Dh565 for health insurance; Dh500 max co-pay for surgery

By June 30, every resident with a Dubai visa must sign up for mandatory health cover, or face penalties.

With health covers ranging from Dh565 to Dh700, Dubai Health Authority (DHA) explains why it makes absolute sense to sign up.

The linking of the visas to the mandatory health cover has also helped track and ensure much of the population is on board, ahead of the June 30 deadline.

In an interview with Dr. Haidar Al Yousuf, Director of Public Health Funding at DHA, we look at how the move is shaping up.

With the June 30 deadline in place, what’s the ground reality?

The ground reality is the category that is coming to insurance is Phase 3. It is slightly more difficult and sensitive than the first two categories – mainly companies with large number of employees with an HR team organizing it. In Phase 3, it is individuals or small companies, or dependents of expatriates living in Dubai, or domestic workers. In fact, a lot of them are getting insurance for the first time. The insurance companies have been prepped and educated on how to deal with them. They have been told not to turn anyone away.

The DHA website has all the information about insurance companies, licensed by the health authorities. There are many competitive packages in the market from Dh565 to Dh650 for people who earn less than Dh4,000. And, starting at less than Dh700 for dependents. And, these are basic benefit packages but they cover essential health needs.

What options are available to low-earners, whose sponsors are not legally obliged to provide insurance to their employees' dependents?

The basic benefit package, or what we call the community rated package, are offered by nine companies in Dubai. The packages for domestic workers or for small companies who have employees whose salary is below Dh4,000 ranges between Dh565 to Dh600.

Then, the next group comprises dependents, who come at a slightly higher premium. The dependents might still be able to get packages in the range of Dh650-Dh700. If it’s an employee with a lower salary. It has 20 per cent co-insurance but there’s a cap in in-patient. For example, if the person requires an expensive procedure he will only pay up to Dh500 participation. It is designed to protect people against serious illness but to also provide coverage for their basic health needs.

There's also the 60-plus dependents. Are there any affordable options for them?

This is a category we have worked hard to get good options. Actually for the elderly, we see Dubai companies packages that are starting from Dh2,500. And, that’s for everyone above the age of 60.

What if an individual can’t get insurance cover because of an already existing medical condition, which he can control. Will his visa still be rejected? Will these be handled case by case?

The essential benefit package, for the first time, has a six-month waiting period. That means, existing medical conditions will not be treated for the first six months. But, after that, they will be covered.

Dubai’s health insurance rules do not require employers to provide coverage for the dependents of their employees, whereas this is the case in Abu Dhabi. Will Dubai look at adopting it?

This is a very good question. I think we need to think deeper about policy decisions rather than look at it from the surface. The business community in Dubai is much bigger, and much more diverse, and very highly dependent on SMEs. So, in Dubai, we have over 135,000 companies in the below 100 employee category. In fact, the average number of employees is about 9.1. Now, if you force those companies to provide insurance for an individual and their dependents. It will become more expensive for employers to hire someone with family. If they hire a single, they pay only Dh600. So, there begins a demographic shift as a result of policy decision and we start to get more singles, and less families. And that’s not something we really want to do.

It will always be the responsibility of the family person to find insurance for his family, if he chooses to bring them to Dubai. And, there’s enough regulators to ensure that there are affordable packages available in the market. For larger companies, they can provide insurance for their employees and their family. But, for smaller companies, it sometimes is not an option. And, you don’t want to push families outside. So, policy decisions have social and demographic implications that we need to be aware of.

Companies that fail to provide health insurance by the relevant deadline could face fines of up to Dh500,000. Is this right?

The Dh500,000 fine is not for this category. The category for penalty is basically Dh500 per employee per month. But, still if you have a lot of employees you can end up with a large amount of money. The penalty has been designed to encourage people to buy insurance. You know, you can buy insurance in the range of Dh600, so to pay a penalty of Dh500 per month does not make sense.

So, what is Dh500,000 penalty for?

Dh500,000 is the highest penalty listed in the decree. So, the decree itself has different kinds of charges, including penalties on insurance companies. For example, violating some of the laws of licensing and regulatory component. There’s a huge list of violations under the law. These parties could be insurance companies, hospitals. Employers is only one of the categories. And, for the employer it is the Dh500 penalty (that he earlier mentioned), and not the Dh500,000 penalty.

DHA has completed the first phase that included companies with more than 1,000 in 2014 and the second phase, which included companies with 999 to 100 employees in 2015. Where are we now?

Remember, when we talk about these numbers we talk about the number of people on Dubai visas. They could be living in Ajman, Sharjah, but regardless of where they live if they have Dubai visas, they need health cover. End of Phase 1 or when the law was signed in end of 2013, we had about 1.1million insured members. By end of 2014, we reached about 1.9million members. End of 2015, we reached about 2.6million insured members. Right now, we are sitting in the range of about 3 million insured members. So, the pick-up has been great. And, obviously those who come into the mandate are not only those in the category. So, remember, these deadlines are deadlines. Not starting points. A lot of companies have chosen to provide insurance for their employees ahead of that. And, there are still a few companies that are in the first and second group that have not insured now and have started to incur penalties. There’s both end of the spectrum.

What is the benefit of health care?

Insurance is about protection. If you look at basic human needs it is access to clean water, food, health care. These are the fundamentals of life. In a place like the UAE, or more specifically the UAE, which is a free economy with a tax-free market, where the employers have a great environment to grow their business. And, we want them to do so, and also take care of their employees. As part of that, the government has decided to introduce affordable healthcare to every one.

It's about protection. Recently we've seen a case of someone who had to pay Dh80,000 to treat his housemaid of pneumonia. She had to be in the ICU for a few weeks. I would ask him why he didn't buy a package for Dh600? He would have paid Dh500 participation in the treatment and that's all.And, insurance would have protected you. But, not having it will put you in fanatical ruin.

You know health catches up with you. Maybe you will just head to the pharmacy and take a Panadol, but at some point you will need health cover.