Showing posts with label Health Insurance in Dubai. Show all posts
Showing posts with label Health Insurance in Dubai. Show all posts

Dubai health insurance rules

It is an obligation of the employer to provide employee the health insurance cover, while bearing its entire cost. Article 10 of the Law No. 11 of 2013 concerning health insurance in the emirate of Dubai, states: "The employer shall be obliged to do the following:

1. Cover the employees by health insurance in accordance with the health insurance policy applicable thereby; providing to comply with the provisions of this law and the resolutions issued pursuant thereto.

2. Bear the costs for such health insurance coverage rather than making the beneficiaries do so.

3. Verify that the health insurance of the employees is valid for the length of their work period at the employer's company.

4. Bear the health services and medical intervention costs in emergencies for the employees, if any of them has no health insurance in accordance with the provisions of this law.

5. Give the employees the health insurance card.

6. Provide health insurance policy upon the residence visa issuance or its renewal.

7. Any other obligations specified by the authority pursuant to the resolutions issued thereby in such concern."

Based on the aforementioned provisions of law, it is responsibility of the employer to provide health insurance coverage to the employees in the emirate of Dubai. The employer should not demand or request the employee to bear part of cost of health insurance premium.
Know the law
The employer is obliged to cover the employees by health insurance in accordance with the health insurance policy applicable. The employer can't ask the beneficiary to bear the insurance cost. read more

Basic facts that you need to know about your health insurance

1) Coverage:
The Dubai Health Law No 11 stipulates mandatory health insurance for all. This means, every single resident will have to be covered for health insurance. Every health insurance package has a range of coverage which refers to the list of health conditions and health care services that will be addressed.

At the very basic level of coverage is the Essential Basic Package, a health insurance cover that comes at the minimum premium so it is affordable.

What is the premium for EBP? It ranges between Dh620-975 per annum to be paid by the employee sponsor.

What does this coverage include? It could include General Physician consultation, dental and maternity cover, features that are usually covered in the basic package.

This EBP cover also provides a maximum insurance limit of Dh150,000 per annum in case of emergencies.

All pre-existing conditions are also covered in the EBP package after six months from the first time you buy insurance.

“The annual premium amount for EBP has not gone up in the last three years since mandatory health insurance law came into effect. It indicates that insurance for the masses is working in general to provide healthcare delivery to all,” said Dr Al Yousuf.

2) Network:
A network is the organisation contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. The network provider organises a group of clinics, diagnostic centres and pharmacies to which an individual subscribing to a plan falling under it can go to. This, in other words, means the full list of clinics and hospitals that your insurance package gives you access to. This is also known as an in-network provider.

An out-of-network provider is not contracted with the health insurance plan. On your insurance card, the name of the network is mentioned under the subhead Insurance Provider (IP) net. The policy holder can look up the list of the medical care outlets that he can avail of in the annexure that is provided by the insurance company. Additionally, the TOB provided by the insurance company also includes the list of family health physicians, diagnostic centres and pharmacies that are approved under the EBP. Hospital visits in EBP come on the recommendation of the family doctor.

It’s mandatory by law to have adequate geographic coverage of EBP network all over the UAE, however, one can look at the list and see if the network includes clinics they prefer to use or which are located near their home.

All EBP insurance provides for free emergency treatment at any hospital and maternity cover is also provided.

3) Group v/s individual insurances:
Most people employed in a company can avail of a group insurance which has group discounts. Individual insurances usually are tailor-made and have higher annual premiums depending on the health of the policy holder.

4) Deductibles:
These are sums that have to be borne personally by the insurance holder. There is a basic amount an individual has to pay for consultation at the clinic. For instance, if a doctor’s consultation fee is Dh100, and the deductible is fixed at 10 per cent, the insurance holder will have to pay Dh10 as his portion of the financial contribution.

5) Co Insurance:
Also abbreviated to the acronym COINS on the health insurance card, which refers to the percentage you have to pay from your pocket towards the total bill. The co-insurance is upto 20 per cent of the total bill. So, for example, if you incur a total bill of Dh200 on X-rays, blood test, CT imaging and medicines on a visit to the clinic, if your coinsurance is set at 20 per cent, you would be paying an amount of Dh40 from your pocket.

