Emerald

New generation cover for those who need affordable in-hospital and day-to-day benefits. The member makes a basic monthly contribution plus a predetermined optional monthly allocation amount (MAA). The MAA is deposited into the member’s individual savings account, called the Accumulation Fund (AF). All in-hospital and related expenses are paid out of the Fund’s pool, which consists of all the individual members’ basic contributions. All recognised day-to-day expenses are paid from the member’s Accumulation Fund. The principle of the New Generation Option is completely different to that of the Traditional Options. The member takes an active role in the management of a portion of his/her medical expenses. He/she has access to funds in his/her personal medical savings account called the Accumulation Fund (“AF”) for day-to-day expenses. This offers protection against possible abuse of the Fund and of the accumulation funds.

Key Benefits

Hospital: Major Medical Expenses
AHB Cover: GP & Specialist in-hospital services payable to a maximum of 225% of NAMAF Tariff

Benefit Cover
Accommodation – private wards 100%
Accommodation – other than recognised hospital 100% of cost
MRI & CT Scans 100%
Internal Appliances & Materials 100% of cost
Oncology – Active Therapy (Surgery, Chemotherapy and Radiotherapy) 100%
Organ Transplant 100%
Refractive Surgery 100%
Maternity - Confinement – Full Procedure
  • 12 Ante-natal Consultations
  • 2 Sonars per Beneficiary per pregnancy
100%

Optional Cover: Member Selection
AHB Cover: GP & Specialist in-hospital services payable to a maximum of 225% of NAMAF Tariff

General Practitioners 100% of cost from Accumulation Fund
Dentistry 100% of cost from Accumulation Fund
Medicine & Injections 100% of cost from Accumulation Fund
Optical 100% of cost from Accumulation Fund
Primary Health Care Services 100% of cost from Accumulation Fund
Auxiliary Services 100% of cost from Accumulation Fund
Specified Illness Conditions 100% of cost from Accumulation Fund

Contribution Cover
Emerald Group Contributions Applicable Major Medical Expenses - Hospitalisation
Member determines contribution to the Accumulation Fund Day-to-Day expenses - Member in control of utilisation of Day-to-Day Expenses payable from Accumulation Fund

Contributions

Individuals
Age Band Main Adult Child
0 25 815 516 204
26 30 907 580 204
31 35 1 001 647 204
36 40 1 131 730 208
41 45 1 239 811 208
46 50 1 339 883 208
51 55 1 463 974 208
56 60 1 567 1 048 208
61 65 1 670 1 124 208
66+
1 781 1 197 208
Individuals
Age Band Main Adult Child
0 25 815 516 191
26 30 907 580 191
31 35 964 594 191
36 40 1 038 634 194
41 45 1 111 697 194
46 50 1 206 766 194
51 55 1 246 800 194
56 60 1 318 858 194
61 65 1 429 932 194
66+
1 463 955 194