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While Dubai's mandatory insurance roll-out process is proceeding smoothly despite initial teething issues, a special segment of society have voiced their concern, saying they are not being covered enough under the scheme.
British resident Francesca R.J., mother of three children - one of them an autistic boy - said she was denied medical insurance while pregnant with her fourth child, as the insurance company found out he would be born with Down Syndrome (DS).
"Due to my age factor, I underwent precautionary tests during pregnancy and discovered that the baby I was carrying had DS, and I was concerned," Francesca told Khaleej Times.
"But when I approached insurance companies, I was told that they could not provide him insurance cover other than the basic one," she said. "Immediately after birth, the child is covered for one month as part of the mother's insurance cover, I was told by the company," she added. "I had to fight with them on this issue, saying they couldn't have foreseen the problem before birth. so how could they refuse insurance?"
However, tragically, the baby had a foetal death before birth. Francesca, who is also a manager at a special needs centre, said the coverage provided to children and adults with special needs was far from adequate. "We are talking about people here who earn less, but have to pay more to receive proper treatment," she said.
Francesca also said that she had to struggle to deliver her dead child. "Private hospitals did not have the facilities I required, and I chose a government hospital.
"But the government hospital would not accept my private insurance, so I had to cover the costs out of my own pocket," explained Francesca. Her elder autistic child is being cared for back in Britain.
If her child had been born with DS, his surgery would have cost at least Dh100,000. "I was already anticipating expenses and wondering how I would manage," she said.
Resident in Dubai for the past six years, Francesca is of the view that basic needs for special needs children and adults should be covered by insurance. She said her centre has lots of overheads and despite keeping the services at the lowest, the costs are very high. "We are barely breaking even.
"It is only privileged people who get access to quality services, but disability does not discriminate," she said.
Even for those paying high premiums, not all treatments are covered. "Some patients may need more therapy sessions, but the company covers only limited ones based on the medical condition," she said.
"I appeal to the government to make insurance cover and premiums for special needs affordable and also available at the earliest stage of the disability," she said.
Certain conditions excluded: insurance official
Under anonymity , an insurance company official told Khaleej Times that some medical conditions are standard exclusions in insurance; these include medical issues at birth, issues caused by medical procedures or research work, radiation, nicotine addiction, sex transformation, as well as hormone therapies, among others.
"The medical condition has to be declared and if the insured has the above conditions, the coverage will be limited," he said.
He said that though some cases are covered, the premiums remains high and variable, depending on the condition and the follow-ups required.
A special insurance card for those with special needs
Sanad, a special insurance card, was released by the Community Development Authority (CDA) for disabled people among Dubai residents only, earlier this year. However, the card offers limited discounts on medical services though it supports other services such as public transport.
DHA issues warning to insurance companies
Based on complaints that the insurance companies were refusing to cover people with special needs despite a looming deadline, the Dubai Health Authority (DHA) issued a warning and asked all companies to comply and provide the minimum benefits.
A circular was issued in this context last month, reminding all companies to comply with the regulations. "It has been brought to our attention that members of the population with special needs are being refused insurance by various insurance companies," the circular read.
"This is to remind insurance companies and intermediaries that health insurance companies must provide benefits that meet or exceed those required under the Essential Benefits Plan (EBP) to individuals with special needs... at the earliest date possible and no later than June 30," it said.
"Insurance companies are not permitted to decline to quote for any individual with special needs except for standard terms, conditions and exclusions that apply," it added.
asmaalizain@khaleejtimes.com
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