Dubai: If your family members aren’t insured by your company and you’ve been wondering how to cover them under Dubai’s mandatory insurance scheme, here’s what it takes at the very least.
For starters, be ready to shell out a minimum of Dh500-Dh700 per dependent towards the annual premium for an essential health benefits (EHB) package.
Industry sources told XPRESS the package, specially designed for expatriate workers whose salaries are less than Dh4,000, can also be obtained for dependents without an income. It is available with seven insurance companies - Oman Insurance, Alico, Daman Insurance, AXA, Arab Orient, Takaful and RAK Insurance.
The basic package provides not only access to a general or family physician, but also referrals to specialists, surgical procedures, laboratory tests and investigations, emergency services and maternity care.
It allows an upper aggregate claims limit of Dh150,000 per year, excluding any co-insurance and/or deductibles. In-patient cover which includes diagnostic tests, treatments and surgeries in authorised hospitals in non-urgent cases, requires approval from the insurance company.
Prior authorisation is not needed in emergency situations like accidents or sudden illness where immediate medical attention is warranted.
Sources said co-insurance or the money payable by the insured is 20 per cent of the total bill with a cap of Dh500 per inpatient visit. There’s an annual aggregate cap of Dh1,000, above which the insurer will have to cover 100 per cent of the treatment.
For outpatient services, the co-insurance is 20 per cent. There is no payment for a follow-up visit if it is within seven days.
Sources said laboratory and radiology diagnostic tests are also subject to a 20 per cent co-insurance. Prior approval is required for MRI, CT scans and endoscopies. Up to six physiotherapy sessions are covered in a year.
Maternity insurance includes outpatient ante-natal services, inpatient care and new-born cover, with a 10 per cent co-insurance over eight visits to the public health centre and a maximum benefit of Dh7,000 per normal delivery and Dh10,000 for C-section. Newborns are covered 30 days from birth.
The package sets an annual limit of Dh1,500 for medicines, including co-insurance. The insured is required to pay 30 per cent of the prescription, with no cover being provided beyond the annual limit.
Chronic and pre-existing conditions are also covered, but not in the first six months of the policy. The policy does not cover dental treatment, domiciliary care, cosmetic care, surgical and non-surgical treatment for obesity etc.
Medical billing solutions consultant Dr Ayham Refaat of Accumed PM said: “The basic package is very comprehensive and provides sufficient cover which can always be topped up to enhance benefits.”
He said: “At first glance the coverage for medicines seems low. We wish the policy coverage for chronic diseases didn’t carry a six-month waiting period and was from day one.”
Sanjay Tolani of Goodwill Insurance Brokers said: “The basic package is the first step towards creating social security for expats. It can’t get cheaper than this. The co-insurance limits will prevent misuse and wastage.”
Andre Daoud of third party administrator NEXtCARE, said: “The basic insurance package is a very positive and humanitarian step, especially for those who do not have insurance. As a TPA, NEXtCARE is well-prepared and our systems and solutions are in place for the roll-out of the mandatory insurance scheme.”
David Hadley, CEO Mediclinic Middle East, said: “We at Mediclinic have swiftly adopted the mandatory health insurance requirements into our employment benefits, well ahead of the required timelines as a show of support. Developing a universal coverage system is no mean feat and I would like to congratulate the entire DHA team … on their approach to planning and implementation.”
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At a Glance: Essential Health Benefits Package
Annual premium: Dh500-Dh700
Annual claims limit: Dh150,000
Inpatient coverage: 20 per cent of the total bill to be paid by the insured with a cap of Dh500 per visit. Above annual aggregate cap of Dh1,000, insurer will cover 100 per cent of the treatment.
Outpatient coverage: 20 per cent to be paid by the insured. Follow-up within seven days free.
Lab tests, radiology services: 20 per cent to be paid by the insured. Up to six physiotherapy sessions covered in a year.
Maternity services: 10 per cent co-insurance over eight visits to PHC and maximum benefit of Dh7,000 per normal delivery and Dh10,000 for medically required C-section. Newborns covered 30 days from birth.
Medicines: 30 per cent co-insurance with annual limit of Dh1,500.