Your complete guide to mandatory health insurance in Dubai

Dubai residents who have failed to secure mandatory health insurance cover by December 31 will face a fine of Dh500 a month once the deadline comes into effect from January 1 next year, a top Dubai Health Authority official has said.

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.

The final phase completed the roll-out for employers with less than 100 employees, dependents of employees and domestic help.This scheme will ensure that all children, lower income employees, non-working residents and domestic help will have access to good quality healthcare at reasonable costs. Here is everything you need to know about the plan.

Note: This is an informative guide only. Any queries regarding this must be addressed to Dubai Health Authority

Do you need the EBP for your dependants?

Yes

If you have uninsured dependants (spouse, children, elderly parents)

If you employ domestic help (who earn less than Dh4,000 per month)

No

If your dependants are insured by your employer

If you have insured them in a separate insurance scheme which has a higher cover

Why EBP?

Essential Benefits Plan is exactly that – essential benefits at reasonable costs, standardised packages with premiums from Dh650 to Dh725 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.

Who must be insured?

Elderly parents, your spouse, children and domestic help need to be insured one way or the other. Due to obvious health reasons, insurance premium for elderly parents (older than 65) is higher and so is the premium for married females (aged 18 to 45), who are considered most susceptible to pregnancies.  

If your domestic help (nannies, cooks, housemaids and drivers) earn Dh4,000 or less per month, they will have to be insured under this plan as well. If they earn 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.

Premium range per annum

DHA announces premium ranges every year that the participating insurers for EBP must adhere to. This year it is from Dh650 to Dh725. (For employees who earn more than Dh4,000, insurers have the EBP plan at higher premiums.)

For dependants

- General non-working group aged zero to 65 years – From Dh650 

- Non-working married females aged 18 to 45 years – From Dh1,600

- Elderly parents – From Dh2,500 

For domestic help

- General – From Dh650

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

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.

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.

You can find complete details regarding health coverage in the official ISAHD employer information page here.

Geographical coverage

The basic EBP plan in Dubai covers everything mentioned above in Dubai and emergency treatment in Abu Dhabi or other emirates. It is best to discuss this with your insurer. This plan is limited to coverage within the UAE for the basic plan.

We spoke to Mr. Damodhar Mata, an independent financial consultant in Dubai about the plan's coverage and he remarked, “You can choose to take an enhanced plan which will cover you in countries outside UAE but the premiums for these can go up to Dh15,000 per annum taking away the benefits of the EBP plan. Even if insurers agree to cover medical expenses outside the UAE, it will be largely emergency-based treatment and not elective“.

Choose your insurer 

There are 45 insurers who have valid health insurance permits issued by DHA as of July, 2015. Out of these, there are only nine participating insurers for the mandatory EBP health scheme by DHA.  

Visa renewal

If  your dependents' visa was issued or renewed recently, you still have to get them insured before the end of the year, or you may attract fines and legal complications when you go in for a renewal later.