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10 Must-Know Facts About Health Insurance in the UAE

Written by Sahar

Health insurance in Dubai and the UAE has been mandatory since 2013 . All things considered, it has been a successful venture. Employers are responsible for covering their employees, and sponsors are responsible for the health insurance of their dependants.

Since it is such an important part of our life we should know everything about our coverage, right? But that’s the thing, most of us don’t know much about what’s covered in our health insurance. Most people only realise they need to confirm coverage once a medical emergency presents itself. And, by that time, it’s usually too late to change coverage.

So, let’s dive in and find out 10 must-know facts about health insurance in the UAE. This is so you know exactly what to expect from your healthcare provider.

Coverage in Health Insurance

All residents in the UAE have health insurance. Sure, not all of them make the same wages or belong to the same salary groups. Therefore, there are different health insurance tiers for them to choose from. Every insurance provider in the UAE has different levels of coverage that buyers can choose from.

Take the Essential Basic Package (EBP) for example. It is the most basic form of health insurance you can hope to buy in the UAE. Its range varies from Dh. 550-750 per year. The maximum coverage you can expect on EBP is Dh. 150,000 per year and it covers the basic medical package like GP consultations, maternity, outpatient care etc. Chronic illnesses are also included in the cover after a six month waiting period.

These are just a few basic things you should know your policy covers. Make sure you ask your health insurance provider what is and isn’t covered.

The Network

One phrase you must have heard a few times when buying health insurance is ‘network.’ But what does network mean? Essentially, it refers to the network of clinics and hospitals that are partnered with the insurance provider. They usually don’t require cash payment. You just need to present your insurance card.

Now, as a policyholder, you need to be aware of the network. Why? Because you don’t want to end up at a non-network hospital in an emergency and scrape cash for the treatment. They won’t deny you treatment. But you will have to pay out of pocket and then claim reimbursement from your provider. It’s a tedious long route to get your money back. It is easily avoidable. You just have to know which hospitals and clinics are part of the network.

It’s very easy to check your health insurance provider’s network. It is mentioned under Insurance Provider (IP) on your insurance card. Simply check the network before you go for treatment.

Group or Individual Health Insurance?

UAE law stipulates that health insurance is mandatory. However, it isn’t mandatory for employers to provide it to employees. Before you panic, let us explain. In Abu Dhabi, employers are obligated to provide health insurance for employees, not so in Dubai, although it is strongly recommended. Similarly, it isn’t an obligation in the other Emirates either.

Therefore, there are two types of health insurance – group, and individual. Group insurance policies are usually bought by employers and corporations. Because of the number of people that can be added to group insurance they usually get discounts and lower premium rates. On the other hand, individual policies are tailored for the individual who might have special medical needs. They do have a higher premium though.

Depending on what you need from your health insurance you can decide which category suits you better.

Deductibles in Health Insurance

Deductibles are one way of getting cheap insurance. In a sense. At the time of negotiating the premium, you can opt for higher deductibles. What this means, essentially, is that you are willing to take more risk in the policy. This results in lower premiums. However, there is a catch. If you go for treatment the insurance provider will only supply a fraction of the cost, the rest you will provide for yourself.

If you’re not comfortable with higher deductibles, you can opt for a lower deductible. The premiums will be high but the onus of paying for treatment will be on the insurance provider.

Deductibles in health insurance operate a certain way. Your health insurance doesn’t kick in till you’ve paid your deductible for the year. For example, fixed deductible is Dh. 3000. You have to pay for Dh. 3000 out of pocket in the year before the insurance takes over and pays for your treatment.

Co-Insurance

This might sound similar to deductibles, but it isn’t. Deductibles are fixed. Co-insurance isn’t. Co-insurance is a percentage you decide to co-pay with your insurance. So if your co-insurance is 20% you will pay 20% on treatment bills throughout the year. This can get really expensive if you have chronic illnesses and massive medical bills.

However, it is ideal for those who have individual health insurance, are in the pink of health, and want to pay lower premiums.

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Limits on Pharmacy Purchases

Health insurance policies come with a limit of pharmacy purchases. For example, it is Dh. 2000 per year in EBP. Once you reach your pharmacy limit you need to pay for your pharmacy purchases out-of-pocket.

This coves a majority of pharmacy expense, especially for policyholders who don’t have chronic diseases. Even for patients of chronic disease, it takes care of a big chunk of the expense.

So, plan your pharmacy purchases carefully. Know your limit and use it wisely.

Seeking Pre-Approval

Expensive procedures or tests prescribed by the hospital must seek pre-approval from the insurance company. This is to ensure that the tests are not unnecessarily prescribed by the hospital. After approval, it is easy for the claim to pass.

This is not to say that all tests and procedures seek pre-approval. Pre-approval isn’t required in emergencies. In fact, in case of emergency, all hospitals in the UAE are dutybound by law to provide service even if they aren’t in the insurance companies network.

Pre-Existing Conditions

This term is only relevant at the beginning of an insurance policy. You will be asked about your medical history. It is essential to be honest and forthcoming about any and all illnesses. Chronic illnesses are only covered after six-months of the policy. If you switch providers, or change companies you won’t have to wait another six months for your chronic illnesses to be included.

Reimbursements

As mentioned before, if you get treatment from a network clinic or hospital you won’t have to file a claim. The hospital will seek direct payment from the insurance provider. In cases of out-of-network treatment, you will have to pay out of pocket. But you can claim reimbursement.

This is fairly simple. You will collect all the bills and receipts and send them to your insurance provider. They will process the billing and reimburse you the expenditure. It takes a little longer for reimbursement like this. Whereas with direct payment, you don’t have to worry about it at all.

Coverage in the Last Month

A few hospitals and clinics refuse direct payment from the insurance provider in the last month of your insurance policy. This is due to their fear of whether the policy will be renewed in time for them to get their payment. This is illegal. You can file a complaint. Your insurance policy lasts the entire term. This includes the last month of coverage. A network hospital can’t refuse your insurance card as a form of payment. If they try to do so contact your insurance provider or register a complaint on http://ipromes.eclaimlink.ae

And there you have it. 10 facts you needed to know about health insurance in the UAE. Now that you’re up to speed it should be easy to navigate the world of health insurance and medical care. If you still don’t have medical insurance, no worries. Our website has many health insurance partners. Compare policies on an independent website like BuyAnyInsurance and find reliable policy comparison. After all, health is wealth.


Originally published Feb 20, 2021 00:03:00 AM, updated May 10, 2021

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