Help: I bought maternity insurance cover, but now my claims are being rejected
Expecting a baby? Here is what you need to check before purchasing a health insurance
Dubai: Looking for maternity cover? Read the details of your insurance carefully before you sign on the dotted line, as maternity coverage can vary depending on the type of policy and insurance provider you choose. A Gulf News reader wrote in sharing his experience with the maternity cover he purchased for his wife. While the reader had paid a higher premium, he was surprised to find out that the medical insurance claims were now being rejected.
He said: “I recently renewed my wife's medical insurance here in Dubai. The insurance company charged double the fee since she is pregnant. Now our claims are being declined, with the insurance company claiming that under the insurance policy only eight doctor visits are allowed. I wanted to check if it is legal in the UAE to decline the claim even after the policy holder has paid an additional amount? Please let me know if you could help me figure out the allowed practice in UAE for insurance. This might also help people in the future to choose the right insurance without going through what I am facing.”
Gulf News raised the query with Hitesh Motwani, Chief Marketing Officer of insurancemarket.ae, who advised people to read through the terms and conditions of an insurance policy before they sign up for one.
“The policy purchased by the reader is the Essential Benefits Plan, which provides a basic coverage. As per this plan, eight visits to a clinic are covered,” he said.
Higher premium
The premium, or the amount of money you pay to get the insurance coverage, depends on a variety of factors, including but not limited to your age, geographic location, type of policy, body mass index, medical history and any pre-existing conditions. This is why when applying for an insurance coverage, pregnant women have to pay a higher premium.
“The insurer has all the right to charge an additional premium after they know of the pregnancy and the coverage will be provided as per the policy, which has been the case here,” Motwani added.
Essential Benefits vs Comprehensive Coverage
Essential Benefits Plan
In Dubai, the most basic health insurance plan is referred to as an Essential Benefits Plan, which is supposed to provide a fair enough coverage. The annual limit for basic plans is Dh150,000, which means that medical consultation and procedures would be covered up to that cost. Coverage for medicines is separate, and an Essential Benefits Plan provides coverage for medicine up to Dh1,500 per year. Maternity cover is Dh7,000 for a normal delivery and Dh10,000 for a cesarean delivery (C-section).
However, the basic plan also has limited network coverage, which means that the network of clinics and hospitals covered in the plan is quite small. Even if the clinic or hospital is covered, you would not be able to see a specialist immediately. A General Practitioner’s consultation is necessary for the consultation, treatment and medicines to be covered. So, if you have a specific preference for a doctor or a hospital, find out if they accept the basic health plan coverage. If not, you would need to purchase a higher insurance coverage.
Comprehensive plan
The next tier of health insurance coverage is the comprehensive plan, which provides coverage in the UAE as well as other countries that you can choose.
While annual premiums can be higher, these plans provide a greater network coverage. So, if you have a preference for a specific type of hospital, find out which insurance companies and policies are covered for the treatment you seek.
For a detailed guide on how you can get health insurance in the UAE, and what to look out for when decided on a policy, read our detailed guide here.
Do you have a similar query related to finding the right health cover? Or have you faced an experience where you were unsure of what the UAE's laws and regulations are? If so, write to us at readers@gulfnews.com, sharing your questions and experiences.