UAE residents have options to keep their health insurance claims in check

Under the mandatory health insurance laws of Abu Dhabi and Dubai, employers of foreign workers (an estimated 85 per cent of the UAE population) are required to effect private health insurance policies to cover employees’ healthcare costs. As annual medical cost inflation amounts to anything from 10-12 per cent this becomes an increasing burden on employers.

It is therefore not surprising that employers are seeking to reduce benefits under their schemes.

This is evidenced by data published by the Central Bank of UAE that shows that from 2017-21 the total health insurance premiums generated remained static at Dh19 billion each year. This raises the question that if medical inflation is running at, say 10 per cent per annum, why are insurers not increasing their premiums by a similar amount to cover the increased cost of claims?

The answer is that during that 4-year period, employers were containing their health insurance premium costs by reducing benefit levels for employees to achieve premiums at no greater level than the previous year. So, as an employee with an employer funded health insurance plan why should you care?

Clearly you do not want to see your benefits reduced, be that in your annual pharmacy benefit limit, your overall coverage limits or a restriction on the healthcare providers that you can access. You will also not want to see an increase in the share of costs that you have to pay yourself, known as co-insurance or co-pay.

The very fact that employees in Abu Dhabi and Dubai have the benefit of private medical insurance cover without themselves having to contribute to the insurance premium means that many see this as a ‘free’ service and rush to the clinic or hospital at the sign of the slightest sneeze, cough or pain. Once there, the healthcare provider will recommend a multitude of (often unnecessary) lab tests and pharmaceuticals because they know that your insurance company will be paying the bill.

In case you are not aware, there are internationally recognised guidelines called ‘clinical pathways’ that physicians should follow in order to arrive at a diagnosis. But here in the UAE physicians often ignore these pathways, instead preferring to recommend multiple lab tests and diagnostic procedures because that is how they earn money for themselves and their employer.

Insurers’ carry the pain

Sometimes, these unnecessary tests can be potentially harmful (such as X-rays). They are also very costly, not to you of course (apart from any co-pay required), but definitely costly to the insurance company which covers your employer’s health insurance plan costs. And so, at scheme renewal date, the insurer asks your employer for more money in terms of its annual premium.

The employer does not want to pay a higher premium so instead negotiates reduced benefit levels. This means that as the employee, you are the loser.

As an employee, often with family members covered on your policy (a mandatory requirement in Abu Dhabi, but not in Dubai) you will want to ensure that your coverage is not reduced. So what part can you play?

The first thing you can do is to stop running to the clinic or hospital every time you feel a little unwell just because you know that the cost will be covered by your employer’s health insurance plan. The more often you do this, the greater the claims cost to the insurer and the more likely that your employer will reduce your benefits next year.

Put a check on those medical tests

The second thing you can do is, once at the clinic, question the multiple tests and diagnostic procedures that the physician is recommending. You don’t need an MRI scan just because you have a headache… The third thing you can do is to start using tele-health consultation apps that are simply more convenient for you, cheaper for your insurer and often can provide a diagnosis without the need for expensive lab and diagnostic tests. Finally, take ownership of your own health. Eat well, exercise, reduce or avoid toxins such as tobacco and alcohol and sleep.

As an insured member within your employer’s health insurance program you are responsible for keeping the cost down and maintaining your benefit levels for the time when you really need them.