What is Health Insurance?

Health insurance or medical insurance is a type of coverage wherein the insurer covers all the medical expenses of the insured that arise due to an illness. These expenses could be related to hospitalization costs, cost of medicines or doctor consultation fees. Health insurance also protects the policyholder’s family against the medical costs.

Benefits of Health Insurance in the UAE

The different features and benefits of health insurance in Dubai and across the UAE are listed below:

  • Cashless Treatment : The insured doesn’t have to pay for the medical treatments, if he/she has been admitted to the hospitals which have collaborations with the insurance companies. The insured can avail the advantage of cashless treatment facility by sharing the policy number and rest of the items are going to be taken care of by the hospital and therefore the insurance. However, if the medical expenses go beyond the pre-specified limit by the insurance cover then the insured will need to settle it directly from the hospital.
  • Pre & Post Hospitalization Coverage :  In this the insured gets medical insurance coverage for pre & post hospitalization expenses for a specific number of days before and after a policyholder is hospitalized.
  • No Claim Bonus (NCB) : If the insured/policyholder doesn’t make any claim for any sort of treatment during the whole policy year then he/she will be rewarded with No Claim Bonus. One can take the benefit of NCB on the renewal of their health insurance
  • Medical Check-Up : The insurance policy also entitles the policyholder to receive frequent medical check-ups. However, a free medical check-up is offered by a few health insurance companies in UAE, and is base on their history of No Claim Bonus.
  • Transportation Charges : If the insured gets admitted to the hospital, this policy also covers the expenses incurred on using an ambulance to transport the policyholder from home to the hospital or vice versa.
  • Room Rent : The insurance policy also covers the expenses on room rent, if in case the insured is hospitalized. Having a medical insurance will ensure that all such expenses are covered to a specific extent.
  • Third Party Administrators : TPA plays vital role in the health insurance sector and acts as a link between the insurer and the policyholder. TPA’s have their collaboration with most of the medical insurance companies in Dubai and across the UAE to manage a wide range of services like enrolment, premium collection, claim settlement, and so on.
  • Government Policies :  Government provides a certain level of protection for the residents of Dubai or Abu Dhabi in terms of medical insurance. For example, Abu Dhabi Government provides a full medical coverage for all UAE nationals living in Abu Dhabi which is known as “Thiqa programme”. Similarly, Dubai Health Authority offers “Saada” as a health insurance policy to unprotected residents.

Types of Health Insurance in the UAE

Most of the insurance providers offer the following different types of medical insurance plans that cover everyone from the solo expat to the relocated family:

  • Individual Health Insurance Plans : As the name suggest, this plan is for a single policyholder or family group individuals looking for a comprehensive UAE medical insurance. This plan offers several benefits like cashless hospitalization, pre & post hospitalization, etc.
  • Family Health Insurance Plans : This plan can provide a great value with qualifying family discounts with a wider coverage. Instead of purchasing insurance for each family member separately, one can opt for the family plan in order to cover the entire family under one single cover. This type of insurance has some restrictions of including fixed number of children and a spouse. Under family medical insurance policies, all the family members that are included in the scheme share the sum assured.
  • Senior Citizen Health Insurance plans : This plan is specifically designed for anyone who is 60 years old and above and has pre-existing medical conditions which comes with discounted/lowest premium cost. Usually, senior citizens' medical insurance policies come with discounted premium rates. Although only a few UAE health insurance companies offer such policies, they may ask for a medical check-up before the coverage is sold out. In addition, relative to insurance programmes for young people, such initiatives could be marginally higher because senior citizens are more vulnerable to infections and health illnesses.
  • Group/Employee Health Insurance Plans : These types of health insurance plans are designed and developed to provide comprehensive coverage to a specific group of individuals usually employees of an organization or members of a company. Group medical insurance has several benefits with comparatively lower prices.
  • Plans by Nationality : Government medical insurance companies in Dubai and other emirates and other health insurance providers offers better benefits to UAE nationals. There are different insurance benefits provided to expatriates also which are different from UAE nationals.

Health Insurance Inclusions

In the UAE, health insurance plans strictly adhere to a list of inclusions that sets out the specific amount of medical protection for which a policyholder is liable.

