While health insurance plans could provide coverage for inpatient and outpatient procedures upwards of Dh100,000 annually, some plans set a limit on pharmaceuticals for dental or optical treatments Image Credit: Corbis

The picture of the impact of diabetes on the Middle East is painted by percentages. The World Health Organisation estimates the disease’s global prevalence at 9 per cent. You could more than double that number for the UAE — recent figures from the International Diabetes Federation (IDF) indicate that 19 per cent of UAE residents have diabetes.

Given these statistics, anyone switching jobs in or moving to the country may want to scour the health insurance plan from their new employer for any mention of diabetes.
For all the reassurance of quality that the UAE’s health services offer, the calibre of care doesn’t prevent nasty surprises if you don’t read the small print.

Hidden clauses

Even where diabetes falls under an employer’s health insurance protocol, caveats may still lurk. The IDF’s 2014 figures indicate that 37 million diabetics aged 20-79 live in the Middle East and North Africa, with 803,900 in the UAE, plus about 327,000 who are unaware that they have the condition. So, the benefits of giving such plans more than a cursory glance are self-evident.

According to Dr Sven Rohte, Chief Commercial Officer at Daman, the National Health Insurance Company, which covers the majority of residents in Abu Dhabi, any snags in relation to diabetes cover may lie in the specifics. “Generally, diabetes is covered as a standard plan, especially with group plans [by employers] where the general clause of pre-existing conditions does not apply,” he explains.
“Nonetheless, there might be a sub-limit for the costs covered under these conditions. A sub-limit is the maximum cost an insurer is obliged to pay that is less than the overall limit of the policy.” Dr Rhote says Daman doesn’t have such limits for chronic conditions.

Know your limits

He explains that the ceiling on medication costs is also an area that employees need to focus on, as it could have ramifications in diabetes cases. “While health insurance plans could provide coverage for inpatient and outpatient procedures upwards of Dh100,000 annually, some plans set a limit on pharmaceuticals for dental or optical treatments,” he says. “Residents [should] check this.

“The situation in the market and globally is different with individual policies, where it is customary for coverage to be included if the insured member declares in his or her application.” If there is coverage, the treatment and tests — including insulin injections — are taken care of, confirms Dr Rohte. The same does not necessarily apply to screenings, unless the employee is showing symptoms of diabetes. “If the member just wishes to have a screening as a precaution, then it may not be covered
as it is not part of the diagnosis and treatment,” he says. “Some plans include a health check annually. “Generally speaking, treatments such as injections and medications are covered. But monitoring devices and other disposables such as glucose-measuring strips, are not covered since those are for monitoring reasons, not treatment. But some plans include these.”

Chronic conditions

It’s unclear how many UAE diabetes sufferers are provided with cover under employers’ health insurance plans — no statistics are available — although Dr Rohte believes diabetes will be addressed as standard for most workers in medium-to-large companies. Meanwhile, the fact that health insurance is mandatory in Dubai and Abu Dhabi means chronic conditions must be covered by such agreements. However, he says that insurance firms require that chronic conditions be declared in an application.

In Abu Dhabi, a 2005 law makes insurance for workers compulsory. Dubai’s mandatory insurance programme came into effect in February 2014, giving universal health care to workers. Earlier this year, the Dubai Health Authority (DHA) confirmed that screening, care, and treatment for diabetes will be covered under the basic insurance scheme, which is being rolled out in phases that will continue into 2016. This means patients visiting GPs will be informed whether they are borderline diabetic and if screening is required, as one of the elements of the essential benefits package (EBP) that everyone with mandatory health insurance in Dubai is entitled to. Annual premiums will cost between Dh500-700 a person, with the monthly cost for a diabetic, depending on their condition, averaging Dh2,000.

Conditions are, however, in place to stave off the potential for the system to be misused, said Dr Haider Al Yousuf, Director of health funding, DHA, in a statement. The EBP will cover screening for diabetes, and treatment for the disease and its complications, but will not cover pre-existing chronic disease for the first six months for people who have not previously had health insurance while in the UAE. This will not affect someone who is already living in Dubai, who already has insurance, and moves to another policy. “This is obviously designed to prevent abuse of the system,” said Dr Al Yousuf. “But after six months any plans will fully cover diabetes.”

Currently about 213,000 diabetics are covered in the emirate under the mandatory health insurance scheme, he said. A further 500,000 people in Dubai have been tested for diabetes. The DHA’s goal is that everyone in the emirate be annually screened for the disease from the age of 18, he said. “We are moving not only to cover it under the essential benefits plan to making it mandatory so they have to do it once a year and that is the next step,” added Dr Al Yousuf. “So we catch any diabetes as early as possible and treatment starts for diabetes early as well.”

At the time of going to press, the Health Authority — Abu Dhabi had not responded to requests for comment.

Regardless of how strong your health insurance is, diabetes will always be something that everybody hopes they do not have to face. In the case of type 2 diabetes — the UAE’s most prevalent strand of the disease and the one most commonly linked to obesity — Dr Rohte stressed that the best precautionary measures remain positive lifestyle changes and regular physical activity.
“From a patient’s perspective, if you combine the programme with the advice and treatment you receive from the doctor, you will have a strong support system to help you cope with the disease.”