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05 June 2023

Take cover for healthy living

By Sandi Saksena

Blood test, urine test, ultrasound, CAT scan, electrocardiogram, endoscopy plus any other "scopy" you can think of – you do them all and then the doctor says you just have the flu!

What's more you'll probably need medical treatment when you see the bill – and that's why you need health insurance. In the UAE, even a simple consultation with your GP can be expensive, never mind any tests or scans he may recommend. Medical insurance can take care of these bills – provided, of course, you go about it right.

Does your job cover you?

Increasingly, people receive this type of insurance as a job benefit, often with their employers paying all or part of the premiums.

But employers may not cover everything; smaller companies may offer only a basic package that is restricted to the area and to medical facilities available. In such a case, you may only be covered in the UAE, and for a particular network of doctors at the smaller polyclinics; specialists are usually excluded.

If so, you may want to augment your insurance with private add-ons. However, health insurance purchased privately can be expensive depending on factors such as deductibles, choices of cover and location, but going private tends to have fewer constraints than schemes provided by employers.

Depending on your age and other factors, if you're looking at an annualised premium, you could be paying anything between Dh1,800 and Dh6,000 or more.

Premiums depend on the kind of plan chosen. An international plan that includes North America and Canada will be three times more costly than a UAE and Sub continent plan. The more comprehensive the coverage the higher the premium. Choose your cover carefully so that you don't pay for unnecessary 'benefits'.

What are your options?

Finding the right plan is very important. Making the correct decision will make you feel secure as you will know that financial burdens will be taken care of in the event of sickness or emergencies.

Basic plans cover in-patient, out-patient, diagnostics, and medicines. However, dental and maternity packages are excluded.

Providers generally do not cover serious pre-existing conditions such as diabetes, asthma and heart disease as they are likely to require expensive and long-term treatment. This is an important issue particularly here in the UAE as 20 per cent of the adult population has diabetes – four times the worldwide average, according to Al Zahra Hospital endocrinologist Dr Nader Lessan.

And cardiovascular disease accounts for 28 per cent of all deaths in the UAE and 31 per cent of deaths in Dubai.

However, some international insurance providers will agree to cover pre-existing conditions for a higher premium after reviewing detailed information. The insurer will put a moratorium on the condition and if during a period, typically two years, no symptoms, treatment, medication or check-ups occur then the insurer will agree to cover the condition.

The best way to maintain coverage for pre-existing conditions is to stay with the same insurance company. For this reason it is important to select a good company from the start with a plan that is renewable for life, regardless of location, age or medical condition. Insurer William Russell, for example, is among those covering pre-existing conditions.

Are you too fat?

One more worry in our sedentary lives is obesity, one of the leading causes of serious health problems. Obese people have a higher tendency to develop a number of conditions including diseases that affect the heart, stomach, lungs, skin, bones and brain.

In the UAE, 74 per cent of women are obese or overweight, according to a 2005 report by the International Obesity Task Force, a London-based think tank.

Insurance companies use the body mass index (BMI) to determine if you are insurable, and it is important your BMI falls within the normal range – meaning the person is not obese. Otherwise individuals could find themselves without adequate protection should they develop a serious medical condition.

A person's BMI is usually subject to a number of outside factors including age, ethnicity, bone structure, fitness levels, simple genetics, and muscle mass.

What if there's an accident?

In the past most people travelling or living outside their home countries were most concerned about major accidents, not receiving prompt and adequate health care or having to support the financial burden of expensive medical treatment.

But in recent years a new risk has emerged – terrorism, a threat that is no longer confined to certain parts of the world. The realisation that terrorist attacks can happen anywhere has led to growing interest in insurance cover. Expat Medical Insurance is one of the first brokers to offer cover against global terrorism.

Finally, remember health insurance is not maintenance-free – it can't be turned on and forgotten. Just like you take an active role in staying healthy, you must stay alert and understand how your medical care is authorised and paid for.

Understanding the documents

What are you covered for? This is an easy question, but answering it can be the biggest problem of all. Insurance contracts are hard to read and often do not make sense to the layman. But do not try to read the entire document as that will confuse you further and send you to sleep.

Instead, look for the parts that describe the benefits to you, as well as when you are covered and where your cover ends.

SCHEDULE OF BENEFITS: This states what the insurance company pays and what you pay. It lists deductibles, the insurance percentages they pay, and what you are expected to pay.

COVERED BENEFITS: Often different from the schedule of benefits, this tells you what you are covered for. With some plans this will be a fairly long list and others will give a short list of a broad range of benefits.

EXCLUSIONS & LIMITATIONS: This lists the things that the plan will not cover such as experimental treatment, cosmetic surgery and pre-existing conditions. It also lists things that are covered but to which special limits apply.

CLAIMS PROCEDURES: Tells you how to appeal when claims are rejected. Read this thoroughly as there are usually important time limits and other restrictions.

How much does it cost?

As you might expect, with medical insurance, one size does not fit all. Rajvi Agrawal, Assistant General Manager at Compass Insurance Brokers (www.cfsme.com), says each consumer is unique, with a variety of different medical complaints. "Additionally, depending on how much you want to be insured for, the level of hospitals you opt for, the geographical areas you want to be covered in and who the insurance provider is, premium costs could vary significantly."

Who's covering you?

- A man aged 32 years taking out a basic, Dh100,000 policy with National General Insurance could look at paying Dh2,400 a year. A woman of the same age would need to pay Dh3,454. A $1-million policy with companies such as Goodhealth could cost men and women $1,500, depending on the case. The former may restrict you to a fewer clinics, but the latter allows the use of a wider range of hospitals.


- Premiums also vary depending on deductibles or how much consumers can pay each time they visit their doctor. Across companies, these could range from Dh30 to Dh100 or more. "The higher the deductible, the lower the premium," says Agrawal. The NGI policy above is priced to include no payment from the consumer, while the Goodhealth one factors in a deduction of $50 per visit.

Pre-existing conditions

- Should your medical history include problem such as diabetes, cover will be harder to find; but do ask your insurance broker about companies like Goodhealth, says Agrawal.