This month the DHA issued permits to 43 insurance companies to operate as health insurance provider within Dubai's Mandatory Health Insurance Scheme. Among these seven companies, labelled the Participating Insurers (IP), were approved to provide the Basic Benefit Package.
The Basic Benefit Package (BBP) is the minimum health insurance coverage designed for those with an income of less than Dh4000. For a premium of between Dh500-700 the basic package provides an inexpensive medical plan that meets the basic medical needs without affecting the quality of health care.
Although the DHA has not yet announced the list of PI’s, some companies have already acknowledged to be nominated. AXA Gulf, Takaful Emarat, DAMAN, and Arab Orient Insurance Co are some of them. Emirates24|7 spoke with Axa Gulf and Takaful Emarat about the packages.
How much will it cost?
The BBP must be priced in the range of Dh500-700 as by the DHA regulations. The premium of each basic package may vary slightly depending on the insurance company, but expectedly the difference will not be much.
There will be a coinsurance payable by the insured of between 20 per cent, and the annual upper aggregate claims limit will be Dh150,000, excluding any coinsurance and / or deductibles.
Who is eligible for the BBP?
“An Insurer with the PI status is obliged to offer the Basic Benefit Plan when requested to any person with a monthly income less than Dh4,000.However, the insurer would have the right to underwrite any member who is out of this exclusive pool and increase the premium as per its own underwriting rules,” AXA Gulf explained.
Indeed, the DHA has confirmed the right of the insurance company to underwrite those with a salary exceeding Dh4,000, adding that there will be beneficial packages provided for all groups of income.
AXA continued to explain that in fact anybody could opt for the BBP. However, when the income of a person is higher than Dh4,000, the premium for the same package would be higher. The premium would be based on the income of the person.
Furthermore, under the new regime insurers will not be permitted to deny individuals coverage under the Basic Health Plan due to pre-existing conditions, although treatment for chronic and pre-existing conditions may initially be excluded for the first six months of cover, explained Takaful Emarat.
What does it cover?
The benefits of the BBP will be the same with all insurance companies, as these have been determined by the DHA.
For outpatients this means examination, diagnostics and treatment by general practitioners, specialists and consultants; laboratory testing; radiology diagnostic services; physiotherapy; medicines; vaccines and immunizations; diabetes screening (every 3 years from 30 years or from 18 years for high risk patients); diagnostics and treatment for dental and gum treatment; hearing and visions aids; corrective laser and surgical treatment for vision.
Inpatients are covered for tests, diagnosis, treatment and surgery, and emergency treatment. When it comes to maternity cover, inpatients are covered for the maternity care and newborn care, while out-patients are covered for ante-natal care.
Which health providers are involved?
“The BBP is a local plan and does not cover treatment outside the UAE. Coverage within the territory is restricted to the Network only – non-Network would however be covered only for emergencies within the UAE,” explained AXA Gulf.
The network of providers will be where the insurance companies differentiate, as it has been left to the discretion of the insurer. Although the network must cover health services in all areas of the emirate, each insurance provider has its own network which is defined as per their agreement with the medical providers, the insurance company added.
Takaful Emarat, in its case says to include over 750 Provider and over 20 hospital distributed geographically to cover UAE in general. “These providers were selected to provide complete health care taking in consideration the cost and geographical location without compromising quality of health care.”
Where else do the packages differentiate?
It is in the services levels where insurance companies differentiate, say both companies. “The basic benefit package of AXA stands out in its service levels and the ability to provide a one-stop solution to all employee categories with a variety of plans from the low-end to the top-end benefits,” AXA Gulf explains.
“Being insured with AXA gives the client the advantage of easy accessibility through shops, branches, online platforms etc., for purchase of cover as well as for further services, along with an international experience with a brand known for its wider capacity and capabilities and financial stability,” it added.
Takaful Emarat in turn explained that the Takaful concept would distinguish their package from others. One of the benefits of this concepts is the surplus participation on the pool, will be applicable for all participants as per the Sharia’s Law and Takaful Concepts.
“In Takaful Emarat - Insurance we manage participants’ financial security with full compliance with Shariah. We have gained trust and confidence by providing value-added products, acting fairly and transparent in the best interest of participants,” the company explained.
The DHA said earlier that the insurance companies qualifying as a PI had undergone a rigorous assessment procedure to ascertain their ability to provide an insurance package at an affordable rate.
Issa Al Maidoor, Director-General of DHA, said: “Only those capable of handling volume business and who can operate effectively over the long term can make the system sustainable. Consequently they are required to meet additional standards. Those companies that met the standards with the highest quality have been awarded PI status.
As per the Health Insurance Law, companies with more than 1,000 employees will be required to ensure every employee with health insurance coverage by end-October 2014 (Phase 1). In the second phase of the plan, companies with 100-999 employees must implement full health insurance coverage by July 2015
Under a third phase, companies with less than 100 employees have until June 2016 to arrange for complete insurance coverage. The DHA timetable demands that spouses and dependents as well as domestic workers must also be fully insured for basic health coverage by end of the third phase in June 2016.