There are separate limits for outpatient and inpatient coinsurance percentages. Usually in the EBP cover, outpatient coverage — which means a visit to a family clinic for a cough, cold, fever or even a maternity consultation — would be 20 per cent of the total consultation bill.

In the case of a hospital visit for a surgical procedure, the co-insurance could be 20 per cent of the total bill. Check your insurance card for inpatient and out patient coinsurance percentages to know how much you would have to pay per visit.

However, the DHA has put a ceiling on this amount. So, if a patient has to undergo a surgery worth Dh40,000, he will have a ceiling of not more than Dh500 as inpatient coinsurance per episode. A patient can avail of this facility three times in a year, not exceeding Dh1,000 in one year as coinsurance for any inpatient visits.

6) Pharmacy limits:
Each policy sets a limit for the expenses you can make at the pharmacy which in a EBP is usually Dh2,000 per annum. Beyond that sum, the expenses incurred will have to be paid from your pocket. For instance, if you have hypertension or diabetes or both and every two months you incur an expense of Dh400 on your insurance for medicines, in 12 months, you will have visited the pharmacy six times and incurred a bill of Dh2,400. So you would have exceeded your pharmacy expense limits which means you would have to pay Dh400 from your pocket.

The policy holder needs to read the Table of Benefits (ToB) carefully. It also means that in case of a sickness episode which is over and above these number of visits, the policy holder will have to pay from their pocket for the medicines, if he has exhausted the Dh2,000 limit.

Dr Yousuf explains: “One must look at this positively as the resident is covered for a majority of his medical expenses which was not the case earlier, before the insurance became mandatory. Now, he needs to foot the bill for a small percentage of his total medicine requirements.”

7) Pre-Approvals:
Despite the limits, many insurance providers prefer that the clinic seeks a prior approval for particularly expensive diagnostic tests and procedures. This is done to make sure clinics are not over-prescribing these tests. Once the pre-approval is in place, there is no chance of the claim being rejected. In case of an emergency of course, the patient can walk into the nearest hospital, where no questions are asked and immediate treatment is extended. All hospitals in Dubai are bound by law to attend to a patient in emergency where the coverage of the insurance card is not an issue.

8) Pre-existing conditions:
This is relevant only to a first-time subscriber of a health insurance package. In case an individual suffers from any condition such as diabetes, hypertension, cancer or any other ailment, he or she must disclose this at the outset to the insurance company. The condition will not be covered for the first six months after which the insurance will cover it.

What if a person changes jobs or opts into another insurance plan? Will this alter the insurance policy parameters in any way? No. All pre-existing conditions have to be treated under the EBP.

9) Reimbursements:
Usually all EBPs have a direct billing arrangement where the clinics claim the total treatment cost from the insurance provider. However, in many cases, your insurance might allow for an ‘out of network’ consultation or treatment where you pay the cost of treatment upfront and later file a claim with the bills and get reimbursed. Read the fine print on the ToB to know whether you can go to clinics and hospitals that are not in the network of your policy.

10) Last month coverage:
There are instances when insurance policy holder is denied coverage in the last month – such as medicine coverage in the month of December even though the coverage is up to end of that month. This is illegal according to the UAE law.

“If any pharmacy or clinic is doing that, it was illegal,” says Dr Al Yousuf. “The clinic must provide the insurance cover until the last day of the health coverage and insurance policy holders have a right to register a complaint if there is a violation of this right.”

Residents can register complaints on http://ipromes.eclaimlink.ae which is usually attended to within 48 hours of the receipt of the application.(GN)

Limit to visit a doctor
There is a limit to the number of times a patient can visit a doctor for a single episode. Let’s say when a patient discovers he has a fever, or any ailment where he consults a physician at the clinic, he can visit the same doctor for the same episode usually three times within 10 days for the same ailment. So on day one he goes for the first consultation, day three he might report for a follow-up and day six or seven he might want to reconsult to chart his recovery. He will be charged one time consultation fee for this. Once this limit has been reached, further approval from the insurance company must be sought.

