A guide to Dubai’s mandatory health insurance law

You will probably be aware by now that the Dubai Health Authority (DHA) has issued a law requiring all Emiratis and Dubai expats, including dependents, to have insurance in place to pay for their emergency and curative healthcare needs. It follows in the footsteps of Abu Dhabi – which implemented its mandatory healthcare initiative in 2006.

While Emiratis will be handled by a Dubai government-funded scheme, Dubai expats and their dependents will be handled under private health insurance schemes.

The law applies to all economic areas of the emirate including free zones, with its implementation phased in over the past couple of years, initially targeting companies with 1,000-plus employees then moving to those with more than 100 in July.

Now it is the turn of SMEs and micro SMEs, including all dependents and domestic workers, and time is running out. The looming deadline of June 30 next year means companies and individuals need to get plans in place. Until then, those without insurance either have no protection or a government health card which offers care in government health facilities.

How the insurance works

Each year, the DHA will set a price range within which Participating Insurers (PIs) must set their premium pricing for the Essential Benefits Plan, the minimum level of benefits any plan can have.

For 2015, the premium range has been set at Dh520 to Dh730 per insured per year.

Companies with existing policies for employees earning less than Dh4,000 will need to satisfy the following two criteria;

– The scheme benefits must meet or exceed those of the Essential Benefits Plan.

– Cover must be provided only by PIs.

If necessary, employers will have to restructure their existing arrangements to meet this criteria by the first renewal date (and no later than 12 months) after the implementation deadline specified for a company of their size.

Employee rights

So how is this going to affect the average employee?

Firstly it is paramount that any employee understands his or her rights. This benefit must be provided by the employer and cannot be deducted from your salary and by law an employer cannot reduce salary to mitigate the cost.

Those earning less than Dh4,001 must have a plan provided by one of the nine PIs and cover levels must be equal to the minimum guidelines set out by the DHA.

Spouses, dependents and domestic workers

It will be the responsibility of the employee or sponsor to arrange insurance coverage for their own spouse, dependents and domestic workers and to pay the premiums directly to the insurer.

A company is not obligated to add dependents, so a husband wanting to sponsor his wife, children and domestic helper, for example, may need to take out a separate policy. While some companies will offer to insure an employee’s children at no extra cost, this cannot be on the basic DHA plan. Domestic helpers, though, must be covered on a separate policy.

Residents should compare all the options as the basic cover is designed for low-salaried individuals. The basic plan could be regarded as restrictive (in terms of facilities you can use) and has limiting copay options. It also only works in the UAE so would not cover someone electing for treatment overseas.

What the plans must include

The minimum level of benefits that must be provided by any health insurance plan offered in Dubai must include:

• An annual limit of Dh150,000 per person on all claims per year

• Pre-existing and chronic conditions – covered in full subject to a six-month waiting period

• In-patient treatment – covered with a 20 per cent excess up to maximum Dh500 per encounter or a maximum of Dh1,000 per year.

• Outpatient treatment – covered with a 20 per cent excess

• Cost of medicine – limited to Dh1,500 per person

• Maternity services – eight outpatient visits; inpatient treatment covered up to Dh7,000 for normal delivery, and up to Dh10,000 for medically necessary C-section and other complications. All maternity services are covered with a 10 per cent excess.

This move means everyone in Dubai is now covered to a minimum level. As medical history is disregarded, people who previously did not have access to affordable health care can now be treated.

Stephen Maclaren is the head of regional sales, employee benefits at the insurance broker Al Futtaim Willis.

pf@thenational.ae

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