Individual Medical Insurance (Sahatuna)

A health insurance plan that helps you deal with any sudden health adversity and high medical cost burden, Sahatuna helps you live a worry free life without compromising on your good health needs.

Features and benefits

Age of Entry: - 14 Days to 60 Years.
Citizens / Residents of Oman with Valid Visa for stay in Oman
Out Patient Cover
Cover starts after 15 days of policy issuance
Limit for Optional Dental and Optical cover is OMR 250 (Only with Platinum Plan)

Sahatuna- Individual Medical Insurance Policy		Bronze	Silver	Gold	Platinum
Benefits	Inpatient and Out Patient	Yes	Yes	Yes	Yes
Optional Benefits	Dental and Optical (100 Omr), Dental(65 Omr) Only, Optical Only (65 Omr)	NO	NO	NO	Yes
Annual Limit per person			OMR 3000/-	OMR 3000/-	OMR 5000/-
Annual Limit per person			OMR 5000/-	OMR 5000/-	OMR 10000/-
Hospital Network	NLGIC Designated Medical Network	Bronze Network	Band B only	Band A, Band B only excluding MPH	Band A, Band B including MPH
In-house pharmacy Access	Pharmacy Access within Hospital/ Clinic	No	No	Yes	Yes
Territorial Limit- Elective Treatment	Oman, India, Sri Lanka and Bangladesh only	Yes	Yes	Yes	Yes
	Thailand Only	No	No	Yes	Yes
	Other Countries	No	Yes	Yes	Yes
Territorial limit - Emergency Treatment ##	Worldwide excluding USA and Canada	Yes	Yes	Yes	Yes
Maximum Limit per Admission or Treatment	As per annual limit	Yes	Yes	Yes	Yes
Hospital Accommodation & Services	Coverage for single Private Room	Yes	Yes	Yes	Yes
Maximum no days per Admission or Treatment	45 days	Yes	Yes	Yes	Yes
ICU	Direct Billing @agreed rates at Designated Medical Provider Network	Yes	Yes	Yes	Yes
Consultant's, Physician's, Surgeon’s , Anaesthetist’s Fee	Direct Billing @agreed rates at Designated Medical Provider Network	Yes	Yes	Yes	Yes
Diagnostics (X-ray, MRI,CT Scan, Ultra Sound etc.)	Direct Billing @agreed rates at Designated Medical Provider Network	Yes	Yes	Yes	Yes
Laboratory	Direct Billing @agreed rates at Designated Medical Provider Network	Yes	Yes	Yes	Yes
Medication	Direct Billing @agreed rates at Designated Medical Provider Network	Yes	Yes	Yes	Yes
Physiotherapy Charges		Yes	Yes	Yes	Yes
Nursing at home for recovery and in lieu of hospital stay	upto a 14 days per admission or procedure	Yes	Yes	Yes	Yes
Pre Existing / Chronic Condition		Not covered for 6 Months (Omr 250 Only)	Not Covered for 1^styear, From 2^ndYear 50% sum insured	Not Covered for 1^styear, From 2^ndYear 50% sum insured	Not Covered for 1^styear, From 2^ndYear 50% sum insured
Deductible / Coinsurance	For each and every claim / visit	OMR 2	10%	10%	10%
Transportation expense for inpatient treatment abroad	Amount per person per annum	RO 500	RO 500	RO 500	RO 500
Maternity, Psychiatric Treatment, Congenital Hereditary and Birth Defects Treatment		Not Covered	Not Covered	Not Covered	Not Covered

Exclusions

Major Exclusion - All treatments within the first 15 days from the date of acceptance of the proposal by the insurer.
Other Exclusions for 1st Year– Hernia , Hysterectomy, Hydrocele , Piles , Surgery on joints , surgery for gastric or duodenal ulcers , Sinusitis and related Disorders , Knee Replacements due to Arthritis , Hip replacements.
Maternity and related expenses
Drug Abuse
Treatments arising out of racing/ hazardous activities
As a consequence of person under the influence of any alcoholic/narcotic or drug unless administered on the advice of a physician
Intentional self-injury while sane or insane.
War and nuclear perils.
Any treatment or related to HIV /AIDS
Congenital anomalies
Cosmetic treatments and routine medical examinations.