Renewal Offer P olicy Holder : NASS FAMILY - (ALHILAL) P olicy No. : NASSF/ALH/00038/17 NC - 0 3 P olicy Period : 14/06/20 2 5 - 13/06/202 6 Schedule of Benefits PLAN NAME BASIC CARE Geographical Area Kingdom of Bahrain BENEFIT Outpatient & Daycare Network Provider s • Al - Hilal Hospital - Muharraq • Al - Hilal Multispecialty Medical Center - RIFFA • Al - Hilal Multispecialty Medical Centre - Manama • Al - Hilal Multispecialty Medical Centre - Salmabad • Al - Hilal Specialty Medical Centre - Saar (Upcoming) • Al - Hilal Multispecialty Medical Centre - Hamad town • Al - Hilal Medical Centre - Asker • Al - Hilal Multispecialty Medical Centre - Hidd Industrial Area • Al - Hilal Multispecialty Medical Centre - Sitra • Al - Hilal Medical Centre - Manama Center Out Patient Care : Annual Benefit Limit per person Unlimited Deductible: (With FREE 10 days Follow up) BHD 5 Consultation: General Physician Specialist: If required Upon referral and requirement (Internal Medicine, Pediatrics, Gynecology, ENT, Ophthalmology, Orthopedics, Radiology, Dermatology and Pathology ) Covered Super Specialist Consultation and Care: (Upon referral and requirements) Cardiology, Urology, Neurology, General Surgery and Laparoscope and Gastroenterology Covered 24 Hours Emergency Care / Emergency Ambulance Transport (Minor and Major Emergencies including stabilizing Emergencies and shifting to Government Hospitals ) Covered Primary Investigations : Laboratory Services, X - ray and Ultrasound and Other Basic Investigations Covered Renewal Offer P olicy Holder : NASS FAMILY - (ALHILAL) P olicy No. : NASSF/ALH/00038/17 NC - 0 3 P olicy Period : 14/06/20 2 5 - 13/06/202 6 Medicines, Injections and IV Fluids (As Prescribed by the treating Doctor) Covered Emergency CT Scan and Cardiology Investigations Covered Physiotherapy: Covered for a maximum sessions/year, when requested by the treating physician Unlimited 24 Hours Clinic Care Covered 24 Hours Ambulance Care Covered 24 Hours Pharmacy Care Covered 24 Hours Lab and Radiology Covered 24 Hours Emergency and Non - Emergency Health Care Services including holidays Covered Immunization (vaccination) against contagious diseases following the instructions issued by the Ministry of Health & Sexually Transmitted Diseases (For Employees only) Covered up to BD 50 With 50% Co - insurance. Out Patient : Minor Surgeries: Such as I&D, Drainage of Abscess, Nail Removal, POP/Cast Application, Foreign Body Removal and other Minor Surgeries. Covered Out Patient: Pre - existing / ChronicConditions Unlimited BENEFIT Dental Consultation, prescribed medication, extraction and fillings and Dental Minor Surgeries BD 500 Root Canal Treatment Covered Renewal Offer P olicy Holder : NASS FAMILY - (ALHILAL) P olicy No. : NASSF/ALH/00038/17 NC - 0 3 P olicy Period : 14/06/20 2 5 - 13/06/202 6 IMPORTANT NOTES RELATED TO THE ABOVE SCHEDULE OF BENEFIT AS AGREED WITH AL HILAL (NETWORK PROVIDER): • Network Provider – Al - Hilal Hospital - (Muharraq), Al - Hilal Multispecialty Medical Center – ( RIFFA ), and any other new Hospital(s)/Clinic(s) affiliated to Al Hilal Hospital • Cover is only comprehensive Out Patient Only. • All confirmed dependent will covered from policy inception, and once the policy is incepted existing dependent will not be added except on a case by case basis as reviewed by Nass Management . Only new joiner’s dependent will be added with full premium. There is no refund for dependent leaving due to change of employment or any other reason. • Dependents can be added at policy inception only or at the time of addition of primary insured with full premium regardless of addition date or period. And no refund in case of deletion. • Free Mammogram will be offered to all female dependents who are above 40 year subjected to symptoms. • The Policy is annually ren ewable with all existing parties provided that Nass Corporation renew the staff insurance program after its expiry , or i f there is a change in the law which prevents the contract remaining in force or if there is some similar development that prevents each party to the contract from effecting the renewal. This is also subject to the cancellation provision. • The policy is non - cancellable for the paid insurance year. • GCC out Patient Coverage on emergency cases at the Al - Hilal Branches in Dubai, Muscat, Qatar and Jeddah, Makkah