enhanced plan manual

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Damans Health Insurance Plans

Member Guide


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CEOs

Message

MessageDear Member,

Thank you for choosing the National Health Insurance Company Daman.

Daman is the UAEsfirst specialised health insurance company and today we proudly serve over

2.4 million members.

Our members enjoy high-quality health insurance plans and customer services with access to thelargest healthcare network in the UAE and a growing international network of across the MiddleEast, Africa, Asia, Europe and the Americas.

In addition to our insurance services, we have disease management programmes that are uniqueto us. These programmes are managed by a qualified team from Daman in liaison with thetreating physician to form a special three-way relationship that centres on the membershealth.

In line with our vision to become the most trusted partner in health for the community, we havecreated our Activelife initiative, which aims to mobilise the entire UAE community to lead ahealthy, active lifestyle.

Finally, I would like to wish you and your family, the very best of health.

Dr. Michael Bitzer

Chief Executive Officer


3/35 800 4 DAMAN (32626) | www.damanhealth.ae 3

We are glad to inform you that Daman is supporting the Nadafa green initiative led by theEmirate of Abu Dhabi and supervised by The Center of Waste Management in the Emirate.

The Centre of Waste Management supervised the campaign of implementing the WasteManagement Strategy in the emirate of Abu Dhabi to ensure better health, environment andeconomy, and that is in line with the Abu Dhabi 2030 strategy.

As the leading specialized health insurer in United Arab Emirates, Daman is fully committed tothe Nadafa initiative, and will be extending its full support to the program by taking stepsinternally such as paper waste control, use of eco-friendly materials, and recycle system. As oneof the steps, all our customer documents are being converted into electronic format to controlpaper wastage.

We truly believe thatgoinggreen looks good, feels good, and most importantly, does a world ofgood.

We look forward to your understanding and support on this initiative to have a greener andhealthier environment for our society.

Go Green!


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Welcome to Daman

Welcome

to Daman

As your health insurance specialists, we are here to make

sure that you have access to the best of medical services,whenever you need it.

Within this guide, you will find valuable information on thebenefits and services available to you as a Daman member.Please go through this document to help you understand anduse your benefits better.

About Us

Your Plan

Finding a healthcare provider

Availing health benefits

Other valuable services

At your service anytime

Your Rights and Responsibilities

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About Us



About Us

The National Health Insurance Company Daman is the regions leading specialised health insurer,

providing comprehensive health insurance solutions to more than 2.4 million members in the UAE.

Over the years, the company has been the partner of choice for a number of the countrysmostprominent organisations and multinational companies in various industries including oil and gas,aerospace, energy, construction, investments and media.

Daman is a public joint-stock company that is 80% owned by the Abu Dhabi Government with theremaining 20% owned by Munich Re. The company is backed by the reliable support of the AbuDhabi Government and its strategic partner, Munich Re, one of the worldsleading reinsurers, playsan important role as both reinsurer and a valuable source for knowledge transfer.

Headquartered in Abu Dhabi and established in 2006, Daman offers a range of health insurance

plans for both individuals and organisations and exclusively manages the Governments healthprogramme Thiqa for UAE Nationals and Abu Dhabi Basic Plan for low income expatriates.Members enjoy access to the largest healthcare providers network in the UAE and an extensiveinternational network of over 45 countries.

Daman, a pioneer in health care insurance, drives innovation through a combination of state-of-the-art technology and healthcare-related expertise offered by a highly skilled and knowledgeableworkforce. Members benefit from added value through unique offerings such as the disease and casemanagement programmes as part of the acclaimed Health Support services. Daman also operates a24/7 customer call centre and has a medical services authorisation team in direct contact withDamansnetwork of healthcare providers. It also provides a diverse range of online services that areunmatched in the UAE.

Daman has set high standards in the health insurance industry and has been awarded a number ofinternationally recognised awards and quality-focused certifications in a relatively short span of time.The company is ISO 9001 certified for Quality Management Systems and ISO 27001 certified forInformation Security Management. The companys successful application of the online-basedPharmacy Benefit Management system has received a full accreditation by URAC.



Our Values

Performance

We set unprecedented targets for ourselves, and strive not just to attain these targets, but alsoto surpass them.

Innovation

We not only value innovation, but promote it as well. This is showcased in our various productsand services.

Customer Focus

Every product we develop, every service we launch, is designed with a single-minded focus - thecustomer.

Social Responsibility

We understand that it is our responsibility to actively contribute to the betterment andenhancement of the society at large.

Trust

We value honesty and good intention, and strive to be more than just a company. We strive tobe your trusted ally.



