Dubai: While the Dubai Health Authority (DHA) stipulates that all health insurance must cover chronic illnesses, residents need to scour the fine print.

Those who are transferring from one insurance provider to another do have a coverage for pre-existing and chronic illnesses. However, those coming under a health insurance cover for the first time will not be covered for the first six months after which the policy will cover pre-existing or chronic illnesses. Herein lies the catch, health insurance specialists point out.

Seventy per cent of the first-timers category includes blue collar workers which means if they suffer from a lifestyle disease they will only be covered after six months. The second catch is that the Essential Benefits Package (EBP) which covers blue collar workers for an annual premium of Dh650 has a maximum limit of Dh2,500 for medicines annually, along with 20 per cent co-insurance payment.

So, if a blue collar worker suffers from diabetes, for instance, he will not be entitled for coverage for the first six months. After that the Dh2,500 annual medicine expenditure limit will be enough to only cover the treatment for diabetes.

A senior health expert pointed out. “In the usual treatment for diabetes, most doctors prescribe lipid lowering medication as diabetics have a tendency for high lipid levels. Then they prescribe ace inhibitors which are for protection from kidney disease and the anti-diabetic drug. These together will easily amount to Dh2,500 or even more annually. The Dh2,500 would include 20 per cent co-insurance payment which would mean the worker would be shelling out Dh500 annually for his diabetes treatment protocol.”

What’s more, if the worker suffers from insulin-dependent diabetes, he will have to pay for the insulin himself as health insurance does not cover hormones and insulin is one of them, the expert noted.

So, in effect, the worker will exhaust his entire medicine expense limit on one disease and if he requires to be treated for other conditions such as cough, cold, diarrhoea or flu, which he is likely to contract during the year, he will have to pay for these himself.

This is just one instance as the situation will be similar for anyone suffering from any other non-communicable disease.

Health experts cautioned that it was important that officials looked into this issue and worked out some arrangement such as lowering the co-insurance payment or using inexpensive but efficacious generic drugs for treatment, otherwise the burden of expenditure for health care was likely to fall partially on blue collar workers.

Where to shop for health insurance

The DHA website, www.isahd.ae, has a comprehensive list of all 46 registered insurance providers in UAE. We have a section called the marketplace on the website where you can compare the benefits against the fee and shop for the best cover. The 46 insurance companies are registered permitted insurance companies, of which nine participating insurers provide the essential health benefit package (EBP) for employees who earn less than Dh4,000 and these nine providers cannot deny this package to people who fall under this category.

What does the Essential Benefits Package (EBP) cover?

The EBP cover includes outpatient consultancy at clinics, referrals to specialists and for surgical and pathology investigations, maternity health cover, emergency visit to hospital and any surgeries required. It includes a maximum coverage of Dh150,000 annually and has a co-insurance payment of 20 per cent of the bill in case of outpatient treatment. In case of a major surgery the DHA has provided a special protection package that puts a ceiling of Dh500 total payment in case of a surgery and the patient is protected for up to two surgeries. This means in one year he will not be expected to pay more than Dh1,000 in case he is hospitalised and undergoes two surgeries.

The EBP is priced at Dh625-Dh650 and the prices are coming down as more and more people are being insured with economies of scale coming into operation making the market more competitive. While employers have group insurance schemes for their employees, including blue collar workers, a resident can shop for a tailor-made cover for his dependants that include spouse, minors and domestic house help.