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Basics?of?Health?Insurance:?
?
Different?aspects?of?Health?Insurance?and?why?should?you?take?it?
The?three?most?popular?things?that?are?insured?after?life?are?cars,?homes?and?health.?Cars?
can?and?homes?can?be?rebuilt?and?renovated?but?your?health?almost?always?in?a?state?of?
degeneration?with?age.?So?it?is?important?to?keep?yourself?insured?at?all?times.?
Dr.?Haidar?Al?Yousuf,?Director?of?Public?Health?Funding?at?DHA?has?stated?that?75?per?cent?of?
Dubai?expatriates?are?now?covered?by?insurance,?thanks?to?the?mandatory?health?insurance?
law.?
“This?means?we?have?25?per?cent?left?to?cover?by?June,?we?hope?to?have?close?to?100?per?
cent?of?Dubai?expatriates?covered?by?the?insurance?by?the?end?of?next?month,"?said?Dr?Al?
Yousuf.?
Dubai?Health?Authority?(DHA)?will?complete?the?implementation?of?Dubai’s?Mandatory?
Health?Insurance?Scheme?ISAHD?(Bringing?Happiness),?by?the?end?of?June,?2016.?DHA?is?
currently?in?the?third?and?final?phase?of?implementing?the?scheme?on?companies?with?less?
than?100?employees,?including?all?spouses,?dependents?and?domestic?workers.?
Typical?benefits?covered?under?a?health?insurance?policy:?
? Inpatient services
? Emergency services
? Hospitalization
? Maternity and newborn care
? Mental health and substance use disorder, including behavioral health treatment
? Prescription drugs
? Rehabilitative and habilitative services and devices
? Laboratory services
? Preventive and wellness services and chronic disease management
? Pediatric vision
? Outpatient benefits
?
Types?of?Health?Insurance?Policy??
Individual?–?covered?by?self?or?employer:?
Health?insurance?that?you?purchase?on?your?own?or?through?your?employer?which?
covers?only?the?medical?expenses?related?to?your?health?is?called?an?individual?policy.??
Family?insurance:?
Such?a?policy?covers?an?individual?and?their?immediate?family?members?including?
spouse,?children?and/or?dependent?parents.?The?policy?can?have?a?fixed?coverage?for?
each?individual?or?a?total?coverage?“floater”,?which?can?be?shared?among?all?
members.??
Do?you?know?what?insurance?premium?is??
Premium?is?the?amount?the?policy‐holder?or?their?sponsor?(e.g.?an?employer)?pays?to?
the?health?insurance?provider?for?providing?coverage.?
o Some?of?the?popular?health?insurance?providers?in?the?UAE?are:?
1. Axa‐gulf?
2. Aetna?
3. Bupa?
4. Orient?Insurance?
5. Dubai?National?Insurance..?&?many?more?
?
?
Some?health?insurance?terminology?
o Co‐payment:??The?policyholder?has?to?pay?a?certain?percentage?of?the?overall?
treatment?cost.?In?the?UAE,?maternity?benefits?usually?have?10%?co‐payment,?
whereas?dental?treatments?typically?have?a?20%?co‐insurance.?
o Deductibles:?Deductibles?are?fixed?charges?that?policyholders?have?to?pay?out?of?
their?own?pockets?when?undergoing?a?treatment.?Also?known?as?co‐payment?or?
co‐insurance,?there?are?a?few?types?of?deductibles:?
Generally,?there?are?three?types?of?deductibles?available?to?customers:?
Annual?Deductible?or?Excesses?
With?an?annual?deductible,?the?insurance?company?will?not?start?paying?for?any?
treatments?until?you?have?paid?up?to?the?deductible?amount?from?your?own?
pocket.?Let’s?say?your?health?insurance?policy?has?an?annual?deductible?of?AED?
1,000,?and?your?overall?medical?expenses?in?the?first?six?months?amount?to?AED?