Our Core Services

International Medical Emergency Service: Offering the services of Assist America, the largest

provider for global emergency medical services, to members travelling 120 kilometres or moreaway from home, or in another country.

Second Medical Opinion Services: Offering the services of Europ Assistance which givesmembers access to a pool of internationally renowned doctors to review their cases and providetheir opinion and advice.

Case Management: Guides members through the medical system and ensure that they arereceiving the best care and service.

Disease Management Program: Aids members in managing chronic conditions by a well-trainedcoach who will educate and motivate participants leading to a healthier lifestyle and improved

quality of life.

Daman Customer Club: An online member community offering health and wellness tips, andaccess to an online health forum managed by Damansexperienced health support coaches.

Activelife Program: Exclusive discounts for Daman members in different health and lifestyleretail outlets.

Our Value Added Benefits

Toll Free Number 800 4 DAMAN:Answers members queries and concerns through a 24 hour call centre staffed by bi-lingualrepresentatives.

24-Hour Medical Authorization:Approves requests for medical treatments that require pre-authorization.

In-house Claims Processing:Processes reimbursement of claims within 15 working days.

Direct Billing:Offering direct billing facility at over 9,600 healthcare providers in the UAE and abroad.

Unmatched Online Services:Access to www.damanhealth.ae for members to submit and trackendorsements and claims, search for healthcare providers and many more

Key Benefits Summary



Your plan



1. Visit http://www.damanhealth.ae

2. ClickLogin to My Daman

3. Fill in your Username and Password

4. Click theLoginbutton to open your Policy Information page

5. On the Policy Information page, click the tab onBenefits

6. Read through the Scheduleof Benefits (SOB)document to know more about the coveredservices under your policy

Steps to access your Schedule of Benefits

Your Plan. Your Benefits.

Understand your Schedule of Benefits (SOB)

As a member, you are enrolled in one of our health insurance plans, covering you for a range ofmedical services and benefits. Your policy clearly states the medical services or treatments thatare covered for you. These covered services or treatments are listed in your Schedule of Benefits.You can read your specific Schedule of Benefit on our website or contact our Customer Servicecenter through the toll-free number mentioned on your Daman Card.



1 Member Card Number

Plan name of member Policy, Services on thecard will be covered as per terms andconditions of member policy

Key Benefits covered under the policy

Benefit sub-limits as applicable on direct billing

Deductible to be paid by member on servicesavailed under his policy

Co-insurance to be paid by member onservices availed under his policy

Network name within and outside UAE

Name of policy holder or insurance policysponsor

Member name in English

Member name in Arabic

Tele-consultation service helpline

Know your insurance card better

You would have received from us or your employer a Daman Card. Your card carriesessential details such as the name of your health insurance plan or policy, validity of thecard, your staff number and policy number, and more.

You should present this card at a medical service provider in your policysnetwork to receivebenefits and services as covered under your respective policy. Here are some tips to helpyou understand the key details mentioned on your Daman Card:

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Your Card.

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Findinga healthcareprovider

Finding ahealthcare provider



Need medical help,find in our network

DamansMedical Service Providers Network

You are important to us and so is the quality and delivery of medical care that you receive. Thatis why we established and continuously work towards establishing relationships with reputablemedical facilities to provide you with the best medical treatment available. We have acomprehensive list of network providers around the globe to help you whenever you needmedical attention.

Within UAEWe have over 1,600 providers in our network, the largest in the country, comprising of differentmedical facilities such as hospitals, pharmacies, specialty centers, polyclinics and more.

You can visit any of our network providers to enjoy a cashless treatment via direct billing where

your bills will be settled directly by Daman. You may, however, have to share a small portion ofthe bill according to deductibles or co-insurance charges for certain services offered under yourhealth plan (such as consultations, medicines, etc.). Such charges will be mentioned on yourDaman card and which you have to pay either before or after the service is provided.

Outside UAEYou have access to over 8,000 medical facilities as part of our international network. In the USAalone, you can access around 950,000 physicians through MedSave International which isincluded in all our plans covering USA. Your policy will clearly indicate the geographies in whichyou can access health services outside the UAE, such as worldwideor worldwideexcept USA

and Canada,etc.

Our international network offers you direct billing access in territories such as Saudi Arabia,Bahrain, Kuwait, Qatar, Oman, Jordan, Syria, Egypt, Yemen, Sudan, Morocco, Tunisia, Algeriaand Lebanon if the countries are part of your policy territory. In other geographies within ourinternational network, inpatient services are available on direct billing and outpatient serviceswill be on reimbursement. Any service in the provider network will be covered as per the termsand conditions of your policy.

Want to find a network provider?

