers in the UAE, including Al Zahra hospital networks without deducting 20% co-insurance.
• Outside the network providers, reimbursement at 100% “Reasonable and Customary” charges at the country of treatment
• American Hospital, Dubai – Direct billing for both In-patient and Out-Patient treatment without 20 % co-insurance
• Welcare Hospital, Dubai – Direct billing for both In-patient and Out-Patient treatment without 20 % co-insurance
• Pharmaceuticals: - covered 100% based on medical policy limits under the network pharmacies without 15% co-insurance.
• Deductible: grade 1to 6 – AED 50 per visit, grade 7 to 9 = AED 60 per visit and grade 10 & Faculty =AED 70 per visit 
• Plan IV Premium for the period September 1,2009 to August 31,2010 

Plan V – effective September 1, 2009

Employee electing coverage under this plan may receive medical treatment worldwide and need not pay 20% co-insurance for elective treatment in Europe, USA and Canada.

Scheduled benefits under Plan V are:

• Maximum limit per person per year is US$ 500,000. (Equivalent to AED 1,835,000)
• Maximum outpatient limit per person per year is US$ 15,000. (Equivalent to AED 55,000)
• Inpatient treatment is covered at 100 percent, within the network providers in the UAE.
• Treatment outside UAE is covered with involvement of SOS (within geographical limits).
• Outpatient treatment is covered at 100 percent within the network providers in the UAE, including Al Zahra hospital networks without deducting 20% co-insurance.
• Outside the network providers, reimbursement at 100% “Reasonable and Customary” charges at the country of treatment
• American Hospital, Dubai – Direct billing for both In-patient and Out-Patient treatment without 20 % co-insurance
• Welcare Hospital, Dubai – Direct billing for both In-patient and Out-Patient treatment without 20 % co-insurance
• Pharmaceuticals: - covered 100% based on medical policy limits under the network pharmacies without 15% co-insurance.
• Deductible: grade 1to 6 – AED 50 per visit, grade 7 to 9 = AED 60 per visit and grade 10 & Faculty =AED 70 per visit 
• Plan V Premium for the period September 1,2009 to August 31,2010

Other Benefits

Accidental Damage to natural teeth - Covered in full

International Emergency Medical Assistance

⇒ Emergency Medical Evacuation – USD 1 Million

⇒ Emergency Medical Repatriation and Repatriation of mortal remains – included in above benefit amount

⇒ Compassionate Visit – One Economy Class Return Airfare

⇒ Return of Minor Child – One Economy Class One Way Airfare

⇒ Convalescence Expenses – USD 1,000/- subject to a sub limit of USD 250/- per case

Chronic Conditions - Covered up to Policy Limit

Pre-existing Conditions - Covered up to Policy Limit

Normal Pregnancy and Childbirth – for married females 18 years to 45 years,covered up to a limit of AED 20,000 (sub-limited to normal delivery AED 15,000/-, caesarean delivery AED 20,000/- and legal abortion/ miscarriage AED 5,000/-) with nil waiting period

Maternity Complications including pre-mature birth.( covered up to the applicable sublimit for maternity)

Work Related Accidents for Plan III, IV and V only. Covered over and above WC Policy Limits.

Other Terms andConditions

⇒ Addition of New Born baby from date of birth and all congenital and acute illness covered up to AED 15,000/- for new born children and the cover for such babies to continue as long as they are under the scheme

⇒ Additions and deletions on pro-rata adjustment.

In-PatientTreatment

Covered in full

⇒ Hospital Room and Board

⇒ Diagnostic Procedures

⇒ Operating Theatre charges

⇒ Nursing care, drugs and dressings

⇒ Surgical Appliances used by the medical practitioner during surgery

⇒ Supports, rental of wheel chair (if prescribed by specialist)

⇒ Casts, Splints, Trusses, Braces and Crutches

⇒ Surgeon’s and anaesthetist’s charges including pre and post operative consultations

⇒ Intensive care unit charges

⇒ Consultations and Physiotherapy while admitted for treatment of a medical condition

⇒ Radio therapy and Chemotherapy

⇒ Computerized tomography, magnetic resonance imaging, x-rays and other such proven medical imaging techniques

⇒ Ambulance Services

Out-Patient Treatment

Covered in full

⇒ Specialists Fees per visit per day

⇒ General Practitioner per visit per day

⇒ Surgical procedures

⇒ Drugs and Medicines

⇒ Diagnostic procedures (CT Scan, MRI Scan other such proven medical imaging techniques)

⇒ Physiotherapy as per policy limits.

Click here for Exclusions and Limitations of the Medical Insurance Policy.

"For further details on Medical Insurance, List of Network Medical Providers, List of Network Pharmacies, and Medical Insurance Policy, please reffer to the following link"

Emergencies

Emergencies means: A medical emergency constitutes a sudden sickness or injury whose acute symptoms are of such severity that the absence of immediate treatment at the nearest medical provider is medically expected to constitute a serious threat to the life, health, a bodily function and/or organ of the patient.

Please contact the SOS number on the back of your medical card.
General provisions of the medical plan:

Dependents

• Legal spouse, residing permanently in the UAE.
• An unmarried child, under age 19, attending school (primary or secondary) full time in the UAE, and whose total maintenance or a substantial portion therefore is provided by the employee.
• An unmarried child under age 23, attending school (secondary, university or college) full time outside the UAE, who normally resides with the employee during school holidays and receives at least 50% of their maintenance from the employee.

Termination of coverage: Coverage will cease when a dependent is no longer eligible to participate in the plan or when an employee’s service at AUS is terminated.

Medical insurance dose not continue as per UAE government policy and the policy of UAE insurance carriers beyond the age of 70 years for faculty and 65 years for staff.

Maternity Coverage

Full time permanent female employees or the spouses of full-time permanent employees are eligible for maternity cover. The maternity cover includes: prenatal care, legal abortion, normal delivery and caesarean.

The maternity benefit will be covered according to the reasonable and customary charges and up to the following limit for all eligible females:

Prenatal care and normal Delivery 15,000 dirham
Prenatal care and complicated/Caesarean Delivery 20,000 dirham
Prenatal care and spontaneous miscarriage / or legal termination of Pregnancy 5,000 dirham
(When it is life threatening to the mother, subject to once during one policy period)
More details on this can be obtained from Human Resource Services Department.

Life Insurance

American University of Sharjah provides, group life insurance for all regular, full time permanent employees, up to the age of 70 years for faculty and 65 years for staff. Coverage begins on the first day of employment. The employee is covered, in the case of natural death, for two times their annual base salary of September 01 of every year. In the event of accidental death, the benefit payable is four times the annual base salary of September 01 of every year.

• Life insurance is compulsory for all staff at AUS
• Life insurance premium calculation is based on September 01, salary for every year.

Personal Accident Insurance

This provision of the plan provides benefits in case of partial or total disabilities, due to an accident or sickness. Benefits coverage included are:

Permanent Partial Disability – pays a percentage of 4 times base salary, per policy scale. Permanent Total Disability – pays 4 times annual base salary.
Total Temporary Disability – pays 100 percent of monthly base salary for a maximum of 12 months. Coverage does not start until after the first 30 calendar days of disability.
Accidental Medical Expenses – Expenses to be covered up to 10,000 dirham in one policy year.
Repatriation Expenses – Expenses to be covered up to 10,000 dirham in the event of death.

For further details on life insurance please refer to the life insurance policy document

Exclusions are applicable in different situations and may apply.
Please contact Human Resource Services Department and speak with any representative should you have any questions or need assistance.

Updated: October 2009