Dubai Health Authority has issued a law which required Dubai Emiratis and expats to have a health insurance. The dependents also must be covered under a health insurance plan. The residents can opt for the mandatory Essential Benefits Plan if they are confused about which plan to choose. The mandatory Essential Benefits Plan is for the lower salary band employees and for their dependents. This plan ensures that the employee, dependents and their domestic help will have the required health insurance cover and thus have access to good quality healthcare at a reasonable rate.
Emiratis are covered by government sponsored schemes. Private health care provisions must be made for the expat community who are majorly employed in Dubai. The employer will cover the full cost of cover for their employees. But, companies are not obliged to provide coverage for dependents of their employees and the cover for resident employees is the employee’s responsibility.
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Essential Benefits Plan requirement for dependents
Essential Benefits Plan is to be taken by an employee. If they have uninsured dependents, the Essential Benefits Plan is to be taken for them as well. Dependents includes spouse, elderly parents and children. Domestic help who has been employed for less than Dh4,000 a month will also have to be covered.
In the event your dependents are insured by your employer, there is no need for Essential Benefits Plan for your dependents. You need not take the Essential Benefits Plan if you have insured your dependents under a separate scheme that has a higher cover.
Why choose Essential Benefits Plan?
Essential Benefits Plan offers essential benefits at a reasonable cost. This is a standardised package and the premiums start from Dh650 to Dh725 per annum. This is the best option for expats who cannot afford to pay the exorbitant rates in health insurance for their non-working spouses and elderly parents. This plan drives down cost of healthcare, such as regular illnesses, emergency treatment, check-ups, etc.
This plan is not suited if you wish for a better coverage, medical or geographical or if you want a higher cap on your medical cover. This plan is not valid outside UAE and the overseas treatments will not be covered under this plan.
Who are to be insured?
You must insure the following under the Essential Benefits Plan:
- Elderly parents
- Domestic help
The insurance premium is higher for parent older than 65 years. The premium is also higher for women in the age bracket of 18 - 45 as they will be more likely to getting pregnant.
Domestic help, nannies, housemaids, cooks and drivers earning Dh4,000 or less per month will have to be insured under this plan. If the domestic help is earning more than that the employer can choose any scheme which will exceed or meet the benefits of Essential Benefits Plan. The employer cannot deduct the premium cost from employee’s pay so that he or she can reduce the salary and make the domestic help eligible for Essential Benefits Plan. Deducting premium from employee’s salary is illegal.
Essential Benefits Plan Premiums
- The premiums start from Dh650 to Dh725. Employees earning over Dh4,000 will have to pay higher premiums.
- Premiums for dependents who are in the non-working group and between the ages of 0 to 65 starts from Dh650.
- Premiums for non-working females between the ages 18 - 45 starts from Dh1,600.
- Premiums for elderly parents starts from Dh2,500.
- Premiums for general domestic help starts from Dh650.
Essential Benefits Plan coverage
Essential Benefits Plan offers a total annual coverage of Dh150,000 for all claims. The claims allowed to be made under Essential Benefits Plan are as follows:
- Out-patient treatment: Out-patient examination, diagnosis and treatment on a routine basis is covered and a 20% of the bills are to be paid by the insured.
- In-patient treatment: Non-urgent medical treatments, tests, diagnosis, surgeries will be covered. The insured will have to bear 20% of the bills. The amount payable won’t exceed Dh500 per encounter. The amount coverage doesn't exceed a maximum of Dh1,000 per year.
- Tests: Physiotherapy sessions, lab tests and radiology tests will be covered. The insured will have to pay 20% of the bill.
- Preventive medicine: Immunisation procedures and preventive medicines for children and new-borns are covered.
- Medicines: Per person up to Dh1,500 is covered under this plan. The insured will have to pay 30% of the amount per prescription.
- Emergency: Ambulance service and emergency health care during emergency will be covered.
- Maternity tests: Three antenatal ultrasounds, antenatal blood tests, 8 pre-delivery visits will be covered. The insured will have to pay 10% of the bill.
- Delivery cost: Up to Dh7,000 is covered for normal delivery. For caesarean delivery, up to Dh10,000 will be covered. 10% of the bills are to be paid by the insured.
- Newborn: New-born child is covered under mother’s insurance for 30 days from the date of birth. Screening, neonatal tests and other tests will be covered.
- Pre-existing condition: Pre-existing and chronic medical conditions must be declared when applying for the insurance. The pre-existing conditions will be covered after 6 months waiting period. But if there is any emergency health care related to the pre-existing condition during the waiting period, it will be covered like any other claim under the scheme.
- Geographical coverage: Essential Benefits Plan covers all of the above in Dubai and emergency treatment in emirates and Abu Dhabi. You need to discuss this with your insurer before you take the plan. There is limitation on coverage within UAE for basic plan. You can choose the enhanced plan to cover you in countries outside UAE. The premiums for enhanced plans can go up to Dh15,000 per annum. If your insurer is agreeing to cover for medical expenses outside UAE, it will mainly cover emergency related treatment.
Participating Essential Benefits Plan Insurers
45 insurers have valid health insurance permit issued out of which only 9 insurers can offer Essential Benefits Plan. The 9 participating insurers are:
- Oman Insurance Company
- National Health Insurance Company Daman
- Dar Al Takaful
- Axa Insurance
- MetLife Alico
- Orient Insurance Company
- National Life and General Insurance Company Saoc
- Takaful Emarat
- Ras Al Khaimah National Insurance Company
Health Insurance affects visa renewal
You have to take a health insurance for your dependent if their visa has been issued or renewed recently. Failure to do so will attract fine and legal complication when you go in for visa renewal later. You need to get the health insurance for your dependents by the end of the year.
Do not rush in and choose a health insurance plan. Research well and compare the plans before you choose one. Work with an insurance broker to take the right choice as they can ensure that you choose the right plan and alleviate the pressure. The average length required to take a health insurance is 2 weeks.