1,500,?then?you?are?supposed?to?pay?AED?1,000?while?the?insurance?company?
will?cover?the?remaining?AED?500.?In?addition,?for?the?next?six?months,?the?health?
insurance?company?will?cover?the?cost?for?medical?treatments?while?you?pay?
nothing.?Annual?deductibles?are?not?very?common?in?the?UAE,?of?the?
approximately?100?medical?insurance?plans?on?Bayzat.com,?only?a?handful?(such?
as?Bupa?health?insurance?plans)?have?an?annual?excess.?
Fixed?Deductible?per?Visit?
This?type?of?deductible?is?very?common?in?the?UAE.?Usually,?the?policyholder?will?
have?to?pay?a?fixed?amount?for?each?outpatient?visit?to?the?doctor.?This?can?range?
from?AED?30?to?AED?75?per?visit.?In?the?UAE,?fixed?deductibles?typically?only?apply?
to?outpatient?treatments,?which?refers?to?procedures?or?doctor?visits?where?you?
are?not?hospitalized?overnight.?With?most?medical?insurance?plans?in?Dubai?and?
Abu?Dhabi,?the?insurer?covers?in‐patient?costs?(i.e.?when?you?are?hospitalized)?
without?applying?a?deductible.?
Co‐Insurance?or?Co‐Payment?
This?is?a?form?of?cost‐sharing?whereby?out?of?the?total?amount?paid?for?a?medical?
treatment,?the?policyholder?pays?a?percentage?of?the?cost.?Of?course,?this?can?be?
a?risky?type?of?medical?insurance?to?purchase?if?you?get?very?sick?or?require?an?
expensive?procedure.?Some?health?insurance?plans?might?have?a?fixed?deductible?
per?visit,?combined?with?co‐payments?for?specific?benefits.?In?Dubai,?it?is?
common?to?see?a?10%?co‐payment?for?maternity?benefits,?and?up?to?a?20%?co‐
payment?for?dental?benefits.?
?
Know?your?exclusions?
Exclusions?are?specific?treatments?or?conditions?that?are?not?included?in?your?
plan.?Every?health?insurance?plan?in?the?UAE?will?come?with?exclusions.?It?is?
important?that?you?thoroughly?review?the?plans?beforehand?in?order?to?find?out?
what?is?covered?and?what?is?excluded?under?the?policy.?There?are?certain?
ailments?that?are?permanently?excluded.?When?choosing?a?health?insurance?
plan,?talk?to?an?expert?about?specific?medical?conditions?you?want?covered?to?
make?sure?they?are?not?excluded.?
o Pre?existing?disease?:?
Some?of?us?mistake?pre‐existing?conditions?as?‘an?illness?or?condition?that?a?
person?might?have?at?the?time?of?buying?a?policy’.?
Well,?pre‐existing?condition?does?not?only?refer?to?an?illnesses?that?a?person?has?
at?the?time?of?buying?a?policy?but?it?also?includes?a?thorough?medical?history?of?
any?condition?ranging?from?heart?attacks,?diabetes,?past?hospitalizations,?any?
surgeries,?medications?for?any?disease?or?illnesses?like?high?blood?pressure?or?
thyroid,?skin?disorders,?major?accidental?injuries?and?any?signs?or?symptoms?such?
as?increase?in?sugar,?or?high?blood?pressure.?The?insurance?company?wants?to?
know?about?absolutely?any?disease,?condition?or?injury?you’ve?had?
Many?insurance?companies?in?the?UAE?now?provide?cover?for?pre‐existing?
conditions,?however,?there?are?a?few?steps?they?take?to?mitigate?their?risk.??
Some?methods?like?Premium?Loading?,?Waiting?Period?,?Premium?loading?+?
waiting?period?,?Exclusion?of?Pre‐existing?conditions?..etc?will?likely?impact?you?if?
you?have?an?existing?condition:?
?
? Tips?to?select?a?health?insurance?plan?:?
o Choose?your?insurance?company?wisely?
o Plan?according?to?your?future?needs?
o Make?an?informed?decision?about?the?type?of?health?insurance?
o Think??on?amount?of?‘sum?assured’?
o Check?the?empanelled?hospitals?
o Understand?the?premium?calculation?process?
o Read?the?fine?print?(clauses)?
o Check?waiting?Time?
?
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Basics of health insurance