Our provider directories are continuously updated as we establish new agreements withhealthcare facilities. Please check on the participation status of any provider with Damanbefore you visit the facility.

To find out more about our network providers or to locate any provider nearest to you,please use the Provider Search on our website or contact us.

PhoneToll free number: 800 4 DAMAN (32626)

[email protected]

Websitewww.damanhealth.ae

Need medical help,find in our network



Availing health

benefits

Availing healthbenefits



Direct Billing at Network Providers

As a Daman member you are entitled to be treated without the need to pay at your plansnetwork of medical service providers (Network Providers). Some treatments and services areexcluded, please check your plansSchedule of Benefits (SOB).

Direct billing adds extra convenience where you do not have to worry about paying your eligiblemedical expenses up front. Deductible and co-insurance fees are the only amounts you wouldhave to pay.

To benefit from direct billing services, you just have to follow the below mentioned steps:

Present your Daman card at the Network Providersreception Comply with the Network Providers administrative procedures for availing direct billing.

Network providers will explain and help you in completing the necessary administrativeprocedures.

Some health services may have deductibles or co-insurance charges applicable that you have topay directly to the Network Providers for availing health services. (Deductibleis a fixed fee thatis required to be paid by you to the Network Provider. Co-insuranceis the percentage of eligibleexpenses that is required to be paid by you to the Network Provider). Such charges will be clearlymentioned on your Daman card. Such charges have to be paid either before or after the servicesare received.

Pre-authorization:

A pre-authorization is a prior approval given by Daman to the Network Providers, before certainhealth services are provided. Daman requests this approval for certain health services to supportyour Network Providers choice and to ensure that the Network Provider has appropriateinformation on services covered under your health plan.

The Network Provider will inform you if the requested or prescribed procedure requires pre-authorization and if required, the Network Provider will then carry out the necessary proceduresto obtain the pre-authorization for the health service that will be offered.

As a standard requirement, unless otherwise specified in the SOB applicable to your health plan,the below services require pre-approval from Daman:

All inpatient hospitalisation and day treatment services Outpatient specialised investigations and scans including but not limited to MRI, CAT scan and

Endoscopies Physiotherapy Long term medication for more than 30, 60 or 90 days (as mentioned in your SOB) Dental treatments (if the services are included in the SOB) Medical Appliances, Equipment and Supplies (if the services are included in your SOB) Annual screening (if the services are included in your SOB) Other benefits specified in your SOB

Emergency cases that are followed by a hospital admission do not require pre-authorization fromDaman but has to be notified by the Network Provider within 24 hours for Enhanced plan

members and 48 hours for Premier plan members from admission.

DamansAuthorization team operates 24 hours, 7 days a week. It includes doctors, paramedicsand specialized coordinators, and is fully equipped technologically for Network Providers to get intouch with them through multiple channels.

Cashless Treatment



Visit any provider you want

If you would like to receive medical treatment or service outside of your plans network of medicalservice providers, or if you have forgotten your Daman card, you will be able to claim the amount viareimbursement.

In such cases, as a Daman insured member you have the option to apply for a reimbursement of yourtreatments cost, if the availed services are covered under your health plan and reimbursement isavailable in your policy. You can apply for reimbursement of a claim through the following methods: On-line submission through our website www.damanhealth.ae for claimed amount up to AED 5,000.

In certain cases of on-line submissions we may ask you to submit the original documents to processthe reimbursement.

By visiting any of our branches and service points. Through Sales Administration staff, Sales Representatives, Health Insurance Specialists or

Customer Support Agents (CSA).

Required Documents:The following documents are required to be submitted with the Reimbursement Claim Form: Copy of your Daman card Original itemized bill/invoices with service date Original prescription for medication prescribed by your doctor Investigation results and/or reports (e.g. - laboratory test results, x-ray report etc.) should be

attached for procedures above AED 1,000 In case of inpatient (hospitalization) claims you are required to submit a medical report/discharge

summary stamped and signed by your doctor. In case of treatment availed outside the UAE you are also required to submit a copy of the passport

page with the entry and exit stamps or any other document proving your stay outside the UAEwhen the treatment was received

Important to Note:Validity of reimbursement requests: Health Insurance Plans (Except Premier Plan) - You must submit your reimbursement form to

Daman within 120 days from the last treatment date for services availed within and outside UAE. Premier Plans - You must submit your reimbursement form to Daman within 180 days from the last

treatment date for services availed within and outside UAE.

Coverage Outside UAE (as specified in Schedule of Benefits) Health Insurance Plans (Except Premier Plan) - Coverage outside UAE is limited to 90 days per

treatment. A single holiday or business trip may not exceed 90 days. Any treatment after 90 days

from leaving the UAE is not covered under your policy. Exception: For Maternity benefit, coverage isextended up to 180 days.

