Wednesday, June 1, 2016

Mandatory health insurance law become effective on June 30 2016 in Dubai

By end of June, almost 95 per cent of residents with Dubai visas will have to come under the mandatory health insurance cover as per the Dubai Health Insurance law, a top official said on Monday. An interview by journalists Dr Haidar Al Yousuf explained about mandatory health insurance

Approximately 3.8 million people are on Dubai residence visas. Residents and employers who fail to comply will face fines What is the mandatory health insurance law?

The Dubai Health Insurance LawNo 11 of 2013 that came into effect in January 2014 mandates that all nationals and residents with a Dubai visa should have compulsory health insurance cover. The last deadline for it is June 30, 2016, by which time every person with a Dubai visa must have this insurance.

Tell us about the different phases of coverage.

In the phased implementation, Phase I, that covered companies with 1,000 or more employees, ended on October 31, 2014; phase two covered all companies with 100-999 employees and ended on July 31, 2015. Phase 3 covers companies with 100 or less employees and includes every resident, including domestic workers and dependants of employees, who have to come under the cover by June 30.

All UAE nationals in Dubai are covered under government insurance programmes like Enaya and Sa’ada insurance. So far 75 per cent of the beneficiaries with Dubai visas have complied. That leaves 25 per cent who have a month’s time to comply.

Can you provide details of insurance coverage?

According to the law, the legal liability for every sponsor is to provide the essential insurance package and the coverage is the same irrespective of whoever takes it. Sponsors are free to top up this insurance cover. The premium for this essential package is fixed between Dh565 and Dh650 so that those with salaries under Dh4,000 receive adequate cover. These include all the blue collar workers, including domestic help, maids and nannies.

The second key group are dependents of expatriates. The sponsors of employees do not have to pay for the health cover for the spouse and dependents. However, we strongly advise them to pay for the employee’s dependents. The premium for this is Dh650 or a little more unless the dependents are above 60 years of age. The third group comprises the elderly. Now every individual above 60, whether employed or a dependent, with or without a history of diseases, can buy an annual insurance cover of Dh2,500. The pre-existing conditions will not be covered for a period of six months and after that everything will be covered.

Where does the consumer shop for insurance?

The DHA website has a comprehensive list of all 46 registered insurance providers in UAE. We have a section called the marketplace on the website where you can compare the benefits against the fee and shop for the best cover. The 46 insurance companies are registered permitted insurance companies, of which nine participating insurers provide for the essential health benefit package (EBP) for employees who earn less than Dh4,000 and these nine providers cannot deny this package to the people who fall under this category.

What does the essential health cover package cover?

The basic cover includes outpatient consultancy at clinics, referrals to specialist and for surgical and pathology investigations, maternity health cover, emergency visit to hospital and any surgeries required. While employers have group insurance schemes for their employees, a resident can shop for a tailor-made cover for his dependants that includes spouse, minors and domestic house help.

What is the maximum coverage and how much is a beneficiary expected to pay?

The beneficiary with basic insurance cover gets a maximum coverage of up to Dh150,000 and has to pay 20 per cent [at every visit to the doctor]. So, if he has an outpatient bill of Dh200 he will have to pay Dh40.

What is a special protection package?

The protection package mandates that although a beneficiary has to pay a minimum of 20 per cent of co-insurance payment in case of a hospital stay or surgery, this is capped at Dh500. So, if someone has major surgery amounting to Dh40,000, even those in the basic package would be expected to pay Dh8,000 as 20 per cent. But the protection package mandates a ceiling of Dh500. We have put a cap of Dh500 or a maximum payment of Dh1,000 in the whole year. This protects the interests of the beneficiaries.

What are the fines and penalties? What happens in case a person has just renewed his visa?

Linking the visa renewal to insurance is a check mechanism. But every individual in Dubai has to get the health cover by June 30. If he or she fails to do this, his employer will be fined for every month beginning from July until the time his visa comes up for renewal. If the individual is a freelancer or self-employed, he will have to pay the fines himself. There are monthly penalties which will be levied with retrospective effect from June 30. Fines can range anywhere between Dh500 per person per month. It is cheaper to get an insurance than to pay for default as the fines are far higher than the actual cost of the essential benefits package.

Although basic cover provides maternity benefits is it true that a woman who is pregnant at the time of getting the insurance will not be covered?

That is true. Insurance is a protection or cover for future conditions or illnesses. So, even if a woman falls pregnant one day after getting the insurance she has to be covered. However if she subscribes to the cover after she conceives she will not be covered. In case of other conditions such as diabetes, hypertension and other lifestyle disease, the insurance will not cover these for the first six months after which all pre-existing conditions have to be covered.

What happens in case a blue collar worker has an accident or cancer?

The insurance company has to pay the bills up to the annual aggregate limit. It is Dh150,000 annually. Then insurance firms are linked to visas and the organisation has the right to take the decision of renewing the visa of an employee with an insurance renewal. But until the validity of the visa, his treatment episodes will be covered. In addition, we are in the final stages of establishing a public fund in case of any eventuality where the payment accrued is far beyond the aggregate limit. Such cases are likely to be only a handful and can be dealt with on a case-by-case basis. The system is designed to take care of the health needs of the majority and there are always going to be some exceptions.

In the case of newborns who covers their medical expenses?

A newborn is covered under the mother’s health insurance cover for 30 days after which the parents have to get the child an individual cover. The child’s birth complications will be covered to the maximum aggregate limit of the mother’s cover. However, this cover will not include congenital conditions such as cleft palate, club foot, Down’s Syndrome and the like.

What about special needs children?

All special needs children have basic health requirements which will be covered by the regular health cover. Their requirements for flu, cough, cold and regular requirement will be covered. However, the insurance will not cover special services such as speech therapy, special school or physiotherapy.

Blue collar workers: Blue collar workers can get extended coverage in their home country, too.Blue collar workers are now being offered an essential health benefit package by Takaful Emarat Insurance for Dh625 per annum that will provide them the same cover in their home countries such as India, Pakistan, Bangladesh, Sri Lanka and Nepal at no extra cost. Most South Asian workers come from these countries.

According to Dr Sanjay Patihankar, founder–director of Third Party Admistrator (TPA) for this insurance, said this is the first time that a UAE insurance has tied up with an international insurance provider, Vidal Net, that will give the workers a direct billing option in their home country. “While some insurance companies do provide extension of health services for workers back home, this cover provides direct billing facilities which no other cover in this category provides. The worker will be able to get adequate health cover in their country using the same insurance card with the same aggregate annual limit, etc. In India, for example, beneficiaries of this insurance can go to any of the 25,000 clinics and hospitals across the country.

Such a cover can help the worker in seeking standard medical facilities while on annual leave at home. Dr Paithankar quoted the case of a UAE worker from Varanasi in India who required an emergency angioplasty. The patient wanted to be with family members during his surgery. “The lowest quote we could get from a hospital in UAE was Dh65,000 but we were able to connect to Fortis in Varanasi and they did the same surgery for Dh17,000. We as TPA providers covered the patient’s travel costs and the surgery was carried out successfully. The patient has since recovered and reported back to work.”

It is expected that such an arrangement will improve productivity levels of workers who can now avail of the health services of a commendable standard in their home country.

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