1
المادة 1
Article (1) Definitions In application of the provisions of this Resolution, the following terms and phrases shall have the meanings assigned to each of them, unless the context requires otherwise: State : United Arab Emirates (UAE). EHSC : Emirates Health Services Corporation. Chairman : Chairman of EHSC’s Board of Directors (BOD). Citizen : Natural person who holds the nationality of the UAE. And the Like : Non-citizen family members: Husband - wife - dependent children – parents. Resident (non-citizen) : Foreigner who has a valid residence permit in the State. Visitor : Any foreigner who visits the State in accordance with the laws in force therein. Health Card : The electronic document issued by the institution for the benefit of the Beneficiary, which proves his subscription to the health Card system during the coverage period specified therein. Healthcare Providers : Healthcare establishments affiliated with EHSC. Beneficiary : Everyone who receives or is eligible to receive Healthcare Services. Health Services : All preventive, curative, health services and procedures and rehabilitation (medical convalescence) provided to the Beneficiary in an actual or virtual
-- 2 of 21 --
Cabinet Resolution of 2022 Concerning Healthcare Services Fees Provided in Health Establishments Affiliated with EHSC 3 attendance within the framework of the applicable regulations, from the beginning of the Beneficiary journey, including but not limited to counselling, diagnosis and various treatments, which include medicine - physical therapy - surgery- Interventional treatment and supply – orthodontics, Medical Supplies : Each product used in the process of providing curative health services individually or in combination, including consumables, medical equipment, syringes, needles, sutures, staples, packaging, tubes, catheters, medical gloves, gowns, masks, adhesives and sealants for wound dressing, and a full range of other devices and equipment used in service or surgical Service Providers that are the essential supplies for health systems to provide Healthcare Services. Prosthetic Devices : A device that supports some or all of the lost functions of body parts (prosthetic limbs and orthoses) to compensate the patient for functional deficiency) due to a congenital or acquired defect, by modifying, fixing or supporting the organs and their movement, and is installed on the body or inside the body to limit or increase movement or support a part of the body, or support the functions of the internal organs of the body, including, but not limited to, a pacemaker - stents - cochlea or the like. Insurer : The Health Insurance provided to the Beneficiary by one of the Health Insurance companies licensed in the State: The Insurance Company or entities guaranteeing it, the Company responsible for paying the value of financial claims, the Employer or the legal representative. Coverage Provider : The person or entity that bears the cost of health benefits. Health Insurance Policy : The contract signed between the Health Insurance Company and the coverage provider, which specifies the health benefits granted to the Beneficiary. Health Insurance Card : The electronic document issued by the coverage provider or Health Insurance Company for the benefit of the Beneficiary, which proves his participation in the Health Insurance system during the coverage period specified therein.
-- 3 of 21 --
Cabinet Resolution of 2022 Concerning Healthcare Services Fees Provided in Health Establishments Affiliated with EHSC 4 Health Benefits Schedule : A set of healthcare, medical, therapeutic and preventive services including medications, benefits schedule and medical examinations that the Beneficiary enjoys through the Healthcare Service Provider and stipulates the terms and conditions of coverage for the Beneficiary including but not limited to any percentages or amount of participation and exceptions, and coverage limits. Subscription Amount : The financial lump amount determined in the Health Benefit Schedule specified by the Insurer or in accordance with the Health Insurance Policy required to be paid by the Beneficiary to Healthcare Service Providers directly upon receiving Healthcare Services. Subscription Percentage : The percentage mentioned in the Health Benefit Schedule or specified under the Health Insurance Policy that the Beneficiary is required to pay directly to Healthcare Service Providers, for each time he receives a certain type of Healthcare Service. Services Included : Healthcare Services covered for the Beneficiary and the Insurer shall pay it in whole or in part pursuant to the Health Benefit Schedule. Services Not Included : Non-covered Healthcare Services by the Insurer, and the Beneficiary shall pay them directly to the Healthcare Service Providers. Claim : The Claim submitted by Healthcare Service Providers to the Insurer or to the Beneficiary directly for payment of Healthcare Services Fees, and the Claim shall include: All Healthcare Services provided to the Beneficiary. Emergency : An unexpected situation that requires immediate medical intervention by a Healthcare Provider to save a person life or treat a person from a life-threatening threat or serious damage to vital organs or functions. Other Insurance Policies : These are different types of documents such as car insurance, hazard insurance, life insurance, work injury insurance, etc.
-- 4 of 21 --
Cabinet Resolution of 2022 Concerning Healthcare Services Fees Provided in Health Establishments Affiliated with EHSC 5
