Dubai Health Insurance Rules for Employers

Employers have a duty to offer employees health insurance and to pay the full cost of that insurance. The following actions by the employer are required by Law No. 11 of 2013 on health insurance in the emirate of Dubai, according to Article 10:

1. Provide health insurance for employees in accordance with the applicable health insurance policy, with the stipulation that compliance with this law’s requirements and any related resolutions be maintained.
2. Pay for such health insurance coverage out of pocket rather than requiring the beneficiaries to.
3. Confirm that the employees’ health insurance is still in effect for the duration of their employment with the employer.
4. If any of the employees do not have health insurance in accordance with the terms of this legislation, bear the costs of health services and medical intervention for them in an emergency.
5. Hand out the health insurance card to the workers.
6. Upon granting or renewal of a resident visa, provide proof of health insurance.
7. Any other duties outlined by the authority in accordance with resolutions issued by it in this regard.

According to the aforementioned legal rules, employers in the emirate of Dubai are required to offer their employees health insurance coverage. The company shouldn’t demand or ask the employee to pay a portion of the premium for health insurance.

Basic information concerning your health insurance that you should know

1. Coverage: Everyone must have health insurance, according to Dubai Health Law No. 11. This implies that health insurance will be required for every single inhabitant. Every health insurance plan includes a spectrum of coverage, which is a list of the medical issues and services that will be covered. The Essential Basic Package offers health insurance at the most fundamental level of protection for a reasonable price.What is the premium for EBP? It ranges between Dh550-750 per annum to be paid by the employee sponsor.

   What does this coverage include? It could include General Physician consultation, dental and maternity cover, features that are usually covered in the basic package.

   This EBP cover also provides a maximum insurance limit of Dh150,000 per annum in case of emergencies.

   All pre-existing conditions are also covered in the EBP package after six months from the first time you buy insurance.

   “The annual premium amount for EBP has not gone up in the last three years since mandatory health insurance law came into effect. It indicates that insurance for the masses is working in general to provide healthcare delivery to all,” said Dr Al Yousuf.

2. Network: A network is a corporation that has a contract with a health insurance provider to offer services to plan participants at predetermined, pre-negotiated prices. A person who subscribes to a plan covered by the network provider may visit one of a number of pharmacies, diagnostic facilities, and clinics that are organized by the network provider. In other words, this refers to the complete list of medical facilities to which you have access through your insurance plan. Also known as an in-network provider, this is.The health insurance plan does not have a contract with an out-of-network provider. The name of the network is listed on your insurance card under the subhead Insurance Provider (IP) net. The insurance company’s given annexure contains a list of the medical care providers that the policy holder may use. The list of family doctors, diagnostic facilities, and pharmacies that are authorized under the EBP is also included in the TOB that the insurance provider provides. Hospital visits in EBP are recommended by the primary care physician.

   Although it is required by law for the EBP network to have enough geographic coverage throughout the UAE, one can check the list to determine if the network contains clinics they want to visit or that are close to their house. Every EBP insurance plan offers free emergency care at any hospital as well as maternity coverage.

3. Multiple and Single Insurance: The majority of employees of a company are eligible for group insurance with discounts. Individual insurance policies are typically tailored and have higher annual rates based on the policyholder’s health.
4. Deductibles: These are costs that the insurance policy holder must bear individually. For a consultation at the clinic, there is a set fee that must be paid. For instance, if a doctor’s consultation costs Dh100 and the deductible is set at 10%, the insurance holder will be required to contribute Dh10 of the cost.
5. Co Insurance: Affectionately referred to as COINS on the health insurance card, this term denotes the portion of the total bill that must be covered out of your own money. Up to 20% of the total cost is the co-insurance. As an illustration, if your coinsurance is set at 20% and your clinic visit results in a total bill of Dh200 for X-rays, blood tests, CT imaging, and medications, you would be responsible for paying Dh40 out of pocket.

   

   Outpatient and inpatient coinsurance percentage caps are set separately. Outpatient coverage, which includes going to a family clinic for a cough, cold, fever, or even a prenatal consultation, is typically 20% of the total consultation price with EBP coverage.

   The co-insurance for a hospital stay for a surgical operation may be as high as 20% of the entire cost. To find out how much coinsurance you would be required to pay per visit, check your insurance card for the inpatient and outpatient coinsurance rates.

   The DHA, however, has set a cap on this sum. Therefore, if a patient needs to have surgery that costs Dh40,000, his inpatient coinsurance cap will be Dh500 each episode. Three times a year, a patient may use this service, with a maximum annual coinsurance of Dh1,000 for all inpatient visits.

6. Pharmacy limits: Each policy establishes a cap on the amount you can spend at the pharmacy; with an EBP, this cap is often Dh2,000 per year. Any costs above that amount must be covered out of your own pocket. For instance, if you visit the pharmacy six times and pay Dh2,400 in 12 months because you have hypertension, diabetes, or both, and you spend Dh400 every two months on medication through your insurance. As a result, you would have gone over your pharmacy spending cap and would need to pay Dh400 out of pocket.
7. Reimbursements: Typically, all EBPs have a direct billing system where the clinics bill the insurance company for the full cost of the service. However, your insurance may frequently allow for a “out of network” consultation or treatment, when you pay the full cost of care up front and then submit a claim along with your receipts to be reimbursed. To find out if you can visit clinics and hospitals outside the coverage area of your policy, read the ToB’s fine language.
8. Last Month Coverage: In some cases, an insurance policy holder will be refused coverage in the final month, such as when they need medicine in December even though their coverage is valid through the end of that month. The law of the UAE declares that this is forbidden.”If any pharmacy or clinic is doing that, it was illegal,” claims Dr. Al Yousuf. Insurance policy holders have the right to file a complaint if their rights are violated. “The clinic must provide insurance coverage until the last day of the health coverage.”

   On http://ipromes.eclaimlink.ae, residents can file grievances, which are often resolved within 48 hours of application receipt.(GN)

Limit to visit a doctor

A patient is only permitted a certain number of doctor visits for one episode. Let’s assume that a patient can visit the same doctor for the same episode typically three times within 10 days for the same ailment when they discover they have a fever or any other condition when they consult a doctor at the clinic. So he goes for the initial consultation on day one, reports for a follow-up on day three, and then might wish to reconsult on days six or seven to track his recovery. For this, he will be charged a one-time consulting fee. When this cap is reached, additional insurance company permission is required.

Pre-approval for a medical procedure

A patient is only permitted a certain number of doctor visits for one episode. Let’s imagine a patient goes to the clinic with a fever or any other illness and consults a doctor there. Reality: An approval is only good for a short time. The patient should receive a clear explanation of the validity period. The patient might need to reapply for permission if the treatment is not received within the allotted time frame. Patients should also be aware that clearances for testing and procedures take time. For instance, if a patient needs tests that cost Dh1,500 but his insurance only covers Dh1,000, both the patient and the doctor must pay the difference.

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