Pre-approval for a medical procedure 
Reality: Approval is only valid for a limited period of time. The exact period of validity should be communicated clearly to the patient. If the patient does not have the treatment within the specified time period, he or she may need to reapply for approval. Besides, patients must know that approvals for tests and procedures take time. For example, if a patient is prescribed tests worth Dh1,500 and his insurance provides cover for only an amount up to Dh1,000, both the patient and the doctor must wait for approval unless it is an emergency.

Only in the case of an emergency should the patient receive treatment for their immediate needs. The hospital or clinic should try to get a response from the insurance company as quickly as possible.

How well are you covered?
Insurance companies may not cover all tests, (for instance tests like Vitamin D tests and screening for HIV or Hepatitis B and C are not covered usually and you need to check your insurance policy plan. A lot depends on the kind of insurance policy the patient has signed up for. Most don’t cover opthalmology and dental treatments and this should be communicated clearly to the patient.

Ambulance services
Reality: Ambulance service is only covered if there is an emergency. The insurance company should ensure that the patient understands this.

Call up the insurance company and check the coverage of prescribed procedure
Doctors do not always know which conditions are covered by a specific insurance policy, so it can be difficult for doctors to prescribe treatments or procedures. The best thing a patient can do is to get their clinic or hospital to call up the insurance company and check against the coverage if the prescribed procedure will be covered.
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To prepare your visa applications, call:
QQusais (Al Nahda-2) Near Zulekha Hospital: 04-239 1302, 055 273 2295, 055-345 7829

Qusais, Near DAFZA Metro Station:  Exit#2, Shop No. 7, Al Manzil Building, 

Tel. +971 52 1416869

Qusais (Industrial Area-5), Wasl Village, Retal Center, Shop No. 4. Tel. 0524912412, 0558650577

Bur Dubai: 04-252 22 22, 055-9105757

Hor Al Anz: (Deira): 04-265 8373, 050-715 0562

Qusais (Damascus St): 04-258 6727, 054-300 5931

For Collection & Delivery Service; call 04-239 1302, 055 273 2295, 055-345 7829

For Family visa service of all other emirates, call: 04-252 22 22, 055-9105757
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Are you planning to Set-up your business in Dubai? Call us for Setting up new business, LLC Formation, Amendment in existing license, PRO Service and Translation. +971 55-273 2295, 055-345 7829, 04-239 1302 or mail your queries to visaprocess.ae@gmail.com
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Employer should bear Health Insurance Cost in UAE

It is an obligation of your employer to provide you the health insurance cover, while bearing its entire cost. Article 10 of the Law No. 11 of 2013 concerning health insurance in the emirate of Dubai, states: "The employer shall be obliged to do the following:

 1. Cover the employees by health insurance in accordance with the health insurance policy applicable thereby; providing to comply with the provisions of this law and the resolutions issued pursuant thereto.

 2. Bear the costs for such health insurance coverage rather than making the beneficiaries do so.

 3. Verify that the health insurance of the employees is valid for the length of their work period at the employer's company.

 4. Bear the health services and medical intervention costs in emergencies for the employees, if any of them has no health insurance in accordance with the provisions of this law.

 5. Give the employees the health insurance card.

 6. Provide health insurance policy upon the residence visa issuance or its renewal.

 7. Any other obligations specified by the authority pursuant to the resolutions issued thereby in such concern."

 Based on the aforementioned provisions of law, it is responsibility of the employer to provide health insurance coverage to the employees in the emirate of Dubai. The employer should not demand or request the employee to bear part of cost of health insurance premium.

 The law says:
The employer is obliged to cover the employees by health insurance in accordance with the health insurance policy applicable. The employer can't ask the beneficiary to bear the insurance cost. read more

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Medical (Health) Insurance in Dubai

Dubai visa holders who have not obtained health insurance cover will no longer be able to renew their visas.