and Jubail. The direct billing and coverage is subjected to approval of Al - Hilal Hospital, Kingdom of Bahrain. • Inpatient benefits for acute life - threatening Emergency surgeries coverage on case to case basis and upon requests from NASS. (E.g. for conditions like emergency Appendectomy, Cholecystectomy, Acute Medical Management admissions and Acute kidney stone etc. ) Emergency Medical Management until transfer to Salmaniya or King Hamad. • Coverage of CT/MRI/Endoscopies. • A Complaint Policy procedure should be in place to monitor customers/patients complaints, with complaint ration to be maintained below 2%, defines as “real complaints” Additional Note: • VAT Clause: In case of any changes in the VAT rates, we shall charge you additional VAT on a pro rata basis for the period from the effective date of such changes in the VAT rate till the expiry of the Policy. SERVICES NOT COVERED UNDER THE PLAN 1. Elective In - patient treatment 2. Ante Natal Care, Delivery and LCSC Renewal Offer P olicy Holder : NASS FAMILY - (ALHILAL) P olicy No. : NASSF/ALH/00038/17 NC - 0 3 P olicy Period : 14/06/20 2 5 - 13/06/202 6 3. Work related illness and Injuries , Motor Trauma injuries and accidents.( Covered by GOSI and motor insurance ) 4. Optical services (Refractive Errors & Glasses) 5. Vaccinations 6. Cosmetology related treatments 7. Dental scaling and polishing, dentures, bridges, crowns and in - lays, Fluoride and ceiling application, Cosmetic treatments (i.e. Orthodontics treatment) 8. General Exclusions listed below. GENERAL EXCLUSIONS The Primary Healthcare Plan does not cover expenses arising directly or indirectly for any tests or treatments for the following: 1. Self - inflicted injury. Injuries resulting from playing professional sport or from any dangerous sport or activity. Any costs related to providing or fitting any external prosthesis or appliance. 2. Congenital Diseases and Birth related problems. 3. Illnesses, caused by misuse of certain medicines, stimulants, tranquilizers or by consumption of alcoholic drinks, drugs or abuse substances. 4. Plastic surgery or treatment unless necessitated by an accidental bodily injury not excluded under the plan 5. Routine Checkups, Preventive Check - ups, vaccinations, drugs or preventive Medical examinations including preventive treatment. Medicines and treatment methods of alternative medicine or therapies such as Ayurvedic, Chinese Herbal, and Homeopathic remedies. Rest, general body health programs and treatment at social welfare houses. 6. Equipment, aids, drugs, procedures or treatment by hormones for birth control, inducing or Preventing pregnancy, sterility, impotence, infertility, tube fertilization or any others means of artificial insemination. Physiological changes of the female menop ause, including changes in menstruation. 7. Treatment of HIV, Hepatitis B,C,D&E 8. Psychotherapy, mental or neurotic disorders. Tests for correction of sight or hearing and audio - visual aids. 9. Allergy tests such as RAST or Patch tests 10. Any congenital deformities and treatment related to it. 11. Treatment of acne, Alopecia, baldness or wigs treatments related to obesity or overweight. 12. Any case of organ transplant / implantation of artificial organs that replace any body organ or the cost collecting donor organs or any administrative costs involved. 13. Ionic radiation and contamination with radioactive material resulting from nuclear fuel or any nuclear waste resulting from the burning of nuclear fuel. The radioactive, poisonous, explosive properties or any other hazardous properties of any nuclear mater ials stored or any of their components. 14. The insured involvement or participation in the service of the armed forces, police or their operations. War, invasion, foreign enemy actions, (whether war declared or not) and civil war, Riots, strikes, terrorism or any similar acts Renewal Offer P olicy Holder : NASS FAMILY - (ALHILAL) P olicy No. : NASSF/ALH/00038/17 NC - 0 3 P olicy Period : 14/06/20 2 5 - 13/06/202 6 PREMIUM PER MEMBER PER YEAR Category Age Band No. of Members Premium (BD) Dependents ( 0 - 70) 293 42.5 00 TOTAL 293 12,452.500 Value Added Tax 1,245.250 Grand Total 13,697.750 Renewal Offer P olicy Holder : NASS FAMILY - (ALHILAL) P olicy No. : NASSF/ALH/00038/17 NC - 0 3 P olicy Period : 14/06/20 2 5 - 13/06/202 6