Dubai Health Insurance_ How 2014 Law Works _ GulfNews

UAE | HealthDubai healthinsurance: how 2014law worksGulf News speaks to Dubai Health Authority expertto get the lowdown on the new system

By Suchitra Bajpai Chaudhary, Senior ReporterPublished: 15:52 December 18, 2013

Image Credit: PankajSharma/Gulf News ArchivesAll emergency cases will be covered by the law. In fact, anyemergency procedure will not requirepre-authorisation.italbai

Dubai: The new health insurance law for Dubai, which

December 19 2013 | Last updated

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will be implemented from the beginning of 2014 inphases to be completed by 2016, is a step in the rightdirection.

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 newinsurance initiative will work and what it means for anindividual.

Gulf News spoke to Dr Haidar Al Yousuf, Director ofFunding at the Dubai Health Authority (DHA) to shedlight on the matter.

How many people in Dubai will the new insurancescheme cover?

The entire population of the emirates of Dubai willcome under the purview of the new health insurancelaw. This includes nationals and expatriates numberingabout 3 million. There will be different schemes forvisitors as in their case, we are looking at emergencytreatments. The particulars of this scheme scheme willbe announced in time.

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

Yes, this will be the only health coverage for the entirepopulation. There will be no health card. All DHAfacilities clinics and hospitals- will be part of theinsurance network.

What happens to the health card?

The health card will be replaced by the insurance card.



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

Organisations have to provide a basic health coveragewith an annual premium anywhere betweenDh500-Dh700 and a maximum insurance cover perpersona per annum of Dh150,000.

Which areas of health will be covered by theinsurance? What will be included in the basichealth 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 medicalexpenses will be excluded. Cosmetic, dental andoptical medical procedures will be excluded. In thecase of dental, only dental emergencies will beincluded. Patients will not be entitled to private rooms,only general rooms will be provided under the basiccover.

If Dh150,000 is the health cover per person perannum, will the co-insurance and deductibles(amounts paid by the holder of insurance as hiscontribution towards the treatment costs perepisode) get higher? How will DHA ensure that theburden of added cost is not transferred to thecommon man?

The minimum requirements (premium and annualcoverage) will be defined by law and cannot bechanged. Every thing that has been mentioned will beallowed. Special investigations will require



pre-authorisation but if a patient needs it, it will be donewith a pre-authorisation. No insurance company canshift the burden to the common man. Only insurancecompanies that can provide this basic health benefitswith these premiums and the annual health cover canregister with us. Only those who fulfill DHA criteria willbe allowed.

We will look at companies that have the ability tomanage large portfolios, high numbers, acceptablebenefits and less profit. There will be other high-endinsurance companies catering to other kinds of clients.Even they can apply for additional permit to work out abasic package on our criteria.

Who will decide the bracket of coverage andnetwork?

The government defines the minimum legalrequirement and basic benefit package. Whether youare a cleaner or CEO, you are entitled to the basicpackage. If the organisation chooses to give anythinghigher than that and better insurance networkpackages, it will be their prerogative.

(Every insurance policy has a network of hospitals,pharmacies and clinics which are involved inaddressing and treating his case. So, a patient needsto be aware of which network his insurance policy islinked to as he can only avail of medical facilities atthese the designated points (hospitals, clinics andpharmacies).

Will the company pay only for employee insuranceor will there be provision for family health cover?Who will bear the cost of an employees spouseand childrens insurance?



We strongly encourage organisations to provide familyhealth cover. However, we cannot force them to do thisas small companies will not be able to afford it. Theywill then begin hiring only single executives and thatwill alter the social fabric. As a government, we wantthe emirate to attract families. We are working withinsurance companies to work out attractive familyinsurance packages with low premiums to encourageorganisations to provide for family cover. In case theemployer does not, then the employee will have to payfor insurance cover for spouse and children.

We are in the process of working out affordablepackages that, with a small premium, will help theemployee to be completely at ease about the healthexpenses of his/her family.

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

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

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

All emergency cases will also be covered by theinsurance. In fact, any emergency procedure will notrequire a pre-authorisation. If a patient happens to bein an emergency situation and is taken to a hospitalthat is not covered by his insurance, he will still betaken there and emergency treatment will be carriedout. Only after that can a hospital shift him/her to ahospital that is under the insurance coverage oncehis/her condition stabilises.

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



individual be higher?

Chronic illnesses will be treated only six months afterbeing in the insurance coverage. But once you havecompleted the six months, the illness will beconsidered a pre-existing one and expensesincorporated under the insurance.

What about specific illnessnes like cancer? Will theinsurance policy cover the long period of treatmentand remission?

We have planned a special fund and a specialapproach in such cases and will not burden theinsurance provider. At the moment we are still workingon the plan and cannot disclose it.

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

Initially, the insurance company will have to bear thecost. Ultimately, the person will have to be sent back tohis country of origin. I think all insurances work on theprinciple of pooling of risk wherein they have a largegroup of clients. Some make overt use of theirservices, some use it moderately and some do nothave much use. But the premium amount is pooled andthat pays for those in most need.

How will DHA enforce the rule that the employerbears the cost and does not pass the burden to theemployee?

Legally speaking, no company can shift the burden ofthe premium on the employee and we will have strictpunitive laws in place to take action in case anemployee files a complain. In any case, the DHA isgoing to be the official insurance regulator. Our



sophisticated electronic monitoring system calledE-claim is already up and running. We monitor alltransactions in the health sector to ensure optimumutilisation of the health services in the emirate.



UAE | HealthHealth insurance:what companies haveto doPhases of health insurance plans implementation

By Suchitra Bajpai Chaudhary, Senior ReporterPublished: 16:09 December 18, 2013

Phase One

Companies with more than 1,000 employees will haveto bring their employees under the insurance cover byOctober 2014.

Phase Two

Companies with 100-999 employees will have toimplement the full health insurance coverage by July2016.

Phase Three

Companies with less than 100 employees will have toimplement the health insurance coverage for all itsemployees by June 2016.Related LinksDubai health insurance: how 2014 law works

Completion

December 19 2013 | Last updated 4:00 January 01, 1970

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July 2016: All Dubai residents will be covered underDHAs health insurance plan.

Fast fact

Around 3 million

People who will be covered by the new healthinsurance plan

Health insurance: what companies have to do | GulfNews.com http://gulfnews.com/news/gulf/uae/health/health-insurance-what-companie...


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Dubai Health Insurance_ How 2014 Law Works _ GulfNews