Premier Plans - Coverage outside UAE is limited to 180 days per treatment. A single holiday orbusiness trip may not exceed 180 days. Any treatment after 180 days from leaving the UAE is notcovered under your policy.

Reimbursement is not applicable for particular plans except for medical emergencies.

Reimbursing your treatments cost



Bringing greater value to yourpharmaceutical benefit

Pharmacy Benefit Management

Pharmacy Benefit Management (PBM) is a comprehensive drug utilisation program. Daman managesits PBM program via an internet-based interface between Daman and the pharmacies within Damansnetwork in UAE. PBM is designed to manage your health insurance pharmaceuticals benefit in line withthe best medical practices.

PBM involves a wide range of real time controls such as:

Quality checks on prescribed drugs for consistency with your diagnosis, age, gender as well as otherparameters such as dosage, refill frequency etc.

Checks for possible negative drug-to-drug interactions and drug-to-diagnosis contraindications toavoid possible health hazards. The checks are performed on your prescription history with us.

Performs insurance checks such as drug coverage, benefits and plan limits and any other factors

relevant to your plan. Actively monitoring prescription claims for fraud and abuse.

PBM has an appeal process to address your feedback, a contingency plan to ensure continuity ofservice in case of technical issues, promotes quality, includes a scientific panel in the decision-makingprocess of your pharmaceuticals benefit, and reduces overall claim costs by promoting rational use ofpharmaceuticals.

Complaints and Appeals

Daman is committed to address members' coverage issues, complaints and problems. For any generalinquires related to your policy benefits, or specific complaints concerning your pharmacy benefits such

as adjudication of your claims (declining the pre-authorization request for a drug), dispensingoversight or provider related issues (access, quality and safety), you can call our Customer Servicetoll free number mentioned on your Daman Card. You can also contact us through our website.

For cases where a drug cannot be found with your Network Provider, you have the option to requestexceptional consideration for coverage. If your request is declined, you may further approach usthrough our appeal process. Daman will discuss the merits of your case internally and externally andwill communicate the decision to you within 30 calendar days from the date of appeal. Details ofappeals process and the Appeals/Exception Request Form are available on our website. You can submityour Appeal/Exception request Form along with all supporting documents at any of the DamanBranches or via email to [email protected].
http://www.urac.org/directory/DirectoryLinker.aspx?id=22DDA000000D3



Other valuable

Services

Other valuableServices



Emergency coverage under our insurance plans

We are committed to ensure that you receive the best health care services, especially in anemergency.

In the event of a medical emergency within the geographical limits of your policy, you can availhealth services at the nearest available health service provider. Emergency services are coveredin network and non-network health service providers.

When availing services at Network providers:If the nearest available health service provider is within our list of Network providers, then youdo not have to pay for the availed health services as benefits offered are on direct billing basis.

For emergency services, we have waived the requirement of pre-authorization. However, thenetwork health service provider must notify Daman within 24 hours for all our health insuranceplans (except Premier) and 48 hours for Premier plan members from admission.

When availing services at non-Network providers:If the nearest available health service provider is not within our list of Network providers; thenyou would need to pay for the service and claim the amount via reimbursement. Simply fill in theclaims reimbursement form available at www.damanhealth.ae, attach all necessary documentsand send it to us. For any assistance with our reimbursements process, please call the toll freenumber mentioned on your card.

In an emergency,we are always here!



Medical tele-consultation services

The Abu Dhabi Telemedicine Centre is an innovative telemedicine consultation service offeredexclusively by Daman to Enhanced members where highly qualified physicians provide you world-class healthcare around the clock, without having to visit a clinic or hospital. The centre is staffedby Swiss-trained medical professionals delivering sound medical consultation over the telephonein confidence when you need it, for routine pediatric conditions or simply general medicalqueries.

The Abu Dhabi Telemedicine Centre is a partnership between Abu DhabisMubadala Development

Company and Switzerlandsleading telemedicine provider, Medgate.

The Abu Dhabi Telemedicine Centre offers medical consultation services in Arabic and English,utilising a staff of qualified physicians and an innovative patient management system, to ensureconfidentiality, facilitate referrals to specialised, local physicians and provide personalised care.

Healthcare - wherever, whenever!



Why should you call for medical tele-consultation?

Peace of mind. Helps you decide when to visit a doctor and saves your time from unnecessarytrips to the clinic or hospital

Faster identification of any symptoms requiring further medical attention.

Receive the highest level of medical advice from specialised and Swiss-trained medical staff.

