All emergency cases will be covered by the law. In fact, any emergency procedure will not require pre-authorisation.italbai Image Credit: Pankaj Sharma/Gulf News Archives

Dubai: The new health insurance law for Dubai, which will be implemented from the beginning of 2014 in phases to be completed by 2016, is a step in the right direction.

It will bring every resident of Dubai under its umbrella, offering them basic health coverage as a baseline.

However, there are a few concerns about how the new insurance initiative will work and what it means for an individual.

Gulf News spoke to Dr Haidar Al Yousuf, Director of Funding at the Dubai Health Authority (DHA) to shed light on the matter.

How many people in Dubai will the new insurance scheme cover?

The entire population of the emirates of Dubai will come under the purview of the new health insurance law. This includes nationals and expatriates numbering about 3 million. There will be different schemes for visitors as in their case, we are looking at emergency treatments. The particulars of this scheme scheme will be announced in time.

Will this insurance coverage be the only one of its kind to be held by an employee or can he/she also have a government health card?

Yes, this will be the only health coverage for the entire population. There will be no health card. All DHA facilities – clinics and hospitals- will be part of the insurance network.

What happens to the health card?

The health card will be replaced by the insurance card.

What is the minimum premium and basic coverage promised to each person? What is the maximum?

Organisations have to provide a basic health coverage with an annual premium anywhere between Dh500-Dh700 and a maximum insurance cover per persona per annum of Dh150,000.

Which areas of health will be covered by the insurance? What will be included in the basic health coverage and what will be excluded?

The basic coverage includes:

  • GP visits.
  • Referral to specialists.
  • Surgical procedures.
  • Tests and investigations.
  • Maternity and emergencies.

Basic package obviously means all luxury medical expenses will be excluded. Cosmetic, dental and optical medical procedures will be excluded. In the case of dental, only dental emergencies will be included. Patients will not be entitled to private rooms, only general rooms will be provided under the basic cover.

If Dh150,000 is the health cover per person per annum, will the co-insurance and deductibles (amounts paid by the holder of insurance as his contribution towards the treatment costs per episode) get higher? How will DHA ensure that the burden of added cost is not transferred to the common man?

The minimum requirements (premium and annual coverage) will be defined by law and cannot be changed. Every thing that has been mentioned will be allowed. Special investigations will require pre-authorisation but if a patient needs it, it will be done with a pre-authorisation. No insurance company can shift the burden to the common man. Only insurance companies that can provide this basic health benefits with these premiums and the annual health cover can register with us. Only those who fulfill DHA criteria will be allowed.

We will look at companies that have the ability to manage large portfolios, high numbers, acceptable benefits and less profit. There will be other high-end insurance companies catering to other kinds of clients. Even they can apply for additional permit to work out a basic package on our criteria.

Who will decide the bracket of coverage and network?

The government defines the minimum legal requirement and basic benefit package. Whether you are a cleaner or CEO, you are entitled to the basic package. If the organisation chooses to give anything higher than that and better insurance network packages, it will be their prerogative.

(Every insurance policy has a network of hospitals, pharmacies and clinics which are involved in addressing and treating his case. So, a patient needs to be aware of which network his insurance policy is linked to as he can only avail of medical facilities at these the designated points (hospitals, clinics and pharmacies).

Will the company pay only for employee insurance or will there be provision for family health cover? Who will bear the cost of an employee’s spouse and children’s insurance?

We strongly encourage organisations to provide family health cover. However, we cannot force them to do this as small companies will not be able to afford it. They will then begin hiring only single executives and that will alter the social fabric. As a government, we want the emirate to attract families. We are working with insurance companies to work out attractive family insurance packages with low premiums to encourage organisations to provide for family cover. In case the employer does not, then the employee will have to pay for insurance cover for spouse and children.

We are in the process of working out affordable packages that, with a small premium, will help the employee to be completely at ease about the health expenses of his/her family.

Is this health insurance coverage linked to visa renewal like the Emirates ID?

Yes, it will be linked. No insurance, no visa renewal.

What will happen in case of an emergency? Who will pay for the costs?

All emergency cases will also be covered by the insurance. In fact, any emergency procedure will not require a pre-authorisation. If a patient happens to be in an emergency situation and is taken to a hospital that is not covered by his insurance, he will still be taken there and emergency treatment will be carried out. Only after that can a hospital shift him/her to a hospital that is under the insurance coverage once his/her condition stabilises.

What about chronic and pre-existing illnesses? Will the co-insurance amount to be picked up by the individual be higher?

Chronic illnesses will be treated only six months after being in the insurance coverage. But once you have completed the six months, the illness will be considered a pre-existing one and expenses incorporated under the insurance.

What about specific illnessnes like cancer? Will the insurance policy cover the long period of treatment and remission?

We have planned a special fund and a special approach in such cases and will not burden the insurance provider. At the moment we are still working on the plan and cannot disclose it.

In case a person goes into a vegetative state or a coma, will insurance cover it?

Initially, the insurance company will have to bear the cost. Ultimately, the person will have to be sent back to his country of origin. I think all insurances work on the principle of pooling of risk wherein they have a large group of clients. Some make overt use of their services, some use it moderately and some do not have much use. But the premium amount is pooled and that pays for those in most need.

How will DHA enforce the rule that the employer bears the cost and does not pass the burden to the employee?

Legally speaking, no company can shift the burden of the premium on the employee and we will have strict punitive laws in place to take action in case an employee files a complain. In any case, the DHA is going to be the official insurance regulator. Our sophisticated electronic monitoring system called E-claim is already up and running. We monitor all transactions in the health sector to ensure optimum utilisation of the health services in the emirate.