Worked example
A worked cap-and-co-pay example
A single worked case ties the whole model together. Take a natural delivery at a standard private hospital, an AED 16,000 package, and a patient on a basic / mandatory plan — the calculator’s default. Here is exactly how it splits that package.
Basic plan — the AED 16,000 package
The mandatory plan caps natural-delivery cover at AED 10,000. Covered equals the lower of the cap and the package, so cover is AED 10,000. You pay a 10% co-pay on that — AED 1,000 — plus everything above the cap: AED 16,000 − AED 10,000 = AED 6,000. Your out-of-pocket is AED 1,000 + AED 6,000 = AED 7,000, and the insurer pays AED 10,000 − AED 1,000 = AED 9,000.
Comprehensive plan — the same AED 16,000 package
Now switch to a comprehensive plan, capped at AED 30,000 for a natural delivery. The AED 16,000 package is below the cap, so cover is the full AED 16,000. You pay only the 10% co-pay — AED 1,600 — and nothing above the cap, because there is nothing above it. Your out-of-pocket falls from AED 7,000 to about AED 1,600. That is the whole point of the cap: on a mandatory plan you shoulder everything above AED 10,000; on a comprehensive plan the cap is high enough that the package fits under it.
And if you are self-pay, there is no split — you pay the full package, AED 16,000. Put the cases side by side: basic plan AED 7,000, comprehensive AED 1,600, self-pay AED 16,000. The calculator runs this same arithmetic for the tier, delivery and insurance you pick, so you can see instantly what your own choices leave you paying.