Also, no new visas will be issued if the individual concerned does not have health insurance coverage in place at the time of visa stamping or renewal.
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 Call us for your Medical insurance:

Qusais (Al Nahda-2) Near Zulekha Hospital: 04-239 1302, 055 273 2295, 055-345 7829
Qusais (Al Nahda-2) Behind NMC Hospital: 054 4170879

Bur Dubai: 04-252 22 22, 055-9105757

Hor Al Anz: (Deira): 04-265 8373, 050-715 0562

Qusais (Damascus St): 04-258 6727, 054-300 5931

For Collection & Delivery Service; call 04-239 1302, 055 273 2295, 055-345 7829

For Family visa service of all other emirates, call: 04-252 22 22, 055-9105757
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 Cost for Medical Insurance in Dubai

Company employee: Dh589.00, If the salary of employees is above Dh4000, then the insurance premium will increase to Dh774.00

Housemaid: Dh589.00

Partner/Investor till 65 age: Dh930.00, after 65 years of age: Dh4239.00

Housewife till 45 age: Dh1771.50, After 45 years of age: Dh695.25 

Children till 18: Dh695.25

Parents under the sponsorship of Son/daughter: Dh4239.00Husband sponsored by wife : Dh695.25

Linked with Visa Renewal: According to a circular issued by the DHA last month, the system has been developed to monitor and ensure compliance with the law. It's also designed to detect gaps in insurance. For example: if an individual's health insurance policy expires on February 1, 2017 and their visa expires on January 1, 2017, when they renew the visa during January 2017, it will be renewed without any issues.

However, if the individual does not maintain constant health insurance coverage, the system will track and log the gap in insurance upon the next visa renewal, ie, if they were uninsured for two months between visa renewals, they will incur a fine of Dh1,000 (Dh500 per month) at the time of renewal.

The 12 Companies that provide the essential benefits plan package include:
Noor Takaful Insurance, Abu Dhabi National Insurance Company and Union Insurance, Axa Gulf Insurance, Takaful Emarat, Dar Al Takaful, Orient Insurance, Ras Al Khaima Insurance Company, Daman Health Insurance, Oman Insurance Company, Metlife, National General Insurance.

Employers can choose health insurance packages from 45 approved insurance companies that have Dubai Health Insurance Permits.

Employer's Responsibility: It is the responsibility of the employer to provide medical care facilities to its employees in the UAE. This is in accordance with Article 96 of the Federal Law No. 8 of 1980 regulating Employment Relations in the UAE (the 'Employment Law'), which states: "An employer shall provide his employees with medical care facilities corresponding to the standards laid down by the Ministry of Labour and Social Affairs in co-operation with the Ministry of Health."

Fine: Fine for not renewing insurance card: Dh500. This fine will be deducted automatically via the electronic system at the time of renewing of the visa.
The fine will be imposed on the sponsors and the employers and not the employees. It will be added to the visa renewal and cancelation fees of the General Directorate of Residency and Foreigners Affairs.

Essential Benefits Plan: Under the DHA scheme, special consideration has been given to employees earning less than Dh4,000 a month. This category of employees must be insured with one of the seven approved insurers authorised to offer the Essential Benefits Plan.
This package covers many services that include maternity, emergency, medical tests, referrals, medication etc.

Minimum Basic Package, which has a cover of up to Dh150,000, with premiums ranging between Dh550 and Dh750 per year. This includes all the blue collar workers, including domestic help, maids and nannies.

Wife & Children: Dh1750 or a little more unless the dependants are above 60 years of age.

Parents and individuals above 60: Whether employed or a dependant, with or without a history of diseases: Dh4,000. The pre-existing conditions will not be covered for a period of six months and after that everything will be covered.

Hepatitis C and three cancers now covered on basic plan
Dubai residents are now covered for screening and treatment of three types of cancers and Hepatitis C under an Essential Basic Plan (EBP).

the Basmah Initiative covers colorectal, breast and cervical cancers for EBP policyholders. Screening and treatment cover for these cancers is provided only at the Cancer Centre of Excellence, Dubai Hospital. Additionally, EBP policyholders also have access to screening and treatment of Hepatitis C.

