Dubai: If you are still shopping for a health insurance you might be looking for a plan that gives you real value for money and provides appropriate coverage with a small component of co-insurance or the percentage of the consultation and treatment that you have to pay as a consumer.
Dr Sanjay Paithankar, director of Global Net, the Third Party Administrator (TPA) that provides the health network for your package, told Gulf News: “It is the right of the employee to have the insurance package he enjoys explained by his organisation’s Human Resources in great detail. In case of group insurances the company itself is the main policy holder and has the relevant documents explaining terms and conditions. The employee can demand his copy or ask for a session to be arranged to know what kind of health cover he enjoys.”
According to Jonaki Bhattacharya, director, Lifestyle Insurance, Dubai, “In other words, when you are shopping for a health cover package, you are looking for something that is absolute value for money that justifies your premium and does not make you insecure in case you fall sick. So, you need to pay attention to certain fine print while shopping for the ideal package.”
Dr Paithankar and Bhattacharya suggest 10 aspects that you must look for.
1. What coverage are you getting? Is the insurance covering only the emirate where you are a residence or does it cover the entire UAE, it is important to know this in case you are required to consult a doctor in another emirate. It is also important to know if you have a package that has direct billing (which means that the insurance will directly pay) or do you have to claim the amount after payment. Usually a good health insurance package provides health coverage in the country of employment and your home country. In case of home country coverage check if you need pre-approvals for consultation or what are your terms of payment.
2. Are you looking for coverage in the US or Europe? If you want that kind of a package, then look for premium TPAs and good networks that provide overseas coverage. However, if your insurance gives you world-wide coverage then the premium is likely to jump.
3. What is the type of coverage you are getting? In the Essential Basic Package (EBP) a blue collar worker is assured an annual limit of Dh150,000. So, look for a package that has a good annual limit with a reasonable premium.
4. Are pre-existing conditions covered? Now all health insurances in Dubai cover pre-existing conditions. If you are an existing policy holder and are just changing to another insurance, then your condition will be covered with immediate effect. This includes lifestyle diseases such as diabetes, hypertension, high cholesterol, etc. In case you are a first-time health policy holder then your pre-existing condition will be covered only after six months.
5. Make sure you choose the package that covers the hospital you are comfortable going to. It is important to read the network list of the hospitals and clinics covered by your plan.
6. What is the annual premium? Usually with group plans in a company with less than 100 employees the annual premium is usually about Dh1,000 for employee sand Dh1,200 to Dh1,700 for dependants.
Similarly, some insurances have a variable premium rate for those in the age group of 0-18. Married women will have a different premium as their maternity costs have to be covered as opposed to unmarried women. So, it is important to comb through the coverage and determine what premium are you paying and what health services you will get.
7. You need to also understand what is the co-payment in your insurance cover. Co-payment is the amount that the consumer is expected to pay and, as per Dubai Health Authority (DHA) rules, the co-payment is not usually more than 10 per cent in case of out-patient services such as going to a clinic for a cough and cold or even out-patient maternity coverage such as monthly gynaecology visits during pregnancy and 20 per cent in case of hospital stay.
However, the DHA has put a ceiling on this amount. So, if a patient has to undergo a surgery worth Dh40,000 he will have a ceiling of Dh500 to pay and not 20 per cent. A patient can avail of this facility twice, not exceeding Dh1,000 in one year.
8. What is a deductible? Deductible is the actual amount that is fixed in terms of cash payment that the patient has to pay which could be fixed at Dh25, Dh50 or Dh75 every time he makes a fresh consultation.
9. Check the network that covers you as some networks have arrangements with good hospitals and you might be able to get a good deal organised.
10. Demand to read the terms and conditions of your insurance and request your human resources section to furnish you a two-page copy of the agreement that will give you a complete understanding of what ailments will be covered
How to read your insurance card
Your insurance card may not be the holy grail to health but can help you understand what is the health plan you have exactly applied for. The front of the card contains the following features:
The name of the policy holder
The policy number
The membership number
Your date of birth, your ID number which is usually the passport number.
The name of the policy holder
This makes it easier for pharmacies to understand what exactly you are covered for. In case of collective or group insurances arranged by companies for their employees the policy holder is the company and the product is called the group plan.
In benefits you need to understand that COINS means co-insurance and R&B means Room and Bed and if a private room is provided by your health insurance you can demand the same in the hospital. OP Mat means Out Patient Maternity which includes consultation of gynaecologist for your monthly check up during pregnancy. The coinsurance for these consultations has been fixed at 10 per cent in the standard packages which means if you incur a bill of Dh100 you will pay Dh 10 for the consultation.
In case of hospital stay, the deductible or coinsurance is fixed at 20 per cent. So if you incur a bill of Dh100 you have to pay Dh20 as coinsurance. But as mentioned above, the ceiling of Dh500 is in place in case you require a surgery at a hospital where your coinsurance of 20 per cent is likely to be higher.
The next section shows the date of issue and validity of the insurance.
The last section on the front of the card shows the network that your insurance will be covered by. This is very important as there are standard packages in the network which will indicate the level of coverage. It also indicates if the network covers dental, ophthalmology and if you are entitled to direct billing or have to seek pre approval or have to send in a claim after payment.
The back flap of your card contains emergency numbers to contact in case you are travelling abroad and have an emergency health situation that requires hospitalisation
