The new health insurance law making health insurance mandatory for every resident and tourist in Dubai is being implemented in phases from the beginning of this year through to 2016. More than 40 insurance companies have the permits to provide cover.
The Dubai model of health insurance is similar to policies in places such as Switzerland, Singapore, Netherlands and Abu Dhabi. Saudi Arabia and Qatar already have compulsory health insurance. Insurance companies interested in providing the essential health benefits package to resident employees with monthly salaries below Dh4,000 will have to pass qualifying criteria to ascertain their ability to provide an affordable package.
Positive impact
The emirate is expected to implement electronic medical records before the end of the year, which means wherever you go in Dubai with your password, any doctor in a private or public hospital can access and add to the record.
If you are one of the many currently under medical coverage, chances are most of your health-care needs are already taken care of, depending on the type of cover you enjoy. Dr Haidar Al Yousuf, Director of Funding at the Dubai Health Authority (DHA), said in an earlier interview to Gulf News that the coverage includes nationals and expatriates numbering about three million, instead of the one million currently under coverage.
“This long-awaited measure will have a profound impact on Dubai’s health-care growth and demand mainly in primary health-care services. As per our assumption 60-70 per cent population out of two million will receive primary care and this establishes the need to add an additional 500 general practitioners (GP) to existing registered GP numbers of 1,500 in Dubai,” says Dr Jamil Ahmed, Managing Director, Prime HealthCare Group. “The new law is expected to induce an assumptive growth of over 35 per cent in health care considering the number of people being brought under the coverage.”
If we recall the Abu Dhabi health-care sector grew by 40 per cent in 2006 after imposition of mandatory health-care insurance. Though the growth is expected mainly in primary health care, the secondary and tertiary segments will also need a significant capacity expansion due to significantly increased referrals,” he adds.
New mandates
Legal experts in personnel law have been examining available information to see how it applies to everyone. “The new law is not yet publicly available, although the DHA has promised that it will soon be available through their website. Although the law was signed on November 24, it has yet to be published in the Official Gazette; it will not come into effect until after it has been published,” says an update by Rebecca Ford, Wayne Jones, Allison Beirne and Elizabeth Williamson from law firm Clyde & Co.
To be prepared, the HR and Payroll Services Team at Nair & Co, a UK-based HR services outsource firm, advises: “Companies operating in Dubai with the intention of hiring foreign workers are advised to familiarise themselves with the new health insurance mandates and implement an internal policy for such coverage.”
Based on reports, the feedback is very positive, given that the Dubai law learns from the experiences of its predecessors. Eli Hyder, Managing Partner of Bond lawyers, a UAE-based independent law firm, says: “The new health-care regime shows much promise. We have seen already how as a result of comprehensive health-care reform introduced in Abu Dhabi in 2006, 98 per cent of the emirate’s residents now enjoy coverage. But as well as emulating the capital’s success, it is important that measures are taken in protecting against health-care price inflation and abuse of the system, ensuring the city’s infrastructure can support the changes, and keeping all stakeholders — including residents, employers and tourists — fully informed about their rights and obligations”.
Insurance is only one part of the Dubai Smart Healthcare Model. The Dubai Health Strategy 2013-2025 includes hospitals within 8km to 12km of all catchment areas and health centres within 3km to 5km. The number of hospitals is expected to go up to keep up with patients increasing due to the availability of medical cover.
“In 2014 we will see the opening of two hospitals and a medical centre, followed by our largest hospital in the first half of 2015,” says B.R. Shetty, Chief Executive Officer, NMC, a private health care provider. “Our strategy has been reinforced by the strong population and economic growth seen in the UAE over the past year and the recent adoption of mandatory health care insurance in Dubai.”
Other private health care groups have similar plans. “We have plans to recruit additional doctors and expand our overall service capacity in our existing locations to manage the expected surge in patient encounters for primary health care after the new health-care law. We are also in the process of opening more centres in additional locations to expand our network of multi-speciality clinics and our new 100-bedded multi-speciality hospital located in Garhoud, Dubai is due to be launched this year,” says Dr Ahmed.
All the details
Who does it cover: Every resident is covered. There is no insurance, no visa renewal.
Visitors are going to be covered for emergency treatments as well. Particulars of the scheme have not yet been announced.
Coverage: Basic, including GP visits, referral to specialists, surgical procedures, tests and investigations, maternity and emergencies. Maternity coverage will include out-patient ante-natal, in-patient maternity and newborn cover.
Newspaper reports specify that the law will exclude cosmetic, dental (except emergencies) and optical medical procedures. However, according to the update by Clyde & Co, “Outpatient coverage will include examination, diagnostics and treatment by general practitioners, specialists and consultants; laboratory testing; radiology diagnostic services; physiotherapy; medicines; vaccines and immunisations; diabetes screening (every three years from 30 years or from 18 years for high-risk patients); diagnostics and treatment for dental and gum treatment; hearing and visions aids; and corrective laser and surgical treatment for vision.”
A referral procedure will be implemented requiring the insured to first consult with a GP before consulting with specialists/consultants.
The basic coverage will be defined for UAE nationals, expats and visitors. It will be permissible to provide enhanced cover over and above the mandated essential package.
Treatment centres: All DHA facilities — clinics and hospitals — will be part of the insurance network. The health card will be phased out. Only the insurance card will remain. Insurers, TPAs, brokers and health-care providers will require an annual DHA permit to carry on their medical business in Dubai. The DHA will publish an approved price list for medical services, to be adhered to by health-care providers.
There will be a co-insurance payable by the insured of between 10 per cent and 20 per cent with specific caps and conditions imposed by the DHA for different classes of benefits.
Who covers it: The government of Dubai will be responsible for UAE nationals resident in Dubai. Organisations have to provide for their employees a basic health coverage with an annual premium anywhere between Dh500 and Dh700 and a maximum insurance cover per person per annum of Dh150,000. The government defines the minimum legal requirement and basic benefit package.
DHA is going to be the official insurance regulator. If a company shifts the burden of the premium on the employee and the employee complains, strict action will be taken.
Conditions
Organisations are encouraged to provide family health cover, but it is not enforceable. The government is working with insurance companies to work out attractive family insurance packages with low premiums to encourage organisations to provide for family cover. But in case the employer does not provide insurance, then the employee will have to pay for insurance cover for spouse and children.
Deadline: For foreign domestic workers such as housemaids, caregivers and drivers, sponsors will pay for health insurance. Companies in Dubai with 1,000 or more staff must provide health cover for them before the end of October.
In phase two of the scheme, companies with 100 to 999 employees will have until the end of July 2015 to comply. Companies with up to 100 staff have until the end of June 2016 to provide cover. All spouses, dependents and domestic workers will have to be covered before the end of June 2016.
Failure by employers to provide insurance carries fines of between Dh500 and Dh150,000. Repeated breaches carry a maximum fine of Dh500,000.
Emergency: All emergency cases are covered by the insurance. But emergency treatment does not require pre-authorisation. All hospitals will treat emergencies and move the patient to a hospital covered by his insurance once the condition stabilises.
Chronic illness: Treatment for chronic illnesses will begin six months after insurance coverage starts.
Specific illnesses: Major illnesses such as cancer are covered under a special fund so as to not burden the insurance provider. This plan is still being worked on.