How it works?
Starting from January of this year, all 12 DHA approved insurance providers offering the EBP asked policyholders to pay an additional amount of Dh19 and Dh18 for Cancer and Hepatitis C (HCV) treatment respectively. This sum Dh37 (plus VAT to total Dh39.85) paid to the insurance provider annually, is pooled into DHA’s trust account and helps cover the additional cost of these three types of cancer treatment and the HCV virus, when a patient surpasses the minimum insured sum of Dh150,000 for Low Salary Band (LSB) workers. 

If an EBP policyholder goes to his family physician for a routine examination and during that if the general practitioner suspects any of these cancers, he can refer the patient for cancer screening at the Cancer Centre of Excellence at Dubai Hospital.

If the patient is found positive with any of the three cancers, he is enrolled in the Cancer Patient Support Programme (Cancer PSP). His details go into the DHA patient tracking and follow-up centre which is automatically notified and they ensure that the treatment process is smooth and streamlined.

In the case of the above three cancers, there is unlimited coverage. Once the patient exhausts their sum insured, the funds from the DHA’s trust account cover his treatment costs. “The usual coinsurance for EBP which is 20 per cent of consultation and treatment fee will be applicable.

Hepatitis C
Patients of the HCV virus under EBP have to follow the same procedure. If a family physician during a routine check-up suspects symptoms of the HCV virus, he can refer the patient for additional screening. Once the screening is positive, treatment begins.

All medicines for HCV treatment are covered for the patient. 
The only condition is that the patient must be a resident visa holder with a health insurance cover. An individual seeking a fresh resident visa, who screens positive for these ailments, will not be covered under this initiative.

What is the Basmah initiative?
Basmah initiative makes Dubai Health Authority the first government entity in the world to provide a complete spectrum of care from screening to treatment for the three types of cancer under the essential benefit plan. Prior to the scheme, cancer coverage was limited to Dh150,000. Now there are no sub-limits and coverage is unlimited.

Medical coverage
The EBP basic plan covers the following subject to an annual limit of Dh150,000 for all claims.
Basic
1. In-patient treatment non-urgent medical treatment including tests, surgeries, and diagnosis with 20 per cent payable by insured. This payable amount will not exceed Dh500 per encounter or a maximum of Dh1,000 per year.
2. Out-patient treatment Examination, diagnosis and treatment on a routine basis with 20 per cent payable by insured.
3. Lab tests, physiotherapy sessions (maximum six per year) and radiology tests with 20 per cent payable by insured
4. Preventive medicine or immunisation procedures for new-borns and children
5. Medicines  up to Dh1500 per person including 30 per cent payable by insured per prescription
6. Emergency health care and ambulance service during emergency.
7. Free screening and treatment for hepatitis C is included under the basic benefit plan of the Dubai Mandatory Health Insurance Scheme.
8. Free screening and treatment for three types of cancers and Hepatitis C.

Maternity:
1. Antenatal blood tests, three antenatal ultrasounds, eight pre-delivery visits with 10 per cent payable by insured.
2. Normal delivery costs up to Dh7,000 and emergency Caesarean costs up to Dh10,000 including 10 per cent payable by insured.
3. 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. Click here for more health coverage details.

Existing medical policies can continue in their present form until the first renewal date (no later than 12 months) after the applicable implementation date. After this, all benefits must be aligned with at least the mandatory minimum.

Employer Information Pack downloadable from www.isahd.ae

How it works?: There are two ways of applying for a new visa or renewal, manual or electronic. If it is manual the GDRFA asks for the insurance certificate copy to be attached with the application. In case the organisation is applying electronically (www.ednrd.ae) for new visas or renewals, automatically a window pops up on the screen asking for the insurance certificates of all the applicants. Scanned copies have to be uploaded to complete the application process.

Complaints and Feedback: DHA has launched a website ipromes.eclaimlink.ae for consumers to register complaints and provide feedback in case they are not getting all the services promised in their insurance package. The DHA will act on a complaint once it is registered electronically on this website.

The DHA website www.isahd.ae has a comprehensive list of all 46 registered insurance providers in UAE.

Certain conditions excluded: Some medical conditions are standard exclusions in insurance with some insurance companies; these include medical issues at birth, issues caused by medical procedures or research work, radiation, nicotine addiction, sex transformation, as well as hormone therapies, among others.

