Medical Insurance Policy

Concept of Coverage

• Outpatient services: consultation and examination, laboratory tests, imaging (X-ray/ultrasound), MRI, physiotherapy.
• Inpatient services: surgeries, hospitalization, operating room access, medicines and supplies, ICU, physicians’ and consultants’ fees, day cases, diagnostic/surgical endoscopy (upon the treating physician’s request).

Core Benefits / Basic Coverages

• Outpatient care: consultation, outpatient minor procedures, medicines registered with the Ministry of Health.
• Inpatient care: accommodation, day cases, surgery, physicians’ fees, operating room costs and supplies, ambulance and emergencies.
• Chronic & pre-existing conditions (subject to the applicable limit).
• Pregnancy & delivery (subject to the applicable limit).
• Dental (subject to the applicable limit).
• Vision (subject to the applicable limit).
• Newborns covered from the date of birth.
• No maximum cap for medication cost (as per plan limits/coverage scope).
• No waiting period.
• Network available in the Arab Republic of Egypt.

Key Advantages

1. Patient care and providing appropriate medical service are top priorities.
2. Multiple categories: VIP, Gold (A), Silver (B).
3. Direct phone support for questions and immediate issue resolution.
4. Fast delivery of prior approvals to providers.
5. Wide network across Sudan with possible expansion per rules and contracts.

Accessing Medical Services

Each beneficiary receives a personal access card for network providers; co-pay applies as per the card category.

Prior Approvals

• Hospitalization / ICU
• Surgical operations
• MRI or CT scans
• Extended physiotherapy
• Endoscopy
• Anesthesia-based examinations
• Hormone tests
• EEG/EMG
• Long-term medication
• Medical eyewear

Issuance Requirements (Enrollment)

1. Complete the insurance application and set maximum limits per category/benefit.
2. Submit a family listing form approved by the institution’s administration.
3. Attach a passport-size photo for each covered person.

Out-of-Network Reimbursement (Summary)

• Optional out-of-network care: reimbursement as a percentage per rules.
• Unavailable service/specialty or emergencies: reimbursement may reach 100% subject to limits and exclusions.