Tuesday, May 7, 2013

Health Insurance For All-Employers cannot recover any health insurance cost; new law coming in UAE

Any employer who does not provide health insurance for his employees will be fined Dh10,000 – or more - per uninsured employee under his sponsorship, according to a draft federal law on insurance.Accordance to the draft federal law for health insurance, the sponsor will be committed to guarantee health insurance coverage for each person under his sponsorship, reported Al Ittihad newspaper.

Also, any employer who tries to recover any portion of the health insurance policy cost from the person under his sponsorship - will be fined a minimum of Dh10,000 and up to Dh30,000.
Any insurance firm, health service provider or insurance services provider, which works in the health insurance field without a licence from Health Authority and competent authorities, will be fined not less than Dh100,000 and not more than Dh500,000 per case.
Whoever provides incorrect information to anybody with the intent to obtain a service or benefit from health insurance, will be fined between Dh10,000 and Dh30,000.
Also, anybody or firm, which does not maintain the confidentiality of information, data and files and records of the beneficiaries of health insurance services, will be punished by a fine of not less than Dh50,000 and not exceeding Dh200,000.
New Authority
According to the draft law, a new authority is proposed to regulate health insurance.The ministry staff will be designated by the Minister of Justice along with the head of the new authority. The authority will have judicial powers.

Staff of the authority will have the power to control and prove violations, issue regulations and decisions and implement them within the limits of their work and jobs.

The new authority, in coordination with the Ministry of Health and other health authorities, will develop a system to coordinate the transfer of benefits to the beneficiary in the case of transfer of coverage of health insurance to another provider.

Proof of Coverage
According to the law, the sponsor must submit proof of coverage of each beneficiary and submit that information electronically to relevant authorities.
The new law stipulates that the regulations will set out the conditions and the data required for proof of health insurance coverage.

Insurance Premiums

The draft law indicates that the health insurance authority have the power to fix the rates of the benefits offered by health service providers. They can only modify the rates after approval from the authority.

Health insurance companies can only amend the cost of insurance coverage contained in the basic health insurance contract - only after the approval of the Authority and in compliance with the terms and conditions prescribed by the law.
Also, health insurance providers, insurance companies and the third party management companies, have the right to hire doctors and other specialists to monitor and verify the extent to which health providers complied with the conditions and obligations of the contract.
The insurance company will bear the costs of health services provided to the beneficiary in accordance with the terms of the contract of insurance. The insurance company may request refund from any other insurance company responsible for such costs under the alternative insurance provisions.
Obligatory Service

All health services providers will be obliged to provide health services to any beneficiary who provides proof of coverage such as health insurance card.
Health services providers will also be obliged to continue to provide health services to the beneficiary during the coverage period notwithstanding any dispute among the health provider and insurance coverage.

According to the draft law, health authorities will have to provide health services to anyone with proof of coverage even though the person is not within the network of prescribed healthcare providers.
They are obliged to provide health care services in accordance with the professional and ethical standards adopted in the laws in force in the State.
The draft law prohibits insurance companies to own or manage or participate in the management of the facilities of health service providers.
It also prevents health providers to own or manage or participate in the management of insurance companies.
However, there may be exceptions of this article through a decision from the Council of Ministers.
The draft law confines the licensing and accreditation mechanism to the proposed authority in coordination with the Ministry of Health and health bodies.