UAE health care: what does basic insurance provide?

Unlike the UK and Australia, the UAE does not have a national health service – but with a range of high-quality clinics and hospitals, insurance covers most costs of patient care.

It is mandatory by law for employers in Abu Dhabi and Dubai to provide all workers with at least a basic level of health insurance under the Essential Benefits Plan for anyone earning less than Dh4,000 ($1,089) a month.

Anyone earning more can benefit from a broader health insurance plan provided by an employer, offering access to more hospitals and services, such as dental and optical coverage.

Basic coverage in Abu Dhabi provides workers with access to Dh250,000 of care, but pharmacy expenses are capped at Dh1,500 a year.

In Dubai, the annual limit provided by basic care is Dh150,000, with a pharmacy limit of Dh1,500.

Dr Kalyan Gudavalli, director of health insurance and services at Burjeel Holdings, said the UAE had an effective interconnected health system to deliver expert care to all residents.

“A basic plan will cover inpatient and outpatient benefits,” said Dr Gudavalli.

“It depends on the condition but it will include maternity care and cancer treatments although there is a benefit cap on coverage.

“The coverage is data-driven and 90 per cent of people will not require the high-end limit of their plan.

“The majority of health conditions are covered under the basic insurance policy as per criteria established by the government, with anyone earning under Dh4,000.

“Anyone earning above that must buy a higher health plan.”

Co-insurance is payable by the insured party and usually accounts for 20 per cent of basic inpatient treatment.

Such treatment, when a patient must visit a hospital for care, is limited to Dh500 per visit under a basic plan and capped annually at Dh1,000.

The insured must pay costs exceeding these limits and a top-up payable to a private health insurer can extend coverage for an additional fee.

What is not covered in a basic health insurance plan?

For workers earning below the Dh4,000 threshold who qualify for the Essential Benefits Plan, not all health needs will be provided.

Regular dentistry and ophthalmology check-ups are not covered by a basic health plan but emergency eye care and dentistry is.

Not all psychiatric conditions, nor dementia, are covered under UAE insurance plans but existing ailments can be treated under basic insurance, excluding allergies.

“There must be continuity of cover, so if someone maintains their health insurance while living in the UAE they should be covered for pre-existing conditions,” said Dr Gudavalli.

“If someone is living here for 10 years and keeps renewing, every insurer must cover your health as there will be a pre-existing policy.

“For anyone who leaves their post, then they will have 30 days from which their visa will be cancelled and they will have cover during that time until they leave the country or are re-employed.

“If someone is moving here for the first time, a corporate plan would cover all pre-existing conditions. It is included in the labour law that a sponsor should provide insurance for this, irrespective of when the person has entered the country.”

Is my family covered?

In Abu Dhabi, an employer must cover the health insurance of the employee and dependents, up to three children, while in Dubai, only the employee must be provided health insurance by law.

A sponsor will then have to take out further health insurance to cover the costs of dependents.

What if the care I require exceeds my coverage?

Government and private hospitals are available to offer a range of treatments, with a further Basmah patient support programme in Dubai offering further treatment for cancer and hepatitis for low-income workers.

Eligible expatriate workers in Dubai who qualify for the EBP can receive unlimited coverage for three types of cancer treatment under the Basmah scheme.

The Dubai Health Authority initiative is the first to provide full coverage for breast, colon and cervical screening and treatment for all Dubai residents.

Existing and new residents in the emirate diagnosed with cancer before entering the country will become eligible for enrolment after a year of residence.

Charities such as the Friends of Cancer Patients or the Rahma Cancer Patient Care Society often step in to support sufferers who are unable to pay for their treatment, outside of Dubai.

Private hospitals often stage free diagnostic and screening campaigns for low-income workers and occasionally offer free check-ups for dentistry and optical for those unable to afford treatment.

For more details about cancer care offered in Dubai by Basmah contact 800-SALAMA.

What are the rules if I Iive outside of Abu Dhabi and Dubai?

Mandatory health insurance has not yet been introduced for workers employed in the Northern Emirates but that could change.

“What has happened recently in the Northern Emirates is for the Ministry of Health to create a new claims portal for insured patients who received their treatment there,” said Dr Gudavalli.

“Any claims that come into health facilities from patients with a Northern Emirates visa are being uploaded into the national system.

“Anyone can be insured by paying portal fees of Dh38 per member.

“This applies to all patients with health insurance in Ajman, Sharjah, Umm Al Quwain, Fujairah and Ras Al Khaimah, so we expect it to become mandatory soon.”