Medical consultation in full confidence. The telemedicine centre maintains the highest level ofdata security and confidentiality.

When do you call the telemedicine centre?

Call anytime 24/7, even in the middle of the night

Call from anywhere, to speak with a doctor even from the remotest location

Call if you are not sure whether to visit a doctor or not, for any symptoms

Call for routine pediatric conditions, general medicine and dermatology

When do you go to a hospital or clinic? Incase of emergencies

For specialised medical services

For consultation requiring face- to-face interaction with the doctor

What happens when you call the telemedicine centre?

When you call, you will speak directly with a nurse for a preliminary assessment who will takenote of your symptoms, personal details, and arrange to have a doctor call you back shortlyfor a full assessment.

Within 30 minutes, you will be contacted by a doctor who will conduct an assessment of your

symptoms. The doctor will then either recommend a personalised treatment programme orrefer you to a nearby network provider for further assessment and specialised care.

Important to know:

If your plan covers medical tele-consultation service, you can avail this service anytime of theday. To know about the coverage under your plan, please refer to your Schedule of Benefits.

The Abu Dhabi Telemedicine Centre will uphold the confidentiality of the information that youprovide to their medical staff, as per the requirements of UAE law. All calls are recorded; theywill create electronic medical records and authorise us, Abu Dhabi Telemedicine Centre and/orother healthcare providers to receive or exchange your personal or medical information, asmedically necessary.

As part of the data security check, please keep the following information handy:

Your Member Card Number Your insurance policy expiry date as mentioned on the card

No Deductible will be charged for availing this service

24/7 helpline for medical tele-consultation

+971 2 502 9999



When you are travelling away from home, its important to know how to get immediate medicalhelp, should the need arise. That is why Daman has teamed up with Assist America to provideemergency medical assistance services, which are available to you while travelling to anothercountry or travelling 120 kilometers or more away from your home.

To access the Global Emergency Assistance services from Assist America, you are requested tocall their telephone number, which is printed on the back of your Daman card. Assist Americasoperations centers are staffed 24 hours a day with trained multilingual and medical personnel,including nurses and doctors, to advise and assist you immediately in case of a medicalemergency.

Our arrangement with Assist America provides you with access to the following services:

Medical Evacuation and Repatriation Emergency medical evacuation Medical repatriation co-ordination Return of mortal remains to country of origin Return of minor children to their current residence (Economy Class One Way Airfares)

Medical Assistance

Medical consultation and evaluation Medical referrals to doctors and hospitals Hospital admission assistance Medical monitoring Prescription assistance Compassionate visit (One Economy Class Return Airfare)

Global emergency assistancethrough Assist America



Travel Assistance Pre-trip information Emergency message transmission Interpreter and legal referrals, on request Lost luggage or document assistance Bail Bond co-ordination Emergency cash co-ordination

Assist America completely arranges and pays for all the emergency medical care received whiletraveling. Once a qualified physician or hospital has begun care, the costs of actual treatmentand hospitalisation will be managed under your health insurance plan and are subject to thepolicy limits of your coverage.

Important to know:

Assist America will not provide services if the travel is undertaken specifically for securingmedical treatment; or if you transfer from one medical facility to another of similar capabilitiesthat provides a similar level of care.

Assist America will not provide services for travel exceeding ninety (90) days or one hundredand eighty (180) days (as specified in your plan) whilst traveling away from your legalresidence.

Assist America will not evacuate or repatriate you (i) without medical authorisation; (ii) withmental or nervous disorders unless you are hospitalised; (iii) if you have mild lesions or simpleinjuries such as sprains, simple fractures, or a mild sickness that can be treated by localdoctors and which does not prevent you from continuing your trip and returning home and (iv)an advanced pregnancy beyond 6 months.

All services must be arranged and provided by Assist America. Assist America will not acceptany claims for reimbursement.

Call Assist America anytime, from anywhere

In UAE call: 800 4 DAMAN (32626)

In USA call: 877 488 9857

Worldwide (call collect): +1 609 275 4999



Second medical opinion services through Europe

Assistance GCSIf you are diagnosed with a serious illness, you may need to seek further confirmation on yourdiagnosis and treatment options, before deciding on the next steps. We can support you at sucha time. We can arrange for a second medical opinion on your case from top international medicalexperts.

We have partnered with Europ Assistance Global Corporate Solutions (GCS), a leadinginternational specialized health care service provider to offer you a comprehensive and well-selected network of the best medical experts in different medical fields. The network includes anumber of centers of excellence, such as the internationally renowned Harvard Medical School,

giving you the peace of mind that a medical advice of the highest medical standards is offered toyou, whenever you may need it.