What does the essential health cover package cover?

The basic cover includes outpatient consultancy at clinics, referrals to specialist and for surgical and pathology investigations, maternity health cover, emergency visit to hospital and any surgeries required. While employers have group insurance schemes for their employees, a resident can shop for a tailor-made cover for his dependants that includes spouse, minors and domestic house help.

What is the maximum coverage and how much is a beneficiary expected to pay?

The beneficiary with basic insurance cover gets a maximum coverage of up to Dh150,000 and has to pay 20 per cent [at every visit to the doctor]. So, if he has an outpatient bill of Dh200 he will have to pay Dh40.

What is a special protection package?

The protection package mandates that although a beneficiary has to pay a minimum of 20 per cent of co-insurance payment in case of a hospital stay or surgery, this is capped at Dh500. So, if someone has major surgery amounting to Dh40,000, even those in the basic package would be expected to pay Dh8,000 as 20 per cent. But the protection package mandates a ceiling of Dh500.

What are the fines and penalties? What happens in case a person has just renewed his visa?

Linking the visa renewal to insurance is a check mechanism. But every individual in Dubai has to get the health cover by June 30. If he or she fails to do this, his employer will be fined for every month beginning from July until the time his visa comes up for renewal. If the individual is a freelancer or self-employed, he will have to pay the fines himself. There are monthly penalties which will be levied with retrospective effect from June 30. Fines can range anywhere between Dh500 per person per month. It is cheaper to get an insurance than to pay for default as the fines are far higher than the actual cost of the essential benefits package.

Although basic cover provides maternity benefits is it true that a woman who is pregnant at the time of getting the insurance will not be covered?That is true. Insurance is a protection or cover for future conditions or illnesses. So, even if a woman falls pregnant one day after getting the insurance she has to be covered. However if she subscribes to the cover after she conceives she will not be covered. In case of other conditions such as diabetes, hypertension and other lifestyle disease, the insurance will not cover these for the first six months after which all pre-existing conditions have to be covered.

What happens in case a blue collar worker has an accident or cancer?

The insurance company has to pay the bills up to the annual aggregate limit. It is Dh150,000 annually. Then insurance firms are linked to visas and the organisation has the right to take the decision of renewing the visa of an employee with an insurance renewal. But until the validity of the visa, his treatment episodes will be covered.

In the case of newborns who covers their medical expenses?

A newborn is covered under the mother's health insurance cover for 30 days after which the parents have to get the child an individual cover. The child's birth complications will be covered to the maximum aggregate limit of the mother's cover. However, this cover will not include congenital conditions such as cleft palate, club foot, Down's Syndrome and the like.

What about special needs children?

All special needs children have basic health requirements which will be covered by the regular health cover. Their requirements for flu, cough, cold and regular requirement will be covered. However, the insurance will not cover special services such as speech therapy, special school or physiotherapy.

Blue collar workers

Blue collar workers can get extended coverage in their home country, too.

Blue collar workers are now being offered an essential health benefit package by Takaful Emarat Insurance for Dh625 per annum that will provide them the same cover in their home countries such as India, Pakistan, Bangladesh, Sri Lanka and Nepal at no extra cost. Most South Asian workers come from these countries.

According to Dr Sanjay Patihankar, founder director of Third Party Administrator (TPA) for this insurance, said this is the first time that a UAE insurance has tied up with an international insurance provider, Vidal Net, that will give the workers a direct billing option in their home country. 
While some insurance companies do provide extension of health services for workers back home, this cover provides direct billing facilities which no other cover in this category provides. The worker will be able to get adequate health cover in their country using the same insurance card with the same aggregate annual limit, etc. In India, for example, beneficiaries of this insurance can go to any of the 25,000 clinics and hospitals across the country.

Such a cover can help the worker in seeking standard medical facilities while on annual leave at home. read more
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Are you planning to Set-up your business in Dubai? Call us for Setting up new business, LLC Formation, Amendment in existing license, PRO Service and Translation. +971 55-273 2295, 055-345 7829, 04-239 1302 or mail your queries to visaprocess.ae@gmail.com

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