Although inclusions vary from one health insurance provider in Dubai to the next, even the cheapest health insurance in Dubai will have the services mentioned below:

  • Pre-existing diseases and health illnesses
  • Pre & post hospitalization
  • In-patient hospitalization costs
  • Ambulance fees
  • Health check-ups
  • Day care procedures
  • Hospital room cost
  • Vaccinations & inoculations
  • Newborn or maternity
  • Medication

Health Insurance Exclusions

The list of exclusions is a compilation of different medical facilities and procedures that are not covered in the UAE as part of a health insurance package. Some of the most common medical insurance exclusions are below:

  • Unnecessary Operations : Simply put, most UAE medical insurance would not cover the cost of medical services unless they are vital to the health and well-being of the policyholder.
  • Cosmetic Treatments : In Dubai or elsewhere in the UAE, it is almost difficult to find medical insurance providers providing a health insurance package with cosmetic care cover.
  • Obesity : Medical services for obesity are typically far beyond the limits of UAE health insurance coverage.
  • Dental & Optical Care : Even the very best medical insurance in Dubai only scratches the surface when it comes to dental or optical treatment. While some UAE health insurance providers provide emergency dental coverage, regular checks and more extensive protection can typically only be used to pay an extra premium.
  • Waiting Periods : Some health insurance contract benefits only come into effect for a defined period of time after the patient has become a policyholder. This is regarded as a waiting time for the policy. Maternity cover, cover for pre-existing conditions, cover for chronic conditions and so on are the most common examples of health insurance providers which have a waiting period.
  • Voided Policies : UAE health insurance providers reserve the right to cancel a medical insurance contract at any time. As a direct result of the actions of the policyholder, medical insurance plans are usually annulled. Criminal activities (such as gambling), failure to pay the medical insurance fee on time self-harm or suicide, and more are examples of activities that may void a health insurance contract.

The Health Insurance Claims Process

The health insurance claim is a request from a policyholder to the insurer to avail coverage benefits under a health insurance policy. You may have heard the term ‘network hospitals’ while going through various insurance plans offered by the best insurance companies in UAE. This network of hospitals plays an important role in health insurance claiming process. There are two ways of claiming health insurance by the members:

  • Within the Hospital Network : Majority of medical insurance companies do tie-up with different hospitals and clinics. These partnered insurance companies help policyholders to avail their health insurance plan benefits without making any payments out of their pockets within the specified policy limits.
  • Outside the Hospital Network : In this claim process, policyholder has to pay for any medical treatment which is availed outside of the health insurance policy’s network hospitals. However, the amount can be reimbursed by submitting all the treatment details, bills and other document proofs to the health insurance provider. All the reimbursement should be subject to the medical insurance policy eligibility and under the limits that has been set forth by the insurance provider.

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Under the DHA’s new insurance law, insurers cannot deny individuals medical insurance coverage due to pre-existing conditions. But you need to wait for nearly 6 months to get coverage for any pre-existing & chronic conditions. If you want to avoid the waiting period of six months then you can choose a deal with private insurance companies that offer several plans for immediate cover.

Health insurance protects you and your family financially in the medical emergencies. Health risks are uncertain and Health insurance can reimburse the insured for expenses incurred from illness or injury.

Health insurance covers a variety of services that ranges from cost of doctors or emergency room visits to major medical expenses like lab tests, medicines etc. The insurance coverage depends on the plan you opt for as different plans carry different benefits.

As per the Dubai Health Authority (DHA)’s new law, every medical plan must provide cover for eight prenatal appointments with an ob/gyn, three prenatal scans, and ‘initial investigations. There are other benefit coverage of up to Dh7,000 for normal delivery and Dh10,000 for medically necessary C-sections.

Most insurance plan does not cover optical & dental insurance unless it’s for an emergency case. To avail these services, you need to get more comprehensive cover by paying more.

It is highly recommended to get travel medical insurance coverage in case of any unexpected health and medical emergencies. Your passport could be seized if you have unpaid medical bills and you won’t be allowed to leave the country.

Deductable is the excess amount deducted from a claim medical expense which needs to be paid by the insured/policyholder. Always remember, the higher the deductable, the lower the premium you pay. This is an advantage to the employers to provide health insurance to their employees in a cost effective way.