Our second medical opinion service covers serious illnesses andconditions such as:

Cancer cases Major organ transplant Major trauma Severe burns Stroke

Autoimmune diseases e.g. multiple sclerosis Congenital anomalies/deformities Heart Disease Paralysis Senile dementia e.g. Alzheimers Disease Slipped vertebral discs

When you need a second medical opinion?



How to avail the second opinion service?

Please contact us by calling our toll free number 800 7226 or sending us an email [email protected].

You will be asked to complete and sign a Medical Request Form and a Release of MedicalInformation Form, provide comprehensive medical records (in English), which should include

all relevant laboratory and radiology reports (Example - X-ray, CT Scan, MRI, blood tests) anda recent typed medical summary of your case by your doctor. This information will enable ourexperts to provide you with detailed and precise medical advice.

Once we review your medical case and ensure that all required documents are in order, yourrecords will be sent to Europ Assistance - GCS. Our systems ensure high confidentiality andsecurity when sending your medical information.

Europ Assistance - GCS will then forward your record to the most appropriate medical expertfor your case.

The expert will review your case and provide their opinion and suggestions on the course oftreatment substantiated by recent medical research as relevant.

Europ Assistance - GCS will send the report to us, and we will contact you to share the reportwith you and explain its details if needed.

The whole process takes around 10 business days from the day we receive the completeapplication. However it can take longer if additional information or investigation results arerequired or if the most appropriate expert is not immediately available. We will stay in touch andkeep you informed throughout the process.



Preventive Health Services

At Daman, we firmly believe in promoting preventive health services for our members to reducetheir health risks and contribute to their overall wellness. We have two different programs for ourmembers.

Annual ScreeningWe have carefully chosen a list of health service providers where you can go for our preventivehealth screening service. We have designed specific health screenings for women and men abovea certain age group.

Under our Annual Screening benefit, female members above the age of 35 years can avail BreastCancer Screening, male members above the age of 45 years can avail Prostate Cancer Screeningand both male and female above the age of 50 years can avail Colorectal Cancer Screening. Thescreening services are available once a year, with pre-authorization (where the health serviceprovider will ask us for a pre-approval before offering you the service).

Services covered under Breast Cancer Screening are: Clinical Exam Mammogram Pelvic Sonogram (if medically necessary) CA 15.3 (CA - Carcinoma Antigen) (if medically necessary)

Services covered under Prostate Cancer Screening are: Clinical Exam PSA (Prostate Specific Antigen) Rectal Sonogram

Services covered under Colorectal Cancer Screening are: FIT (Fecal Immunochemical Test) every 2 years Colonoscopy every 10 years

Annual Health Check-up

We have designed specific annual health check-up module for our plan members. The healthcheck-up service will be available with listed health service providers. The annual health check-upwill offer preventive tests that can be availed once in a year and will include: PhysicalExamination by GP, ECG, CBC, Blood Urea Nitrogen, Total Cholesterol, Fasting Blood Sugar,Creatinine, Urinalysis, Stool Examination, SGOT, SGPT.

Annual Screening and Annual Health Check-up is available with a range of plans.

Take a step towards ahealthier you!



At yourserviceanytime,

anywhere

At your serviceanytime, anywhere



Customer Care

Our Customer Service Centre was set up to serve as your first point of contact with Daman. Weserve members over the phone and email around the clock, and have put in place a qualityassurance team to ensure members receive the best service possible.

Customer Call Support:

Our call support team operates 24 hours a day, 7 days a week and is staffed with bi-lingualrepresentatives. You can call on our toll free numbers for any queries, concerns or complaintsthat you may have about the benefits and services included in your policy. This team isresponsible to handle your requests within Daman and in the process, coordinating with differentteams across the company on your behalf. The team from time to time may call you to checkyour satisfaction with Daman and take any comments you may have.

E-mail Support:

This team will log your email enquiries and answer you within a promised maximum of twoworking days. They are also responsible to record suggestions and answer enquiries madethrough our website.

Quality Assurance:

This team ensures that everyone in the Customer Service Centre works in accordance with ourpolicies that guarantees you are served as best as possible.

Contact Us:

Phone: Toll Free Number: 800 4 DAMAN (32626)Email: [email protected]

We are here to help you



Daman Online Services

We launched our website damanhealth.ae in 2009 to give our members access to a user friendlyinterface to interact with us. Our website is recognized and is well-received in the market. The

online services of Daman remain unmatched in the market. Daman has been recognized for itsadvanced website functionalities at a number of local and international events.

