Local SME Life & Health

Protection your team deserves

Your team is the most important asset for your business growth, when you value them and ensure that their welfare is well taken care of nothing can stop their continued motivation and outstanding performance.

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According to plan terms & conditions and related table of benefits.
Policy provided by AXA Life Insurance Egypt.

Local SME Life & Healthcare

A plan offering small and medium enterprises – between 20 and 300 employees – the opportunity to provide their teams with high quality healthcare benefits and life protection services in Egypt; allowing them to focus on growing their business and moving from one success to another. The plan includes six packages to choose from, meeting your and your team’s needs for life protection and medical services.

Key Benefits:

✓ Pre-underwritten plans, easy issuance with no medical tests needed
✓ Access to inpatient and outpatient treatments
✓ Access to a network of more than 3,000 healthcare provider
✓ 24/7 customer service, claims processors and production staff to ensure best services
✓ Coverage for new chronic conditions, pre-existent conditions, dental, optical and maternity
✓ Coverage for work related injuries
✓ Life coverage includes Group life insurance, accidental death, total and partial permanent disability

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Key Benefits Table

Benefits
	Plan Name
	Prestige Plus	Elite Plus	Diamond Plus	Elite	Diamond	Standard Diamond
Life Benefits
Group Life Insurance (GLI)	EGP 100,000K
Total Permanent Disability (TPD)	EGP 100,000K
Accidental Death Insurance (ADI)	EGP 100,000K			Not covered
Partial Permanent Disability (PPD)	EGP 100,000K
Health Benefits
Referral Letter	No
Area of cover	Inside Egypt only
Medcial Network Class	Elite (golden card)	Elite (golden card)	Diamond (silver card)	Elite (golden card)	Diamond (silver card)	Diamond (silver card)
Yearly maximum per insured member	EGP 150,000	EGP 100,000		EGP 50,000		EGP 30,000
Direct billing inside network	Inpatient and outpatient treatment as applicable
Inpatient Treatment
Inpatient and day care including surgeon, anesthetists, and consultation charge, diagnostic procedures, and physiotherapy	coverage on direct billing basis 100%
Daily room and board	Standard private room
Parent accommodation in the same room when the insured is under 18 years old	coverage on direct billing basis 100%
Outpatient Treatment
Doctor’s consultation	coverage on direct billing basis 100%		coverage on direct billing basis 80%			coverage on direct billing basis 70%
Prescribed labs and diagnostic tests
Physiotherapy
Prescribed drugs	coverage on direct billing basis 80%
Other Benefits
Pre-existing cases	EGP 15,000	EGP 10,000		EGP 5,000		EGP 3,000
New Chronic	Covered
Organ transplant	Covered
Ground ambulance	Covered
Accidental damage to natural teeth	Covered
Passive war and terrorism risk	Covered
Work related injuries	Covered
Pregnancy (Including antenatal care and childbirth)	EGP 7,500	EGP 5,500		EGP 3,000		Not covered
	Two cases per twenty insured			One case per twenty insured
	coverage on direct billing basis 100%
New-born cover	Covered with maximum limit of 3,000 EGP from the annual mother ceiling					Not covered
Dental care	EGP 1,500	EGP 1,000		EGP 500		EGP 350
Dental care	coverage on direct billing basis 80%
Optical care	EGP 1,000	EGP 600		EGP 400		Not Covered
	Two cases per twenty insured			One cases per twenty insured
	80% coverage on reimbursement basis