Your guide to Dubai's mandatory health insurance scheme

1 - The nine companies that are offering the Essential Benefits Plan (EBP) are:
> Axa Insurance
> Ras Al Khaimah National Insurance Company
> National Health Insurance Company (Daman)
> Oman Insurance Company
> Orient Insurance
> MetLife Alico
> Takaful Emarat
> Dar Al Takaful
> National General Insurance Company
2  - EBP eligibility and annual premium
Since this is an individual only package, those eligible are:
> Domestic workers with a salary of less than Dh4,000 (Dh650)approx
> Not active at work people aged 0-65 years (Dh650)approx
> Not active at work married females aged 18-45 years (Dh1,600 to 1,750)approx
> Not active at work parents aged 65 years and above (Dh2,500)approx
3  - Other features of the package include:
> The insured will have to pay 20 per cent as co-insurance
> The package has an annual upper aggregate of Dh150,000
> There is a cap of Dh500 payable on every encounter
> There is also an annual aggregate cap of Dh1,000 for the insured. Above these caps, the insurer will cover 100 per cent of the treatment
> Dental treatment as well as hearing and vision aids are not covered
4  - What is covered in the package?
> Tests, diagnosis, surgeries in hospitals for non-urgent medical cases (with prior approval) (in-patient)
> Emergency services
> Healthcare emergency for cases with chronic diseases
> Ambulance services in emergency
> Accommodation of a person along with in-patient (Dh100 per night)
> Medicines
> Examination, diagnostic and treatment services by authorised general practitioners, specialists and consultants
> Follow up visits with seven days (no payment)
> Lab tests > Physiotherapy services
> Preventive services, vaccines and immunisations
> 10 per cent co-insurance payable by the insured as well as 8 visits to PHCs
> Antenatal blood tests
> Maximum benefit of Dh7,000 for normal delivery and Dh10,000 for C-section (10 per cent co-insurance)
> One month cover for newborn and tests included in mother's cover
5 - Chronic conditions
> Treatment for chronic and pre-existing conditions such as diabetes is excluded for first six months of coverage
6 -  Domestic workers
> Domestic helpers include drivers, housekeepers, maids and nannies. All individuals sponsoring domestic helpers need to ensure they provide health insurance coverage to their staff soon. Imposition of fines for domestic helpers, however, is delayed until beginning of next year.

Asma Ali Zain

asmaalizain@khaleejtimes.com