Available for members, policy holders, brokers and medical service providers each with acustomized interface, our website is completely secure and all medical and personal informationis dealt with confidentially. Here are some of the benefits of using the website to manage yourhealth insurance:

Know your plan - View your plansschedule of benefits and exclusion list.

Search for medical service providers Use the Provider Search available on the website tosearch for hospitals, pharmacies and other medical facilities. You can filter your search byEmirate or City, Plan type, Specialty and even Language. You can also rate providers that youhave visited and help other users make an informed decision.

Submit a reimbursement request - You can submit a reimbursement request online. Just fillthe online claim form, conveniently upload all required documents such as hospital bills, invoicesand prescriptions, input your bank account details and submit the claim online. The claim amountis directly credited to your bank account when approved.

Track your claims You can also track the status of your claims conveniently from your MyDaman account. Paper and online claims reimbursements can be tracked from your onlineaccount, as well as claims submitted by providers on your network. You can view these claims by

year, month and date.

Download Forms You can download important forms and guidelines from our website.

Get new quotes You can use our Premium Calculator on the website to receive indicativerates to purchase new health insurance policies. Once you receive a quote, you can even pay forit online using your credit card.

Access a world of information at theclick of a button!



Callback and Feedback If you wish to speak to one of our Customer Service Representatives,you can submit a Callback request online and our team will call you at the time and datespecified by you. You can also use our Feedback form to share suggestions, feedback or report acase of fraud and abuse etc.

Online Demo If you are new to our online services, you can view our online demo thatexplains all our services step-by-step. You can even share this with your employees if you are the

policy holder

Virtual Assistant - An interactive video-based application designed to provide you with insightsinto our products, services and answer frequently asked questions. Just type your question intothe designated box and let a Daman employee give you the answer through video.

Mobile Enabled While you are on the move, you can access our mobile enabled websitedesigned to fit your mobile screen so that you are able to easily and quickly search for a hospitalor check the status of your reimbursement request.

Active Life Activelife is our customer engagement platform which is designed to give ourmembers value-added services to support them in leading a healthy, active life. Active Life can

be accessed online at www.damanhealth.ae/club (Winner of Middle East Internet Award 2012)and includes the following sections:

Activelife Discounts at selected outlets: We have secured discounts for our members bypartnering with vendors from various industries such lifestyle, health and sports. All you haveto do is, show your Daman card at a participating outlet to receive the discount.

Healthy Living: We have a dedicated Healthy Living section on the website that includeshealthy recipes, fitness tips and information regarding health-oriented events sponsored byDaman

Online Forum: Our Online Forum is a gift to the general community (both members and non-

members) where you can post questions regarding health, wellness, diet and general lifestyle.We have dedicated health coaches in Daman that answer your questions within 24 hours. Theforum currently has a wide range of topics being discussed including maternity, nutrition,diabetes, quitting smoking and many more.

Steps to register:

1. Visit http://www.damanhealth.ae2. ClickLogin to My Daman

3. Click theRegister button

4. Choose your user type as Member

5. Fill in all the required details

6. Click the Continue button and follow the on-screen prompts to set up a user name and

password.

7. Once you register as a Member, you will receive a phone call from a Daman Customer

Service Representative to verify your details and activate your account. However, yourActive Life account will be instantly activated and you will be able to login at

www.damanhealth.ae/club



Resolving Customer Complaints

Do you have a feedback or complaint? We have different channels to hear from you:

Phone: Toll free 800 4 (DAMAN) 32626Email: [email protected]:visit www.damanhealth.ae and go talk to us. We have several ways to hear from youFax number: +971 2 614 9787Post: Customer Service Department

Customer Communication and Complaint Management UnitNational Health Insurance Company DamanP.O Box 128888, Aby Dhabi, United Arab Emirates

If you have raised a complaint, our team will acknowledge it within two working days by sendingyou an SMS or an email with the complaint number. We will then proceed with a thoroughinvestigation into your issue and get back to you within 15 working days. Please be assured thatyour complaint will be dealt with seriously, diligently and confidentially.

To investigate your complaint thoroughly, please provide us with any supporting documents andask us the questions you would like us to answer.

Your concerns are important to us



Are you not satisfied with our response?

We aim to meet, and even exceed our membersexpectations and provide them with solutions totheir complaints. In case you are not satisfied with our response, you may contact us again [email protected] and providing us with your original complaint reference number.A Customer Service Supervisor will acknowledge your complaint within two working days, and willproceed to investigate your case further before responding to you within 15 working days.

In the unfortunate event where we are unable to reach a satisfactory agreement with you, youhave the right to refer your complaint to the appropriate insurance regulator as indicated below.Kindly quote your Daman complaint reference number to the insurance regulator.

