What you need to know about your Dubai Health Insurance.
The health insurance law sets forth the employers’ responsibility to secure insurance to cover residents’ basic healthcare needs. Depending on the contractual agreement between employer and employee, the employer may offer basic or enhanced insurance coverage.
These packages shall be provided through licensed insurance companies operating in the Emirate and shall be monitored by the Dubai Health Authority (DHA).
DHA encourages employers to provide health insurance packages for the employee and members of his or her family. In case the employer does not provide insurance coverage for the employees’ family members, DHA will ensure the availability of suitable and affordable packages.
What is the mandatory health insurance law?
Isahd (Insurance System for Advancing Healthcare in Dubai) means ‘bringing happiness’ in Arabic and is an initiative by the Dubai Health Authority (DHA) to roll out sustainable health care for all nationals, residents and visitors in Dubai. Initiated in 2014, the mandatory Essential Benefits Plan (EBP) for lower salary band employees and dependents completed its final phase on June 30, 2016.
According to the law, the legal liability for every sponsor is to provide the essential insurance package and the coverage is the same irrespective of whoever takes it. Sponsors are free to enhance this insurance cover. The premium for this essential package is fixed between Dh565 and Dh700 so that those with salaries under Dh4,000 receive adequate cover. These include all the blue collar workers, including domestic help, maids and nannies.
If the salary of the employee is more than Dh4,000, the employer is free to choose another scheme, which must meet or exceed the benefits of the basic EBP plan, with other insurers. It is illegal for the employer to deduct the premium cost from the employee’s pay or reduce his salary in order to be eligible for the EBP plan.
What is EBP?
Essential Benefits Plan is essential benefits at reasonable costs, standardised packages with premiums from Dh565 to Dh700 per annum. For expats who cannot afford health insurance for their non-working spouse or elderly parents due to exorbitant rates, this is the best option. This will drive down healthcare costs associated with regular illnesses, check-ups, emergency treatments and various other routine medical requirements.
EBP may not be suited if you want more out of your coverage in terms of geographical or medical coverage or if you want a higher cap on your annual medical cover. The basic plan is not valid outside the UAE, so any overseas treatments will not be covered. However, many companies have special agreement for their workers in their home country such as India, Pakistan, Bangladesh, Sri Lanka and Nepal at no extra cost.
The EBP basic plan covers the following subject to an annual limit of Dh150,000 for all claims.
The EBP plan is limited to cover basic healthcare services in Dubai and emergency treatment within all emirates of the UAE. If you would like to enhance your benefit plan it is best to discuss this with your insurance company or your employer.
Note that Insurance companies provide limited network (clinics, hospitals and pharmacies) for the insured within reasonable geographic access in relation to place of work and residence.
Basic plan included:
- In-patient treatment – non-urgent medical treatment including tests, surgeries, and diagnosis – with 20% payable by insured. This payable amount will not exceed Dh500 per encounter or a maximum of Dh1,000 per year.
- Out-patient treatment – Examination, diagnosis and treatment on a routine basis with 20% payable by insured.
- Lab tests, physiotherapy sessions (maximum six per year) and radiology tests with 20% payable by insured
- Preventive medicine or immunisation procedures for new-borns and children
- Medicines – up to Dh1500 per person including 30% payable by insured per prescription
- Emergency health care and ambulance service during emergency
- Antenatal blood tests, three antenatal ultrasounds, eight pre-delivery visits with 10 per cent payable by insured.
- Normal delivery costs up to Dh7,000 and emergency Caesarean costs up to Dh10,000 including 10 per cent payable by insured.
- The new-born child is covered under mother’s insurance scheme for 30 days from date of birth – for neo-natal tests, screening, and other tests.
Pre-existing or chronic conditions
In case of pre-existing or chronic medical conditions, you need to declare these at the time of application for insurance. The insurer will then provide complete coverage for these after a six-month waiting period. In this waiting period, any emergency health care related to the conditions will be covered like all other claims under the scheme.
Do you need the EBP for your dependants?
If you have uninsured dependants (spouse, children, elderly parents)
If you employ domestic help (who earn less than Dh4,000 per month)
If your dependants are insured by your employer
If you have insured them in a separate insurance scheme which has a higher cover
Note: This is an informative guide only. Any queries regarding this must be addressed to Dubai Health Authority.
It is also very important to use your medical insurance card only when it is really needed to visit a general doctor. Insurance companies and Third Party Administrators (such as Pentacare) control all claims and can reject any of them if they consider that the treatment is not included in your benefit plan or healthcare services are not medically necessary.
If you have any questions regarding your medical insurance coverage, list of exclusions and your nearest provider, please ask your HR manager or contact Medical Call Centre (the phone number you will find on a back side of your medical card).