Health Authority Abu Dhabi(HAAD)

HAADAbu Dhabi, Airport RoadAbu Dhabi, United Arab EmiratesP.O. Box5674Tel: +971 2 449 3333

Fax: +971 2 444 9822Email: [email protected]

Insurance Authorityif you are working or residing in other Emirates.

Insurance AuthorityAbu Dhabi, Aldar HQ, Al Raha BeachP.O. Box113332Tel.:+971 2 499 0111Fax:+971 2 557 2111Email:[email protected]

Or alternatively you may visit the Insurance Authority website to log an anonymous complaint viathe below provided link:https://eservices.ia.gov.ae/Wirestorm/Pages/Render.aspx?page=Complaints&layout=NewAnonymousComplaint



Branch Locations

Dubai Direct Sales Office

Office#601 Capricorn Bldg,

Sheikh Zayed Road, Dubai

Telephone: 04 311 7911

Daman Headquarters

Millenium Tower, Hamdan Street

Abu Dhabi, UAE


Corporate Sales Center

Al Bateen, Tower C4, Bainuna Street,

Abu Dhabi

Direct: 02 651 8295

Service Points Locations

Abu Dhabi Service Points

Infinity Services Moroor Street

Zones Corp. MussafahAbu Dhabi Immigration

Dept. of Economic Development

Abu Dhabi Chamber of Commerce

Marina Mall

Masdar City

Al Shahama Municipality

Central Branch

Airport Road, Abu Dhabi


Mussafah Branch

Global Ascent Business Center

Al Mussafah 4, Abu Dhabi

Plot No. 12 Next to SEHA

Telephone: 02 815 0209Al Ain Service Points

Infinity ServicesAl Wagan Municipality

Mazyad Municipality

Al Hayer Municipality

Sweihan Municipality

Al Qoaa Municipality

Al Ain Immigration

Al Khaznah Municipality

Al Maqam Municipality

Al Ain Branch

G01-G02, Ground Flr, Al Wadi Trading

Centre, Khalifa Bin Zayed Al Awwat St.

Al Ain


Western Region Branch

Saeed Bin Humaid Complex - Block A

1stFloorWestern Region, Abu Dhabi


Western Region Service PointsMadinatZayed, Tamm Center

Ghayathi, Tamm Center

Silaa, Tamm Center

Delma, Tamm Center

Al Marfaa, Tamm Center

Liwa, Tamm Center

Sharjah Branch

Ground Level, Crystal Plaza, Corniche Road

Sharjah

Telephone: 06 517 15 55

Dubai OfficeJLT Office

Fortune Tower, Ground Floor Level

Jumeirah Lakes Towers, Dubai


Sharjah Service Points

Sharjah Immigration

Ras Al Khaimah Service Points

Ras Al Khaimah Immigration

We are here to serve you



As a Daman member you have the Right to: Receive information about Damans health insurance plans and services including but not

limited to health insurance plan benefits, exclusions, policy terms and conditions, PharmacyBenefit Management (PBM) services, details of network providers (including hospital,pharmacy, dental clinic etc.), online services, list of medications covered under your health

insurance plan (Drug List) and your Rights and Responsibilities. Be treated with respect and dignity and have the right to privacy.

Preserve the confidentiality of your treatment records to the extent protected by Federal andEmirate laws in the UAE. You are also entitled to receive an explanation regarding exceptionsto confidentiality.

Voice complaints or to appeal to Daman on benefits offered, claim settlement, servicesoffered, PBM services or any other grievance.

Be provided, upon request, with information about your plan's benefits including limitationsand exclusions applicable and details related to your health plan Drug List.

Receive services in English and Arabic when contacting Daman Customer Service.

Make suggestions and give comments on ways Daman can improve its services.

Exercise your rights in accordance with the Health Insurance Law of the Emirate of AbuDhabi.

As a Daman member your Responsibilities are: To read your insurance policies for the details of benefits, exclusions, other terms and

conditions applicable under your health insurance plan. If you do not understand theinformation, you should contact Daman Customer Service for explanations on the coveredbenefits, limitations and authorization procedures.

To present your Daman Card (health insurance card) when accessing covered health servicesfrom our Network Providers.

To know how to access covered health services and pharmacy benefit you are entitled to aspart of your health insurance plan benefits.

To pay applicable co-insurance and deductible, if any, at the time of availing a health service.

To demonstrate mutual respect and courtesy towards providers (including hospitals,pharmacies, dental clinics etc.) and Daman personnel.

Your Rights and Responsibilities


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Toll free: 800 4 DAMAN(32626)[email protected]

www.damanhealth.ae

Need help?Contact Us

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